You may recognize these behaviors in your children or they may even remind you of your own way of eating – or rather not eating – in your childhood: “The girl doesn't eat anything, she only likes rice and chicken”; “My son only wants to eat tortillas”; “There is no way for the child to sit at the table and then take forever to eat”; “When I was little I was very picky, I only ate this or that”… These are behaviors that are commonly identified as manias, or whims that are not usually given much attention and that normally disappear over time. But sometimes they don't and they can be signs of a serious problem, an eating disorder (ED) known as Arfid.
Although “known” is a way of speaking. Because this may very well be the first time you've come across this term, Arfid. This is despite the fact that, if you consult Google, you will find publications that claim that it is one of the most widespread disorders of this type. For example, recent information stated that in the ED unit of the Sant Joan de Deu hospital in Barcelona, Arfid cases account for 15% of the total cases treated.
But what is Arfid? The name is formed by the acronym in English of 'Avoidant Restrictive Food Intake Disorder', this is Avoidant Restrictive Food Intake Disorder. It is a pathology that has been defined in the 'DSM-5' – a reference diagnostic manual for mental disorders – only since 2013, although, as Dr. Covadonga Canga, from the University of Navarra Clinic, a specialist in Psychiatry and dedicated to child psychiatry. “It was already considered before and appeared in a similar way in the DSM-4,” where it appeared as an eating disorder in early childhood.
It is “a disorder characterized by a lack of interest in the child or adolescent's diet. It appears especially in younger children. It also occurs in adults, although “to a lesser extent.” “It must be made clear that Arfid has nothing to do with disorders such as anorexia or bulimia,” emphasizes Canga. Those who suffer from Arfid “see themselves well in terms of their physical appearance. “They do not stop eating because they want to modify their body, but because they are not interested in doing so, they do not see it as a necessity.” Behind Arfid's cases there is neither aesthetic dissatisfaction nor a desire to lose weight.
This pathology presents itself as a lack of interest in food, an avoidance of it due to the sensory characteristics of food (rejection of certain colors, textures, flavors…) or as a fear of the unwanted consequences of eating it ( for example, fear of choking or vomiting).
How to differentiate the capricious and harmless dislike of this or that food from a problem like Arfid? «The first, which is something very common in childhood, usually refers to some specific types of foods. Children who have these manias, or are picky eaters, are not very selective. They are simply bad eaters, and you have to insist that they eat, but nutritionally they tend to be healthy children,” explains Canga.
On the contrary, “avoidance in Arfid is usually more generalized and also compromises the child's growth. We see that these are children who, because they have no interest in food or are extremely selective with it, present a significant nutritional deficiency and sometimes show delays in growth, because they do not eat.
No pharmacological treatment is required and it is treated with behavioral therapy
Furthermore, «the social part is also compromised. For example, the child has a hard time when he is invited to a birthday party and is not able to eat anything, or he avoids going to friends' houses so as not to experience that situation. The child's emotional development may be affected and cases of anxiety or depression may occur.
Behavioral therapy
Arfid is a serious problem, but once diagnosed it is treated without major complications. “It's not that it's easy, but that no pharmacological treatment is required,” clarifies Canga.
“It usually resolves, as they grow, with therapy that is primarily behavioral,” summarizes Canga. It's about “starting to expose them to foods that they reject.” It is a progressive exposure with which, little by little, the child expands the range and develops habits regarding food that he was not developing naturally.
In this way, “their nutrition improves and they also get used to eating. Because they are going to have to eat and even if they are not interested, they have to develop habits that they do not have. In general, as age advances, the prognosis usually improves,” concludes the specialist.
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