Understanding ARFID: How to navigate and support feeding differences in Neurodivergent folk
Firstly ARFID (Avoidant/Restrictive Food Intake Disorder) is not just “picky eating”, it is a multifaceted eating disorder and neurodivergence characterised by severe food avoidance or restriction. ARFID can originate from anxiety, fear of food and/or eating, past trauma, sensory processing differences (involving texture, taste, and smell), or variations in executive functioning.
ARFID often doesn't primarily revolve around body image or weight concerns, although these concerns can still coexist with ARFID. Common co-occurring diagnoses among individuals with ARFID often include Autism and ADHD. A person with ARFID may be called a FIDer which is a term coined by Kevin Jarvis who has ARFID.
According to the DSM a person with ARFID will avoid food and/or restrict their intake due to one or more of the following reasons:
Avoidant: Those in this category tend to limit their food choices significantly due to sensory differences, particularly hypersensitivity to taste, texture, smells, and the visual aspects of food.
Restrictive: These individuals typically exhibit little interest in eating or food, possibly due to a low appetite or challenges with interoceptive awareness. They might forget to eat or become easily distracted from mealtime.
Aversion: Restriction of food intake is linked to traumatic or fear-based experiences, such as a fear of vomiting, nausea, choking, or allergic reactions.
These eating disturbances may lead to insufficient nutrition and energy intake, which can result in one or more of the following outcomes:
Significant weight loss (or, in children, a failure to achieve expected weight gain or growth). *It's important to note though that a FIDer can be any weight.
Significant nutritional deficiencies.
Dependency on enteral feeding (tube feeding) or nutritional supplements.
Substantial interference with psychosocial functioning (e.g. Inability to eat at restaurants, go to social gatherings, travel due to limited diet)
Understanding the Intersection between ARFID and neurodivergence; Below is not an exhaustive list
Sensory Processing Differences: Many Autistic and ADHD individuals have sensory processing differences, making eating specific foods or even considering certain foods overwhelming, physically uncomfortable, and distressing. Environmental factors can also exacerbate these challenges. The sensory overload from food textures, smells or tastes can lead to limited food diversity and intake, contributing to the development of ARFID.
Routine and Repetition: A preference for routine and predictability is common among neurodivergent individuals. ARFID may manifest as a reliance on a restricted diet of "safe" foods that provide a sense of security and comfort. For example, a box of crackers consistently offers a predictable taste, smell, and texture, while an apple is unpredictable in taste and texture (apples can be sweet, sour, crunchy, floury). This unpredictability and change in taste can be very distressing for a FIDer.
Executive Functioning Differences: Both ADHD and autistic folk can encounter executive functioning challenges, including difficulties in planning, organising and cooking meals. These challenges can make navigating mealtimes more complex, difficult and daunting.
Navigating ARFID in an affirming way
As stated above ARFID is an eating disorder and neurodivergence. It does not need “fixing”, it needs curiosity, kindness, compassion, understanding and accommodations.
Below are general ways for how you can support a FIDer :
Use the model ‘Fed is best’. Simply put, eating anything versus nothing is more important than what a person eats.
Validate Lived & Living Experience: It’s important to listen and learn from those with ARFID. You or your loved ones experience is real. This can drastically help with reducing and avoiding shame and guilt around eating differences.
Make safe and preferred foods easy to access and available always.
Be curious. Ask questions, the person with ARFID is the expert in their experience.
Avoid judgement and comments on eating. Never comment on food, fullstop.
Respect autonomy and allow agency.
Make accommodations so that the eating environment can feel safe.
Get to know their sensory preferences, this includes food and the environment in which they eat.
Exposures to foods need to be led by and decided by the individual with ARFID and based on sensory preferences.
Written by Margo White, your Melbourne-based neurodiversity affirming clinical nutritionist and ND advocate. If you’d like to book a consultation with me, schedule an appointment below.
References
https://nedc.com.au/eating-disorders/types/arfid/
This article is intended as general advice only and does not replace medical advice. It is recommended that you seek personalised advice specific to your individual needs.
