What is ARFID?

Avoidant /restrictive food intake disorder (ARFID) was a diagnosed added to the DSM V in 2013.  The DSM is basically that bible for mental health diagnosis, created by the American Psychiatric Association.  It is extremely picky eating.

Is ARFID a mental illness?

This diagnosis replaced an older one called ‘Feeding Disorder of Infancy and Early Childhood’, which was in the previous version of the DSM, the DSM IV.

The previous diagnosis was a childhood developmental disorder, whereas ARFID is in the psychiatric section of the DSM, and classified as an eating disorder.

What are the symptoms of ARFID?

To be diagnosed with ARFID, your child has to tick one of these boxes:

1. Significant weight loss or faltering growth
2. Significant nutritional deficiency
3. Dependence on enteral feeding or oral supplements
4. Marked interference with psychosocial function.

As you can see, a child’s weight is not the most significant factor or the only factor in an ARFID diagnosis.  Children who eat a very limited range of foods will often be given something supplementary to keep them sustained.  This might be formula or cow’s milk.  Obviously a child who is reliant on formula or cows milk for most of their calories past that age of one if not eating a diverse and varied diet.

Iron deficiency is mentioned a lot in studies about the most significant nutritional deficiency for ARFID.  There are multiple issues with this.  Iron deficiency has many, many causes.  A child presenting with iron deficiency will most likely not have ARFID.  

The are also exclusion criteria, which means if your child ticks one of these boxes, they don’t have ARFID.  These criteria are:

1. The disturbance is not better explained by a lack of available food or by an associated culturally sanctioned practice.  So if a child has a limited diet because there are limited foods available at home, or because foods are not offered for cultural reason, this is not ARFID.
2. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced. If a child is limiting the food they are eating, either in volume or variety because they are trying to lose weight, it isn’t ARFID.
3. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder e.g when the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention. This is potentially the most problematic exclusion criteria.  Many kids who don’t eat well, don’t eat because of an underlying health issue.  The problem is, most of these issues will not have been identified in the conventional medical system.  I’ll discuss this in more detail below

Underlying medical conditions that contribute to ARFID

Every child with feeding difficulties that comes through my doors gets a full health assessment via functional testing.

I do a poop test and then either a hair tissue mineral analysis or a DNA test.

For the extremely fussy eaters, these are the sort of issues I see:

• Heavy metal toxicity – such as arsenic, mercury, lead and aluminium
• Pathogenic bacteria in poo – such as enterohaemorhaggic E. Coli
• Parasites in their poo – such as Giardia
• Leaky gut
• Gut inflammation
• Gluten intolerance
• Weak digestive capacity
• Zinc deficiencies

These children will have been to see many people before they get to me, and none of these issues have been identified.  So if they have been given an ARFID diagnosis, it is incorrect, as exclusion criteria number 3 has not been adequately investigated.

But its not just me.

A 2015 study of 422 children who has been referred for treatment for ARFID reviewed their cases in detail. These children were referred to a hospital feeding clinic by other doctors or professionals after an unsuccessful course of treatment for their feeding issues.

Of the 422 children, only 294 actually met the criteria for an ARFID diagnosis.

Then the exclusion criteria were applied and only 133 of the original 422 still qualified for a ARFID diagnosis.  The others had interfering medical issues such as:

• Reflux
• Constipation
• Diarrhoea
• Allergies
• Food inteolerances
• And other issues.

What’s my point?

If your child has been diagnoses with ARFID, that does not mean you need to get comfortable with the idea of your child only eating 3 foods for the rest of their life.

It means you need to keep searching for answers, which might mean going outside the medical mainstream model. Book a discovery call for the Fuss No More method and find out how we can help.