What is ARFID: A video
What are you truly afraid of? Is it spiders or crocodiles? How about tunnels or heights? If you have a phobia of any of the above subjects, you might be able to avoid regular contact with them, to some extent.
But what would you do if the source of your psychologically entrenched terror were food – a substance that you’re supposed to come into contact with at least three times a day?
According to Gabrielle Maston, spokesperson for the Dietitians Association of Australia, the clinical response would be to avoid food at all costs. And that could lead to malnutrition and serious illness.
“It could feel like a life or death situation for that person experiencing a fear or anxiety response to food."
Herein lies the reality of people living with Selective Eating Disorder (SED) also known as Avoidant Restrictive Food Intake Disorder (ARFID).
“It could feel like a life or death situation for that person experiencing a fear or anxiety response to food,” says Maston, an Accredited Practising Dietitian.
“The person with this disorder might be scared of adding different things into their diet or eating in front of other people.
“…For example, it’s not just that they dislike eating bananas but the mere sight of them or eating them causes them severe anxiety or stress.”
As Maston explains, SED/ARFID is a serious mental health and dietary condition listed in the DSM-5, where an individual reduces their consumption of various foods to the point at which it causes a degree of physical harm.
A fear or food, however, is only one component of the disorder. Eating Disorders Families Australia also identifies a number of additional ‘warning signs’ online. This includes trouble eating or digesting specific kinds of food, avoiding certain types, textures or colours of food, lack of appetite or eating very slowly.
“From what that I see online – people without the disorder will often comment about people with SED, saying ‘why don’t they just eat? It’s that easy.’ Well, it’s not as simple as going and eating something. If it were ‘that easy’, there wouldn’t be a problem. These food disorders are wrapped up in a lot of mental health issues and are not easily fixed.”
"Well, it’s not as simple as going and eating something. If it were ‘that easy’, there wouldn’t be a problem."
Take note of the warning signs
Maston says SED is most often seen in teenagers, and may occur from 11-years-old.
“That’s when we might start to see restrictive eating patterns,” she says. “The teen or child might be swimming in their clothes. They might be always going to the bathroom at mealtimes, or they are not eating dinner and hiding food. They will generally have odd behaviours around mealtime.”
The disorder can be overcome with age but for some people, it will continue into adulthood.
“The patient might not even know or often accept that they have the disorder. But the people around them may notice a severe decline in their weight over a short period of time.
“It might also come up in a random blood test that the person has nutritional deficiencies that prompt a medical professional to ask questions about dietary intake. For example, they might end up with a protein, energy or electrolyte imbalance.
“The patient might not even know or often accept that they have the disorder. But the people around them may notice a severe decline in their weight over a short period of time."
“What you end up seeing is severe health issue like malnutrition, which can lead to heard ta attack, hospitalisation and if left untreated, death.”
The prevalence of SED for Australians aged over 15 years is slightly less than anorexia nervosa. A 2017 study conducted over three months showed that between 0.4 and 0.5 percent of the population studied had anorexia nervosa while 0.3 per cent had SED/ARFID. It also noted that even though SED/ARFID was less common than other eating disorders, it was associated with poor mental health-related quality of life and significant functional impairment.
Why SED is not the same as 'fussy eating'
People living with the disorder may be incorrectly referred to as ‘picky eaters’ or just ‘fussy. But, Maston says, there is a big difference between a fussy eater and someone living with an eating disorder like SED.
A picky eater will most likely not suffer the degree of impairment and malnourishment that a person with SED does. “It goes beyond being ‘picky’, as the person will flatly refuse to eat food in general.
“A child who is a picky eater may also choose foods that are palatable to them. Often these are highly processed foods that taste good. They will get a dopamine and serotonin hit from it. With SED, the teen probably wouldn’t choose junky foods.”
Autism, anxiety and depression are also often co-occurring with SED. Then, of course, there is usually an element of fear that is associated with food for people living with the disorder.
UK psychologist, Felix Economakis, also explains the confusion between fussy eating and SED online.
"SED is a true phobia that just happens to be associated with foods rather than animals, objects or processes," he says.
As such, it is not mere ‘fussy eating’ which tends to just be a conservative stage during most children’s development. Fussy eaters are often merely picky or play on the preferential treatment or special attention they get, but they are not phobic."
“It goes beyond being ‘picky’, as the person will flatly refuse to eat food in general."
Treatment is available
No one currently knows what causes SED. However, the good news is that with the right medical assistance, it can be treated.
“It is a condition that requires intense medical therapy from a multidisciplinary team,” says Maston.
“The best tip is that if you think you have this issue, go and see your local GP first for a referral to a psychiatrist, psychologist or dietitian.”
Maston explains that her role as a dietitian would be to work with other medical professionals to create individual plan meals and reduce anxiety surrounding mealtimes and various ingredients.
“You might end up needing to make regular appointments with your GP for blood tests to test your electrolyte levels and prevent an episode from happening.
“But you certainly don’t have to deal with this on your own.”