ARFID vs. Picky Eating – Key Differences

It is not uncommon for people to have food preferences or be picky about what they will or will not eat. Avoidant/restrictive food intake disorder (ARFID), however, is not just about being picky. It is an eating disorder that involves someone being extremely selective about what they eat, and, in some instances, having very little interest in eating food at all.

Some with ARFID have a limited selection of foods they will eat, so much so that it can lead to poor nutrition and stunted development. How do you know whether your child is merely a picky eater or if they have ARFID? There are some critical differences to be aware of.

What is ARFID?

ARFID (Avoidant/Restrictive Food Intake Disorder), sometimes known as selective eating disorder, is a psychiatric disorder that can lead to nutritional imbalance, deficiencies, and in extreme cases, malnutrition. Children with ARFID will only eat a few types of foods. They also typically have “fear foods” that cause them distress, which can impact them psychosocially as well as negatively impact their health. ARFID usually begins in childhood, but it can persist into adolescence and adulthood. Unlike “picky” eaters, people with ARFID do not tend to outgrow their aversions and specificity about foods. Once more, people who have ARFID may require treatment to overcome it so they can obtain proper nutrition. 

How Do You Diagnose ARFID?

ARFID was originally not recognized as anorexia nervosa or bulimia, but recently it was added to the Diagnostic and Statistical Manual of Mental Disorders, V, which is the official guide for mental health professionals. Therefore, the health community has outlined unique criteria for making a diagnosis. They are:

• Failure to obtain appropriate weight maintenance and nutritional requirements. Such failure may lead a patient with ARFID to require supplemental nutrition and undergo weight management counseling
• It must not be linked to a lack of access to nutrition or cultural values for different types of foods. Meaning, the person is avoiding a specific food for no other reason than personal preference
• ARFID cannot be explained using another mental illness or medical condition

The main difference between anorexia, bulimia, and ARFID is that there is no component of negative body image, pathological desire for weight loss, or distorted sense of self or dysmorphia. People with ARFID are not triggered to avoid foods due to any weight perceptions or body shape issues. ARIFD is related to a negative experience or “fear” of foods. The patient might have either gotten sick, choked, or had a negative experience with a particular type of food, which is then extrapolated to other foods to the extent that it becomes problematic.

Is it Picky Eating or ARFID?

When it comes to mental health, a diagnosis is always best made by a professional clinician. Just because a child is a picky eater does not necessarily mean that they have ARFID. Also, in reverse, someone who is picky can be extreme enough in their preferences to need care. There are many signs and symptoms depending on the individual, but most cases do have certain traits in common:

Significant or Sudden Weight Loss

A person with ARFID will experience extreme or sudden weight loss. The weight loss can be due to an aversion to foods, sensory sensitivities, restrictive eating, or a general lack of interest. Sensory sensitivities are often associated with an adverse experience with food that leads to choking, vomiting, or allergic reactions. Picky eaters are usually able to maintain their weight despite limiting their intake and selectiveness, where those with ARFID can not. 

Failure to Maintain or Gain Weight Appropriately

Most patients who are diagnosed with ARDIF usually fail to gain or maintain weight appropriately. They tend to fall off their expected growth trajectory or fail to thrive early on in life. As adults, people diagnosed with ARDIF usually cannot maintain a healthy weight or meet their nutritional needs. Picky eaters, on the other hand, generally can maintain and even gain weight to meet their expected growth and development. Some patients with ARDIF may be reliant on supplements or, in extreme cases, feeding tubes to maintain proper nutrition. Picky eaters can usually substitute foods to maintain their growth expectations and nutritional needs. 

Disruption of Psychosocial Functioning

Many with ARFID find it difficult to eat in a social atmosphere with their peers. They can also find it hard to be around specific foods while eating. ARFID can lead to a highly anxious experience that can limit someone’s sociability and increase isolation. Picky eaters are typically able to maintain social activities that revolve around food without a problem. Also, they usually have very little distress when foods they will not eat surround them.

Sensory Sensitivities

Many picky eaters will avoid certain foods due to appearance or smell. Also, they are usually not distressed by textures, smells, and visual presentation of foods, as patients with ARFID are. People with ARFID have extreme anxiety related to specific foods and won’t consume them to avoid their texture, smell, look, or taste, and have a high degree of distress leading to gagging or sometimes spitting food out.

Adverse Consequences 

People with ARFID often avoid foods due to experiences like choking or vomiting after eating them, or watching someone else choke or vomit when consuming them. They also usually have either a perceived or a real allergic reaction to certain foods. Picky eaters might have negative experiences that will make them avoid food, but not as intensively.

Lack of Interest in Food or Eating

Although picky eaters will avoid certain foods, they still experience hunger cues and show interest in foods that they like. Those with ARFID often report that they are not hungry or interested in eating any food, not just those foods that they don’t like. There is a general lack of appetite for all foods and eating. 

Types of Treatment for ARFID

Picky eaters will often outgrow their preferences and broaden their palettes as they get older. Also, they are able to maintain and gain weight appropriately by substituting what they don’t like with what they do. When someone is diagnosed with ARFID, they usually require treatment to overcome developmental, weight, and nutritional deficiencies. Often, treatment for selective eating disorders requires cognitive behavioral therapy, nutritional counseling, dialectical behavioral treatment, or a combination of them all. Once the symptoms are evaluated, a treatment regimen can be planned. Some of the treatment courses for those with ARFID include:

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that seeks to retrain distorted behaviors to replace them with healthier ones. CBT requires the patient to recognize disordered and unrealistic thoughts and examine how they affect behavior. At the core of treatment is to reveal the irrationality of their thought process and work through it with logic and rational thinking.

Exposure Therapy 

Exposure therapy is often a useful tool for overcoming many of the consequences of ARFID. One is Dialectical Behavioral Therapy or Cognitive Processing Therapy. Exposure therapy, which was originally designed for people who have extreme phobias, can often be useful. It exposes people to the very foods that they avoid. Like inoculating a patient, exposing them to small amounts for short periods is often tolerated. Each exposure is extended with small amounts until it no longer triggers the patient. 

Often, behaviors are not a problem until they cause a problem. When it comes to kids, being a picky eater usually only causes irritation and frustration for parents. When it deters growth and development, however, it is about more than just being picky. If you have a child or adolescent in your life who has a failure to thrive, struggles with nutritional needs, or is bordering on malnutrition, help is available. The best way to know for sure if it is picky eating or something more is to be evaluated by a professional. Contact us for a professional opinion today.