Understanding the Different Types of ARFID

As a parent, it can be overwhelming when your child struggles with food. You might have heard of ARFID, or Avoidant/Restrictive Food Intake Disorder, and wondered how it differs from picky eating. ARFID goes beyond just being choosy at meals; it’s a serious condition that can impact your child’s health and development. There are three main subtypes of ARFID: Avoidant, Aversive, and Restrictive. Let’s break these down in a way that makes sense, so you can better understand what might be going on with your child and how to help them.

1. The Avoidant Subtype: It’s All About Sensory Issues

Some kids have a super strong reaction to certain food textures, smells, or tastes. If your child is in the avoidant subtype of ARFID, they’re likely only comfortable eating a small list of “safe” foods. These are foods that meet their very specific sensory preferences, and anything outside of that can cause anxiety or even make them gag. Studies show that kids with sensory processing issues are more likely to develop this kind of ARFID (Nicely et al., 2014). For example, maybe they’ll eat smooth mashed potatoes but refuse anything crunchy or lumpy (Zucker et al., 2015). This can make mealtimes a huge challenge.

Signs of the Avoidant Subtype:

1. Extreme Sensory Sensitivities: Your child might reject foods based on how they feel in their mouth, how they look, or even how they smell (Zucker et al., 2019).
2. Sticking to a Few “Safe” Foods: They may have a short list of foods they’ll eat and show resistance to trying new things (Cermak et al., 2010).
3. Nutritional Concerns: Since their diet is so limited, they may miss out on important vitamins and minerals, which could lead to health issues (Bryant-Waugh et al., 2010).

Sensory sensitivities often appear early in life and can continue into the teen years and beyond, which can make it hard for your child to enjoy meals or try new foods (Bryant-Waugh & Kreipe, 2012).

2. The Aversive Subtype: Fear of Eating

If your child has ever had a bad experience with food—like choking, vomiting, or an allergic reaction—they might develop a fear of eating certain foods. This is called the aversive subtype of ARFID, and it’s more common than you might think. Research shows that these negative experiences can lead to a strong fear response around eating (Fisher et al., 2014). It’s almost like they’ve developed a phobia of food.

Signs of the Aversive Subtype:

1. Fear of Eating: They might avoid certain foods because they’re scared they’ll choke or get sick from them (Thomas et al., 2017).
2. Mealtime Anxiety: Eating can become really stressful, and you might notice them getting anxious even before meals start (Norris et al., 2016).
3. Weight Loss or Poor Growth: Because they’re avoiding so many foods, you may see unintentional weight loss or signs that they’re not growing as they should (Sharp et al., 2013).

Kids with aversive ARFID often need a lot of reassurance or specific strategies to feel comfortable eating again (Thomas et al., 2017).

3. The Restrictive Subtype: Just Not Interested in Eating

For some kids, the problem isn’t about fear or sensory issues—they just aren’t interested in eating. If your child falls into the restrictive subtype of ARFID, they might not feel hunger in the same way other kids do, or they might see eating as more of a chore than something enjoyable. Studies have found that children in this group simply don’t get much satisfaction from food (Zimmerman & Fisher, 2017).

Signs of the Restrictive Subtype:

1. Low Appetite: Your child might go for long periods without eating and show little to no interest in food, even when they haven’t eaten in a while (Norris et al., 2014).
2. Unintentional Weight Loss: Because they aren’t eating enough, they might lose weight or struggle to keep up with their growth curve (Eddy et al., 2015).
3. Difficulty Meeting Their Needs: Since they don’t feel a strong drive to eat, they might not get the calories they need to stay healthy and energetic (Zimmerman & Fisher, 2017).

In some cases, kids with the restrictive subtype need reminders to eat because they’re just not tuned into their hunger cues (Eddy et al., 2015).

Hearing that your child may have ARFID can feel intimidating, but knowing the specific subtype they’re dealing with can help guide treatment. Whether it’s addressing sensory issues, helping them overcome food fears, or finding ways to boost their interest in eating, a team of healthcare professionals can work with you to build a treatment plan that’s right for them (Bryant-Waugh et al., 2019). Understanding ARFID and its different forms is key to helping your child build a better relationship with food. It’s not easy, but with the right support, things can get better, and your child can learn to navigate mealtimes with less anxiety and more confidence.

References:

1. Bryant-Waugh, R., Kreipe, R. E. (2012). Avoidant/restrictive food intake disorder in DSM-5. *International Journal of Eating Disorders, 45*(4), 443-445.

2. Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. *Journal of the Academy of Nutrition and Dietetics, 110*(2), 238-246.

3. Eddy, K. T., Thomas, J. J., Hastings, E., et al. (2015). Prevalence and clinical correlates of ARFID in a pediatric eating disorder program. *International Journal of Eating Disorders, 48*(4), 464-470.

4. Fisher, M. M., Rosen, D. S., Ornstein, R. M., et al. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: A "new disorder" in DSM-5. *Journal of Adolescent Health, 55*(1), 49-52.

5. Nicely, T. A., Lane-Loney, S., Masciulli, E., et al. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in a partial hospitalization program for eating disorders. *Journal of Eating Disorders, 2*(1), 21.

6. Norris, M. L., Robinson, A., Obeid, N., et al. (2014). Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study. *International Journal of Eating Disorders, 47*(5), 495-499.

7. Sharp, W. G., Volkert, V. M., & Scahill, L. (2013). Feeding problems and nutrient intake in children with autism spectrum disorders: A meta-analysis and comprehensive review of the literature. *Journal of Autism and Developmental Disorders, 43*(9), 2159-2173.

8. Thomas, J. J., Lawson, E. A., Micali, N., et al. (2017). Avoidant/restrictive food intake disorder: A three-dimensional model of neurobiology with implications for treatment. *Current Psychiatry Reports, 19*(8), 54.

9. Zimmerman, J., & Fisher, M. (2017). Avoidant/restrictive food intake disorder (ARFID). *Current Problems in Pediatric and Adolescent Health Care, 47*(3), 95-103.

10. Zucker, N. L., Copeland, W., Franz, L., et al. (2015). Psychological and psychosocial impairment in preschoolers with selective eating. *Pediatrics, 136*(3), 582-590.