Treating ARFID

Treating ARFID

  • Posted by admin
  • On August 25, 2022
  • ARFID, Avoidant Restrictive Food Intake Disorder, Do I have an Eating Disorder, does my child have an eating disorder, Eating Disorder Help, Eating Disorder Treatment, Eating Disorders, picky eating

Treating Avoidant Restrictive Food Intake Disorder is a challenging process. This post is intended for families or individuals struggling with Avoidant Restrictive Food Intake Disorder (ARFID) and is not intended to be an exhaustive manual for treatment.

If you want to know more basics about ARFID please see our post here.

As a clinician who has been treating eating disorders almost exclusively for years I have encountered a lot of families and individuals living with the pain of ARFID. It is often dismissed as “just picky eating” but when I sit with people that this issue has impacted they will tell me stories of birthday parties missed, family dinners disrupted, trips deferred, and dreams put on pause.

They have been down a long and exhausting road of frustration and anger. Food is supposed to be enjoyable and connecting but food for ARFID strugglers and their families is usually the very opposite. For this reason, people often come to us wanting help desperately. They want all the fighting and struggle to stop immediately. Our role as clinicians is to manage expectations and set realistic expectations, and one of those realistic expectations is that ARFID recovery is slow and challenging. You can’t get out of this struggle with more yelling, bargaining, and bribing. That is a hard expectation to accept. I totally get it. Let me explain why ARFID is so challenging to treat- in the most non-therapisty way I can think up. Then maybe I will bore you with a few more clinical aspects.

I am borrowing this analogy from Intuitive Eating by Evelyn Tribole and Elyse Resch. Imagine that you had been writing with your right hand your entire life and one day I slid a piece of paper over to you and said “from now on you will be writing with your left hand.” That first attempt wouldn’t look very good and it certainly would take a long time for your left handed writing to look like your right handed writing (lefties stay with me here!), in fact the two might never be identical. It would be awkward, uncomfortable, even frustrating. You might even say to me “PLEASE can we go back to using my right hand I really need to be able to do this so I can function in the world?” You would also probably fall back to using your right hand out of ease, comfort and habit and if you were really stressed and needed to write something quickly it would be all the more frustrating and likely to slip back to right handedness (whew, that was a lot of right/write- am I right?).

People who struggle with ARFID find comfort in their safe foods and patterns of eating. When we challenge this, it is like asking a right handed person to write with their left hand. The very act is challenging, frustrating, and distressing.

We don’t want the healing to be more traumatizing than the illness was.

These are the boring details. I don’t use this word lightly- people with ARFID often have a traumatic relationship with food. Some of that trauma can be what created the issue in the first place, like choking and vomiting incidents. Some of the trauma can simply be from having to do something very anxiety provoking every day of their life for six years, often with no coping skills to manage this. We can’t use trauma to heal trauma. It just won’t work. We have to expose ARFID strugglers to the anxiety around food but in a way that their body can stay regulated. Think about trying to overcome a fear of the ocean (sigh, it’s me- I have a fear of the ocean). You would start small. Get in the water up to your ankles, then knees, then chest. It might take years before you could deep sea dive (or, maybe never!). The goal would be being able to enjoy a day at the beach with your family, even if you have to enjoy it with a manageable side of anxiety. The more you did it the easier it would become. That is the goal with ARFID strugglers.

The process is painstakingly slow. Often, what we do is try to build safe feeling bridges to more food variety and volume. If a person with ARFID only eats chicken nuggets and pizza, we try to find adjacent foods that they can try in non threatening situations, starting with imagining trying the food or playing with and touching the food. All during this process we are also building safety nets to help the person cope with the anxiety that trying new foods might bring up, as well as equipping their parents to know how to handle the distress.

If you are someone struggling with ARFID or someone who loves someone with ARFID I hope this post encourages you to be patient with yourself and your loved ones during this process and reach out for professional help. Know you are not alone. We encourage you to reach out to us today and we can provide you with support along this tough road.


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