WHAT IS ARFID? EATING DISORDER IS MORE THAN BEING PICKY ABOUT THE FOOD YOU WILL EAT

Avoidant/restrictive food intake disorder leads people to reject foods because of their smell, taste or consistency, making eating a burden

"No, not even strawberries," is something Mara says a lot. She cannot eat oranges - in fact, almost no other solid fruit, or vegetables - nor cold cooked meat.

She was breaking out in a sweat before her workplace's Christmas dinner, she says.

"For around 30 years, I thought I was just stupid when it came to food and was acting like a toddler."

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That was until she spotted a child with similar eating habits on Instagram. "The mother described her child's behaviour with the word Arfid. I thought: Oh my God, that's me."

Arfid stands for avoidant/restrictive food intake disorder, a condition identified some years ago, and it is not just about being a picky eater.

"It's crazy when you live with it your whole life and then suddenly have a name for it," says Mara, now in her mid-30s. "There's a difference between things I don't like and things I can't eat," she adds.

She does not like marzipan, but she simply cannot stomach cooked ham. She compares it to reality television shows when contestants have to try to eat insects or offal.

"In any case, I'm very relieved to know what I have," she says.

Mara, who is of normal weight, went to a doctor and is weighing whether to see a psychotherapist or a speech therapist who has been recommended for those with an aversion to certain solid foods.

Both adults and children are affected by Arfid, which can lead people to reject foods because of the way they smell, taste, their consistency or appearance, says Ricarda Schmidt from the clinic and polyclinic for psychosomatic medicine and psychotherapy at the University of Leipzig in Germany.

Many children or adults who are affected do not feel hungry, are afraid of eating, or have little appetite.

"Eating is not a pleasure for them, but a burden," Schmidt says, adding that the aversion to food is sometimes so strong that children develop deficiency symptoms or lose weight.

"These children eat so little or so restrictively that they develop physical and psychosocial impairments. For example, they avoid children's birthday parties or school trips because of the food."

The condition is more than just general fussiness or picky eating, a stage many children go through as they develop and which usually passes.

The Diagnostic and Statistical Manual of Mental Illnesses from the American Psychiatric Association has recognised Arfid since 2013, but some countries still do not.

Avoidant/restrictive food intake disorder as an eating disorder was also included in the World Health Organization's International Classification of Diseases of 2022 (ICD-11), though again not all countries have adopted this.

Doctors classify the condition with other eating disorders. It is not clear how many people it affects.

In Germany, one of the countries with little recognition of Arfid, young people with the disorder are often assumed to have anorexia, says Andrea Hartmann Firnkorn, head of the clinical psychology and psychotherapy of childhood and adolescence working group at the University of Konstanz.

"But people with Arfid don't restrict their food because they want to lose weight. They also eat things like chips, pasta and chocolate rolls, for example," she says.

Some of the people who are affected may be underweight, but others are a normal weight or are overweight - though they are often malnourished because of their unbalanced diet.

Little is known about the causes of Arfid. A genetic predisposition could play a role, especially in those who are sensitive to smells, textures or flavours or who have an aversion to many foods, says Schmidt.

Fear of eating or other Arfid symptoms could also be triggered by early traumatic experiences, such as choking badly as a child, an allergic reaction, being intubated at an early age or having suffered an illness involving difficulty swallowing.

An analysis of 77 studies provides indications of possible therapeutic approaches: although these are fairly small studies without long-term observation, they show approaches that should be investigated, says a team led by Laura Bourne from the UK's University College London in the journal Psychiatry Research.

These include family-based therapy, cognitive behavioural therapy and, in some cases, the additional administration of psychotropic drugs. Medics would need to tailor the therapy to the individual involved, depending on their main problem and its severity.

"Arfid is very stressful for the whole family," says Schmidt. "Abnormalities often become apparent early on when eating, for example, during breastfeeding or when introducing complementary foods."

Parents should consult a paediatrician to assess the physical consequences and the paediatrician can also determine whether there are any gastrointestinal problems or food allergies.

"You have to assume that the doctor is not familiar with Arfid and will dismiss it as fussiness. However, fussiness passes, Arfid does not," Schmidt says.

You can also take practical approaches by making sure the atmosphere at the dinner table is relaxed, even if this can be difficult, she says. "Parents should convey a sense of enjoyment around food and keep offering rejected foods in bowls on the table so that everyone can help themselves."

A new food should be tried at least 10 times so that you can get used to it, says Schmidt. But it does not help to pressure children to eat vegetables, fruit, dairy products or meat and fish.

Many people with Arfid do wish they could eat certain things. "Some children would like to eat mashed potatoes, but can't overcome their disgust."

Psychologists Hartmann Firnkorn and Julia Engelkamp have launched an online therapy programme at Germany's University of Konstanz that includes video sessions and self-study modules, in which families receive individual support.

"It's important that someone neutral comes in, because the topic of food has often become a battleground," says Firnkorn. "We won't make Arfid disappear in 12 weeks. Other eating disorders, such as anorexia or bulimia, often require long-term therapy involving around 60 sessions.

"But we want to give families tools they can continue to work with. If children currently only eat three to four foods, it will take longer than the therapy to achieve a balanced diet with enough variety."

It is important to take small steps.

"Maybe start with spaghetti and move on to a different type or brand of pasta, and don't add tomato sauce right away," says Firnkorn.

A sense of achievement is important. "Help your child realise that they have managed to eat something different."

Mara's diet has also expanded over time. "I've been able to eat dried tomatoes and olives for five years," she says.

She has also been eating pumpkin and tomato soup for a long time, as long as everything is finely pureed, and she also drinks orange juice without pulp. At the company Christmas dinner, she finally found something else she liked - hummus with pureed beetroot.

Meanwhile, she is watchful to avoid transferring the condition to her child. She does not spoon-feed him baby food, but gives him soft pieces of food that he can pick up and eat himself.

With the now-widespread method of baby-led weaning, where an infant determines when to stop breastfeeding, children choose for themselves what to eat from what is on offer.

"You offer something, and the child decides for themselves what they want to eat. So far, my daughter eats everything, and she has a big appetite. I hope it stays that way."

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This article originally appeared on the South China Morning Post (www.scmp.com), the leading news media reporting on China and Asia.

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2025-05-27T08:24:06Z