unnamedMany people (especially children or teens) go through phases of “picky” eating. While this is normal developmentally, some children and adults struggle more with these selective eating patterns, leading them to develop problems that can be helped with therapy. This is called Avoidant Restrictive Food Intake Disorder (ARFID).

Children with ARFID often do not consume enough calories to grow and develop properly. Meals may become very challenging, causing parents to become exhausted. Children with ARFID may have an apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating, and struggle to meet appropriate nutritional and/or energy needs, sometimes leading them to be much smaller/less well-developed than peers.

Adults and young adults with ARFID may have similar concerns. They may find that their eating patterns cause problems in their relationships (fights with significant others, inability to engage in social experiences that involve food). They may also struggle with sensory sensitivity or feel that eating is an aversive experience.

Unlike Anorexia, people who have ARFID generally do not have distress about body shape, size, or weight.

At Bucks ESC, we can support people of all ages who struggle with selective eating. Working closely with a dietician who specializes in working with ARFID, the team at Bucks ESC uses a variety of techniques that strengthen people’s relationship with food and weight stability. These approaches include:

• Individual therapy to support teens, adults and families with ARFID

• CBT/DBT to teach specific skills and strategies to target anxiety (coping skills, self-soothing)

• Food desensitization to increase nutritional choice and flexibility

Sometimes children develop selective eating following a food-based trauma (i.e. choking on a specific food, food poisoning or illness after eating). In these instances, we can offer many of the services we have mentioned. Additionally, many clients respond well to EMDR, a targeted treatment to resolve food trauma. EMDR can be integrated into someone’s treatment throughout therapy to offer additional support in improving the person’s relationship with food and eating.



What IS ARFID?

ARFID, or Avoidant Restrictive Food Intake Disorder, is health condition in which a person is unable to get adequate nutrition through their diet.  Common eating problems include difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, lack of appetite, or fears of eating following a frightening experience such as choking or vomiting. Significant nutritional deficiencies may require in a need for supplemental nutrition; there may also be significant weight loss and interference with social or educational functioning.

What ISN’T ARFID?

  • Not Picky eating
  • Not from a lack of food or cultural values
  • A primary disturbance in body weight or shape and is not due exclusively to anorexia or bulimia nervosa
  • Not due to a medical condition or due to another mental health disorder

Why is does the family play such an important role in ARFID treatment?

When working with a client who struggles with ARFID or selective eating, family involvement is key to a successful treatment model!Parents and other family members play an important role in therapy and implantation of skills and food challenges at home in addition to working individually with the team to obtain their own support through this challenging process!

What is food desensitization?

People who struggle with ARFID or selective eating often have a limited number of foods that they prefer eating. Desensitization allows for clients to create a hierarchy or list of foods that they would like to attempt to incorporate into their diet. Food challenges are typically done both in and out of therapy and nutrition sessions to offer clients support in practicing skills needed to increase foods they are comfortable eating.

How does EMDR help with food trauma?

EMDR (Eye Movement Desensitization and Reprocessing) helps clients to get past food and other traumas that may underlie selective eating. This is used in conjunction with food desensitization and can sometimes allow treatment to proceed at a faster pace.

How do dieticians help clients with ARFID?

The dietitian will complete a full assessment to evaluate the medical, development, and feeding dynamics of the past and present. You will work together to implement the trust model of feeding called the Division of Responsibility of Feeding. This will allow you and your child to start partnering together to establish a plan that both honors and respects a positive mealtime. You will get guidance about providing clear structure that will help support your child in trying new foods. Follow up sessions will be used to support both the parent and child in establishing the good relationship with food. These may be used to help coach parents or provide food exposures.