Medicines for Avoidant/restrictive food intake disorder

What it is

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder in which a person limits the amount or range of food they eat, but — importantly — this is not driven by concerns about body weight or shape (which distinguishes it from anorexia and bulimia). Instead, the restriction is usually related to one or more of: a sensory sensitivity to food (strong dislike of certain tastes, textures, smells or appearances, so only a narrow range of "safe" foods is accepted); a lack of interest in eating or low appetite; and/or a fear of aversive consequences of eating (such as a fear of choking, vomiting, or a past frightening experience with food). ARFID is more than ordinary "fussy" or "picky" eating: the restriction is significant enough to cause problems — such as not getting enough nutrition or energy (leading to weight loss or poor growth in children, or nutritional deficiencies), dependence on supplements, or a major impact on daily life and social situations involving food. It can affect children (in whom it is increasingly recognised) and adults, and is more common in some groups, including autistic people and those with certain sensory sensitivities or anxiety. Because it can affect physical health and development, and quality of life, ARFID is important to recognise and treat, and — reassuringly — support is available.

How it is treated

ARFID is managed by a specialist, usually multidisciplinary, team (which may include dietitians, psychologists and, for children, paediatric input), with an approach tailored to the individual's particular pattern of restriction and any effects on their nutrition and health. Assessment considers the reasons for the restriction (sensory, low interest/appetite, or fear-based, or a combination), the nutritional and physical impact, and any coexisting conditions (such as autism or anxiety). Management combines: addressing nutrition and physical health (for example correcting deficiencies, supporting weight and growth, and using supplements where needed); and psychological and practical support tailored to the underlying drivers — for example, structured, gradual approaches to broadening the range of accepted foods (working with sensory sensitivities at a manageable pace), building interest in and routine around eating, and, for fear-based restriction, addressing the specific fear (such as a fear of choking or vomiting) with therapeutic techniques. Involving and supporting the family is important, especially for children. Treating any coexisting anxiety is part of care. Because forcing food or pressure is usually unhelpful and can worsen things, a patient, supportive, individualised approach is key. The reassuring message is that ARFID is a recognised, treatable eating disorder that is not about body image, and that specialist, tailored support — addressing both nutrition and the reasons for the restriction, at the person's pace — can help people eat more variety and safeguard their health.