Charlotte Deville
In light of Eating Disorder Awareness Week (26th February to 3rd March), the UK’s leading eating disorder charity, Beat, focused on raising awareness of ARFID. This condition is severely misunderstood and lesser known compared to similar conditions such as anorexia nervosa, bulimia nervosa, and binge-eating disorder. Impact’s Charlotte Deville explores…
Having watched a close family member grow up experiencing ARFID, it is heart-breaking that sufferers often endure the condition for a longer duration and with less support due to a lack of research and understanding. ARFID was not clinically recognised in the DSM-5 until 2013, and there is still no standardised therapy to treat the disorder in NICE or SIGN guidelines.
As a result, recovery still seems like a fairy tale for many of those affected, and so Beat’s active pursuit to drive greater awareness is a positive sign of a light at the end of the tunnel.
So, what exactly is ARFID?
Standing for Avoidant Restrictive Food Intake Disorder, sufferers typically have fewer than 15 individual food items they consider ‘safe’, and often stick to ‘beige’ foods and avoid entire food groups. Within ARFID, there exists multiple sub-types:
- Sensory based: Restriction and/or avoidance, driven by a sensitivity to taste, texture, smell, appearance, or temperature of foods.
- Concern about the consequences: often resulting from a distressing experience with food, sufferers develop fear and anxiety around the experience of eating, and so restrict themselves to foods they consider to be ‘safe’.
- Low interest in eating: a person lacks hunger signals and perceives eating as an unenjoyable chore.
Sometimes there is no explicit reason or event that has triggered their condition
It must, however, be considered that the same person can experience multiple reasons for avoidance and restriction, and sometimes there is no explicit reason or event that has triggered their condition.
The Warning Signs:
There are many recognisable behavioural symptoms of ARFID. Many of these are common with sufferers of other disordered eating conditions, but those that characterise the experience of ARFID may include:
- Eating less food than necessary
- Difficulty recognising hunger signals
- Feeling full after a few mouthfuls
- Eating is a ‘chore’, and time consuming, because of slow chewing and small bites
- Missing entire meals
- Sensitivity to texture, smell, temperature
- Appearing to be an extremely picky eater
- Always eating the same meals
- Eating foods of a similar colour, especially ‘beige’ foods
- Avoidance of social events involving food
- Not as concerned about their behaviours as others
The Misconceptions and the Reality:
So, here comes the truth.
Painfully misunderstood, ARFID sufferers are often faced with uninformed comments and judgements about their condition which only exacerbate their difficulties. Firstly, ARFID is often placed in the same box as other variations of eating disorders by those who assume this is a blanket term for any food-related difficulties. ARFID differs from anorexia nervosa and bulimia nervosa as beliefs about weight and body shape are not a factor.
ARFID, and eating disorders generally, are psychological disorders. They are real. They are not a choice, for attention, or simply a case of being picky or fussy, something ARFID sufferers are often branded. Non-sufferers with a lack of understanding often pressurise them to “just eat it” or “just try” new foods, as well as drawing attention to the sufferer’s eating habits, expect them to forcefully change their behaviour or “grow out of it” and perceive sufferers as childishly seeking attention.
Non-sufferers attempt to ‘fix’ them without appreciating they are not a broken part, but a human being with feelings and emotions
This only causes distress and makes the sufferer feel self-conscious. They are already aware that their behaviours are not ‘normal’, and battle with this experience daily, along with how it affects their relationships with food, themselves, and with others. Those with ARFID do not simply choose not to eat certain foods. They physically cannot. These ‘unsafe’ foods trigger a physiological stress response similar to being forced to confront a phobia.
Physically, ARFID often causes stunted growth given the lack of sufficient nutrients, required for healthy development and daily functioning. Naturally, this means sufferers often experience low mood and energy levels, spiralling into a plethora of mental, emotional, social, and psychological challenges.
The response to an ‘unsafe’ food can also be characterised by their whole body shaking and feeling physically sick
ARFID stretches far beyond the dinner table, with sufferers often experiencing difficulties at home, school, work, or with friends. Life experiences that are exciting for others such as going out, holidays, special occasions, and making new friends are all tainted by ARFID, which impacts a person’s academic performance, confidence, self-esteem, and their ability to engage in hobbies and fit in with friends.
One sufferer reported “I always felt like a pain” as their family had to prepare certain meals for them, friends had to avoid certain restaurants, and those around them had to experience their hyperventilation attacks if they were faced with an ‘unsafe’ food. The response to an ‘unsafe’ food can also be characterised by their whole body shaking and feeling physically sick.
Another ARFID sufferer spoke of eating disorders generally and revealed “the day of the year I dreaded most was Christmas Day” due to the “pressure of feeling that everyone was watching me”. They described the experience as anxiety-wrenching and that they “desperately wanted to be “normal””.
So, most importantly, how can you support someone with ARFID, or any other eating disorder, to feel secure and make their journey towards recovery?
Firstly, it is important to realise that the sufferer has got to personally want to change. This is a realisation they must come to alone. No one else can change you, and so inflicting pressure, judgements, threats, and comments on their appearance and habits will only cause the person to feel threatened, and therefore intensify their self-restrictions to habits and foods they consider to be safe to stay in control.
It is crucial to create an environment where the sufferer feels unconditionally loved, encouraged
Treating the sufferer differently, and imposing unwelcome food, pressure, or judgements that make them feel unsafe is extremely counter-productive. This only pushes them away as their brain will recognise your presence as a threat. It is crucial to create an environment where the sufferer feels unconditionally loved, encouraged, and therefore safe to make changes. Without any pressure or the anxiety of feeling everyone’s attention, they will feel able to take small steps by trying new foods and having the mental freedom to re-align with their bodily signals of hunger and cravings.
In this situation, it is important to respect the sufferer’s boundaries by gently and privately providing positive reinforcement for the changes they make, such as by asking how it felt, or expressing that you are proud of them for taking that step. It is also essential to not make them feel guilty or like an inconvenience. For example, if they ask to try a new food or meal that is different from the dinner you had planned to make for/with them. Instead, validate their feelings and emotions even if you cannot relate to them yourself, and affirm to them that recovery is a very possible goal.
Focusing on their overall wellbeing and providing an environment that feels safe is essential
Finally, it is important not to expect the person to suddenly make multiple drastic changes after overcoming one small barrier, and not to micro-manage their eating habits by imposing your personal perception of what conventional ‘healthy’ or ‘normal’ eating is upon them.
Ultimately, focusing on their overall wellbeing and providing an environment that feels safe is essential. No matter what the food is, the most important thing for ARFID sufferers is that they are fed, and that it is a positive experience for them.
Charlotte Deville
Featured image courtesy of Annie Spratt via Unsplash. Image license found here. No changes were made to this image.
In article image 1 courtesy of @edgi.uk via facebook.com. No changes were made to this image.
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