Avoidant/restrictive food intake disorder (ARFID) may not be a new problem, but it is the newest form of disordered eating to be recognized by the Diagnostic and Statistical Manual of Mental Disorders. ARFID was included for the first time in the DSM-5, which was published in May 2013. Disordered eating has been present in the DSM since the publication of the first edition of the manual in 1952. That edition included anorexia nervosa, which was categorized as a neurotic illness. The second edition in 1968 saw anorexia classified alongside other “feeding disturbances” such as pica—the desire to eat nonfood substances. Bulimia nervosa was added to the third edition of the DSM, which was published in 1980.
EDNOS and ARFID
Bulimia and anorexia have very well-defined symptoms for diagnosis. However, experts eventually began to realize that not every person with disordered eating fit all of the typical symptoms of anorexia or bulimia. As a result, the fourth edition of the DSM included a new condition known as EDNOS: eating disorder not otherwise specified. A person with EDNOS might be someone with the symptoms of bulimia who purges only a couple of times a week rather than after every meal, or a person of “normal” weight who has lost a significant amount of weight and has a distorted body image. Now, with the fifth edition of the DSM, experts have formally recognized that disordered eating can take even more non-standard forms. Rather than failing to meet just one or two of the usual symptoms for anorexia or bulimia, some disordered eaters may fit almost none of the usual symptoms while still having a serious condition that needs to be diagnosed and treated. They called this condition avoidant/restrictive food intake disorder and defined its sufferers as anyone with clinically significant struggles with food and eating.
ARFID Appears in Infancy or Childhood
ARFID is typically diagnosed in children or even infants who have developed serious problems with eating or feeding. Obviously, infants and other small children do not suffer from the obsession with body image and weight loss that is typically associated with disordered eating. Nevertheless, children of this age can develop unhealthy restrictions in their diets, avoiding things like certain colors or textures to the extent that they are not getting enough to eat. Some children may even become afraid of eating after a frightening experience like choking or food poisoning. The symptoms of ARFID may continue into adulthood if they are not treated in childhood. ARFID can result in significant weight loss or in failure to grow, to gain weight and to otherwise develop normally.
Diagnostic Criteria for ARFID
The DSM-5 has laid out four main criteria for a diagnosis of ARFID:
- An individual is experiencing an eating or feeding disturbance accompanied by either significant weight loss, significant nutritional deficiency, dependence on external feeding or supplements, interference with psychosocial functioning or a combination of more than one of these factors.
- Avoidant or restrictive eating is not explained by general food shortage or cultural food traditions.
- The eating disturbance is not the result of a concurrent medical condition such as another physical or mental illness.
- Avoidant or restrictive behaviors do not occur as a result of an eating disorder such as bulimia or anorexia that includes a distorted body experience.