Unlike anorexia nervosa, ARFID is not about the patient’s experience of their own body and fear of gaining weight. Instead, the disease is characterized by avoidance of certain types of food because of sensory discomfort due to the characteristics or appearance of the food, or for example, fear of choking, food poisoning phobia, or lack of appetite.
It is very important to recognize that each person may have one or more of these reasons behind the avoidance or restriction of food and eating at any given time. In other words, these examples are not mutually exclusive. This means that ARFID may look very different in one person than in another.
For this reason, ARFID is sometimes described as an “umbrella” term that includes a range of different types of difficulties. However, all people who develop ARFID share the central feature of the presence of avoidance or restriction of food intake in terms of overall amount, range of foods consumed, or both.
Other key aspects of ARFID are that it can negatively impact a person’s physical health and psychological well-being. When a person does not get enough energy (calories), he is likely to lose weight. Children and young people may not gain weight as expected and their growth may be affected, resulting in slower height gain.
When a person does not have an adequate diet because they are only able to eat a limited range of foods, they may not be getting essential nutrients needed for their health, development and ability to function on a daily basis. Some people may develop severe weight loss or nutritional deficiencies that need treatment. In people whose food intake is very limited, dietary supplements may be prescribed.
Being limited in terms of what they can eat often causes people to experience significant difficulties at home, school or college, work and when they are with friends. Their mood and daily functioning can be negatively affected. Many people with ARFID find it difficult to go out or go on vacation, and their eating difficulties can make managing social occasions difficult. They may find it difficult to make new friends or form close relationships as social eating opportunities are often part of this process.
ARFID is different from anorexia nervosa, bulimia nervosa, and related conditions; In ARFID, beliefs about weight and shape do not contribute to food avoidance or restriction.
A diagnosis of ARFID would not be given at the same time as any of these other eating disorders, although they may precede or follow. Also, a diagnosis of ARFID would not be given if there is another clear reason for the eating difficulty, such as a medical condition causing loss of appetite or digestive difficulties.
Anyone of any age can have ARFID. It occurs in children, adolescents and adults. People with ARFID may lose weight and become very underweight, their weight may be in a “normal” range, or they may gain weight or be very heavy (particularly if their diet is limited to high-calorie foods) .
ARFID can be present alone or can coexist with other conditions; those that most commonly occur in conjunction with ARFID are anxiety disorders, autism, ADHD and a number of medical conditions. Someone with ARFID’s eating difficulties may have been present for a long time, in some cases nearly as long as they can remember. In other people, it may have a more recent onset.
Maddalena Patrizia Cappelletto, President of the National Coordination of Eating Disorders (https://www.coordinazionenazionaledca.it/), declared: “During adolescence the idea of having to conform to pre-established models in order to be accepted, to be loved is stronger; the body, especially the female one, changes suddenly and is often “observed” as an object rather than as part of the whole that is the person.
Sometimes, parents, family members, educators, adults in general, tend to make a comparison with other historical and social contexts, such as the one in which their parents or grandparents grew up. In that period of wars and economic crises people fought for the satisfaction of primary needs, certainly not for the achievement of aesthetic ideals; while after the war the models of the oversized models established themselves as a symbol of renewed well-being.
This comparison can lead to diminishing the disorder, to the point of considering it a consequence of wealth, of the ease of having everything, of boredom. Furthermore, there is no perception that eating disorders are illnesses, let alone mental illnesses, indeed we are often afraid to accept them as such, preferring to think they are a passing whim.
In this way the sick person also becomes a source of reactions such as anger, incomprehension and derision. I would like to add that family models have changed a lot, that the generation of parents of adolescent children is itself often a generation of “eternal adolescents”, who take care of their physical appearance, fitness and diet in a sometimes too “meticulous” way ”, transmitting a message to the kids that in some cases can be dangerous.
The task of treatment centers is precisely to cure, in order to prevent diseases from “chronicizing” and affecting the lives of the affected persons, taking away the possibility of living their lives to the fullest. This is a fundamental and demanding task and the – in reality not many – economic and human resources within the ambit of public treatment centers are allocated to this.
On the other hand, little is invested in prevention, and it is here that the Associations can perform a truly essential service.
For example, with the Pisan association Life beyond the mirror (https://www.lavitaoltrelospecchio.it/), of which I am president and which is one of the founders of the Coordination, we take care of carrying out school projects modulated on the needs of the various age ranges, from kindergarten to high school children.
These are not the classic experiences of nutrition education based on the “food pyramid”, but of real paths: for the little ones we create sensory taste experiences, familiarization with food and with emotions; while with adolescents we work on the body project and on the cognitive dissonance model.
The Body Project represents one of our main prevention activities: using the cognitive dissonance technique – which consists in raising awareness of the contradiction between thoughts and behaviors adopted (for example if a girl claims that thinness is not important, when in reality does not eat and weighs herself continuously) – the Body Project aims to promote acceptance of one’s body and to favor a positive body image in adolescents and young women.
We talked about prevention but another fundamental aspect is the early detection of the disease.
Who better than free-choice paediatricians and general practitioners could do it? They are that
they know the history of the person and the family and that they could help and support the family members by doing
understand them that these are diseases that should not be underestimated and that the sooner we intervene, the sooner we can do it regress or disappear the disease.
They are also instrumental in referring families to specialized treatment centres. Instead, unfortunately this
it doesn’t always happen.
We have collected many testimonies from parents, even from small children, whose mothers have been
“accused” of being too anxious or too protective.
Then when the disease manifested itself (in an evident and violent way since children are immediately at risk
life) have been advised by the paediatricians or general practitioners themselves to bring their sons/daughters to
other regions, as there is no suitable health resort in your own.
Because of this, the Coordination decided to appoint the members of its Scientific Committee to
write a Guide, the ABC of EDs, aimed at general practitioners and paediatricians of free choice, because
know how decisive their role can be, and when it is crucial that they are an integral part
of the care network, even when the state, the regions, and even the treatment centers themselves don’t do much for
involve them”.
In the West, including Italy, one of the various eating disorders has been estimated prevalence of anorexia of 0.2-0.8% and of bulimia of about 3%with an incidence of anorexia of 4-8 new cases per year per 100,000 individuals and 9-12 for bulimia, with an age of onset between 10 and 30 years, and an average age of onset of 17 years.
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