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Avoidant & Restrictive Food Intake Disorder & Family Therapy

Family therapy is proven to be vastly helpful in treating numerous mental illnesses and eating disorders are no different. Avoidant and Restrictive Food Intake Disorder (ARFID) is often experienced by children and, therefore, can be particularly helped when the family becomes involved in treatment.


Diagnosis

ARFID is a disorder new to the DSM-V but is experienced by nearly 13 to 22% of patients with an eating disorder diagnosis. Previously, it was referred to as “Selective Eating Disorder.”

Similar to Anorexia Nervosa, ARFID is characterized by limitations in the amount or type of food an individual eats. However, the two differ in that ARFID does not involve any of the body image distress or fear of fatness that is commonly seen in Anorexia Nervosa.

Instead, the limiting intake with ARFID results from the avoidance based on the sensory characteristics of food or fear of the consequences of food. An individual with ARFID may often report the firm belief that, “if I eat that, I will die.”

This disorder is often mistakenly referred to as “extreme picky eating, “ an unfair assessment when one considers the lack of control an individual feels in “choosing” whether or not to eat a food.

Individuals with ARFID go beyond refusing to eat certain foods. They often have extreme emotional disturbances and anxiety related to eating specific foods and may have uncontrollable body responses (gagging, choking, vomiting) when trying to eat these foods due to these fears and anxieties.

These responses are a result of the fear causing “physiological constriction of the mouth tissues, throat, and digestive tract [1].”

Research indicates that populations that are particularly at risk for ARFID include children, especially those with a co-occurring anxiety disorder, children that haven’t outgrown typical “picky eating,” and individuals diagnosed with Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder, or other intellectual disabilities [2].


Treatment

Summer music treatmentIndividuals diagnosed with ARFID are often treated using a combination of Cognitive Behavioral Therapy, pharmacotherapy, and nutrition therapy [2].

The emphasis in the treatment of ARFID is on “reducing anxiety, restoring nutritional health, and incorporating problem foods back into the diet using exposure therapy [2].”

Exposure therapy addresses a significant psychological component of treating ARFID, as it helps individuals to “understand and accept characteristics of food nonjudgmentally [2].”


The Role of Family Therapy for ARFID

As this disorder is often experienced by children or adolescents, the role of the family is enormous in treatment.

Family-Based Therapy (FBT) is a treatment model that is:

Designed to help empower family members support the recovery of the patient in a home setting by providing parents and siblings with education on EDs, lifting blame and guilt from the family and patient, raising anxiety about the seriousness of the illness, externalizing the ED as an enemy, and encouraging parents to implement refeeding strategies [2].

Research indicates that FBT is not only effective in promoting weight gain and improving psychological function, it is also more effective at increasing rates of remission [3].

Studies show that incorporating FBT into therapy that also includes nutritional therapy and possible pharmacological therapy results in successful treatment of ARFID [3].


Key Aspects

A 2018 study published in the Journal of Eating Disorders evaluated 6 case studies of adolescents being successfully treated for ARFI using the combination of treatments described above [3].

The study determined that there were specific aspects of FBT that seemed to result in positive outcomes. One of these is psychoeducation of the family, meaning that, the family was taught the negative consequences of low weight and insufficient nutrition as well as the seriousness of the disorder.

Stronger Family Smiling After family-based therapyAnother crucial aspect involved lifting guilt or blame that any family members, or the individual themselves, may be feeling related to the illness.

Parents were also taught to stand up to the illness and to “empathize with their child’s pain, fear, or feelings of discomfort while still being firm with their child about taking the nutrition [3].”

Finally, family issues that may have existed regarding food intake or weight gain are addressed in therapy.


Outcomes

As mentioned above, the outcome of incorporating the family into therapy is associated with positive outcomes and successful treatment of the disorder.

These results indicate that it is incredibly important one does not discount the role of the family in the treatment of ARFID.

Predisposed ideals regarding nutrition, food intake, or weight gain can have a significant impact on the impressionable minds of children or adolescents. Addressing these in the individual alone will not be as helpful as addressing it in the entire family. The same is true with regard to a knowledge of food intake and nutrition.

Supporting and successfully treating an individual then placing them back in the same environment with the same ideals, rules, and interactions can make it more difficult for them to sustain the behavior and ideology changes they gained while being treated.

Teaching and empowering the family helps all involved speak, interact, and behave in a way that supports the individual’s recovery.


References:

[1] Elliot, S., Dire, K. (2018). What exactly is ARFID? National Eating Disorder Association. Retrieved from https://www.nationaleatingdisorders.org/blog/what-exactly-arfid on December 8, 2018.

[2] Ushay, D., Seibell, P. J. (2018). Review of avoidant/restrictive food intake disorder. Psychiatric Annals, 48:10, 477-480.

[3] Spettigue, W. et al. (2018). Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments.Journal of Eating Disorders, 6:20.