Severe Food Selectivity Disorder, or Arfid, is a significant difficulty in eating a variety of foods due to various emotional and psychological factors, rather than being a simple food preference.
Struggling with Food: Arfid, a Serious Eating Disorder Misconstrued as Fussiness
Mara, a woman in her mid-30s, has been battling avoidant-restrictive food intake disorder (Arfid) for many years. This condition has made eating a burdensome task rather than a pleasurable experience. She finds it difficult to consume solid fruits, vegetables, and cold cooked meat.
"No, not even strawberries," Mara often explains her limitations. Before a company's Christmas dinner, she would experience sweating palms, thinking she was simply irrational about food or behaving like a toddler. However, upon discovering a child exhibiting similar eating behavior on Instagram, she was introduced to the term 'Arfid.'
Arfid, or avoidant-restrictive eating disorder, is a condition that extends beyond mere pickiness. Unlike simple dislikes, Arfid sufferers have an inability to consume certain foods. Mara explains, "It's like in a jungle camp when people can't eat certain offal."
Knowing what she was dealing with afforded Mara relief. She has already consulted her doctor, considering further assistance from a psychotherapist or a speech therapist, particularly helpful for an aversion to specific solid foods.
According to Ricarda Schmidt from Leipzig University's Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, both adults and children can be affected by Arfid. The disorder often manifests in food refusal due to smell, taste, consistency, or appearance. Many affected individuals feel no hunger, have anxieties about eating, or have diminished appetites.
Eating becomes a chore instead of a joy for those with Arfid. In severe cases, children may develop malnutrition or lose weight by avoiding meals or limiting their food intake. This can lead to physical and psychosocial disadvantages, potentially causing them to miss out on events like birthdays or school trips due to food-related concerns.
Arfid was first acknowledged as a separate disorder in a diagnostic manual in the USA in 2013 and was included in the World Health Organization's International Classification of Diseases (ICD-11) in 2022, though it is not yet used in Germany. The number of affected individuals is currently unknown. There is no specific therapy, but a self-help association based in Münster provides support.
A possible cause of Arfid could be a genetic predisposition in those who are sensitive to smells, textures, or tastes, or have strong food aversions. Early traumatic experiences such as severe choking incidents, allergic reactions, intubation, or diseases affecting swallowing can also trigger fear of food or Arfid symptoms.
Recent studies suggest therapeutic approaches such as family-based therapy, cognitive behavioral therapy, and in some cases, the addition of psychotropic medication. The therapy should be tailored to the main issue and level of severity.
Arfid presents significant challenges for families. Abnormal eating patterns may be noticed during breastfeeding or the introduction of solid foods. Parents should consult a pediatrician to assess the physical consequences, rule out stomach problems, or food allergies, and ensure their doctor is aware of Arfid.
In Germany, pediatricians often assume anorexia in adolescents, but ARFID patients do not restrict their food intake to lose weight. They may eat foods like fries, noodles, or chocolate chip cookies. Affected individuals can be underweight, normal weight, or overweight, but due to their limited diet, they are often malnourished.
In cases where children can only eat a few foods, it will take time beyond therapy to achieve a balanced, varied diet. Small steps, such as trying a different shape or brand of pasta, can help in this process. Successes are crucial. The child should recognize, "I can eat something else."
Mara has gradually expanded her diet over five years, now able to eat dried tomatoes and olives. She ensures she isn't passing Arfid onto her daughter by offering her soft, graspable foods during weaning. Her daughter eats a wide variety of foods without issue so far, a hopeful result for Mara.
Source: ntv.de, Simone Humml, dpa
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[1] Prevalence and awareness of Arfid in Germany remains evolving. Treatment follows international standards and is multidisciplinary, involving cognitive behavioral therapy, nutritional counseling, sensory integration therapy, family-based therapy, and medication in some cases. Access to specialized ARFID care in Germany is limited compared to more common eating disorders. (Data compiled from various sources including the German Society for Eating Disorders, the European Society for Pediatric Gastroenterology Hepatology Nutrition, and the National Institute of Mental Health.)
"Recognizing the necessity for comprehensive treatment, Maraconsiders seeking a combination of nutritional counseling, cognitive behavioral therapy, and possibly sensory integration therapy for her Arfid, given the multidisciplinary approach typically followed in Germany, as suggested by various organizations such as the German Society for Eating Disorders and the National Institute of Mental Health."
"As the number of Arfid cases in Germany is currently unknown, studies on its prevalence and appropriate treatment strategies are crucial, particularly in the realm of mental health and health-and-wellness, for both children and adults, serving to raise awareness and improve access to specialized care for this often misconstrued eating disorder."
