• Sarah

Phase 1- Theme: ARFID (Avoidant/Restrictive Food Intake Disorder)

Updated: May 5, 2019

Exploring the topic

At the beginning of my research I discovered that Selective Eating Disorder, is now better know as Avoidant/Restrictive Food Intake Disorder (ARFID) with the release of the American Physiatrics Association's Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM 5). I'll make sure I'm using the updated name from now on.

Defintion (Folder)-

BEAT Eating Disorders is the leading UK charity supporting those affected by eating disorders. They classify ARFID under "other feeding disorders" and define it as:" Avoidant/Restrictive Food Intake Disorder is an illness in which someone restricts their eating by eating smaller amounts of food, or avoiding certain foods or food groups". They explain that it differs from other restrictive food disorders with some key differences:

  • ARFID doesn’t affect the person’s beliefs about the size and shape of their body.

  • Someone with ARFID does not restrict their food intake for the specific purpose of losing weight.

  • ARFID doesn’t feature some of the other behaviour that can be associated with anorexia, bulimia, or OSFED, such as over-exercising.

Classification as a medical condition (Folder)-

In 2013, the worlds leading mental health manual, the DSM 5 was released which finally defined AFRID as a medical condition. It defined ARFID as "an apparent lack of interest in eating or food, avoidance based sensory characteristics of food and/or concern about aversive consequences of eating. The manual was praised by many in the field but also had large criticism for "an increasing tendency to medicalise patterns of behaviour and mood that are not considered to be particularly extreme." Which is the thought process within the NHS of the categorisation of ARFID. The NHS does not list ARFID as a eating disorder or does it as any kind of medical condition, despite it falling with their definition of an eating disorder, "An eating disorder is when you have an unhealthy attitude to food, which can take over your life and make you ill." This creates difficulty for patients to get diagnosis of the condition and adds to the general idea that its just picky eating. In contrast to this at Great Ormond Street Hospital, within their National Feeding and Eating Disorder Team who within the feeding team assess and treat avoidant eating disorder. This an anomaly within the NHS's attitude towards to the disorder, which causes a lot of patients to seek private alternatives.

NHS Eating Disorder definition

Along with hypnotherapy I found that globally, exposure therapy, cognitive behavioural therapy and dialectal behavioural therapy (mindfulness and distress tolerance skills) are being used to treat ARFID

Specialist- Felix Economakis (Folder)

Felix is the most prolific, experienced therapist for selective eating in the world. He notes that misdiagnosis of picky eating can be harmful for ARFID sufferers, which is in practice in NHS. He emphasises the differences between picky eating explaining that ARFID is an aversion or phobia, not preference and desire. He defines the limited range of food as "safe foods" which sufferers are able to process and feel calm doing so. There are variety of reasons for safe foods such as their sensory characteristics. He goes on explaining that sufferers may "be desperate to eat other foods bu their brain will make them incapable of eating the food". This see's him treat 500 patients evert year of ARFID with alternative, hypnotherapy.

Hypnotherapy changes the trail of thought when trying new foods. After one session hypnotherapy with Felix their is 90% success rate adult and adolescent patients, providing them a lifeline to explore food.

Visual references (Sketchbook 1 pp.50-51)

Finding visual references was also difficult for this topic, however it did see me explore related imagery that touched on deficiency, control, danger, social implications and the mind. I also looked at the types of food suffers eat, safe foods. These included common foods associated with the disorder such as bland foods i.e. bread, pasta, cheese. This led to a very beige colour palette which questions the health implications of the condition.

Visual references

Typical safe foods are bland and beige

Case study: Hannah Pound (Folder)

Hannah Pound, 16 at the time of the article, had refused to try new things since she was a toddler and had consistently eaten chicken nuggets since then. Her dinners consisted of chicken nuggets and chips which continued well through her teenage years. She explains that "the thought of eating it made me feel panicked and sick". Her parents thought that she would grow out of the condition. However, it got worse throughout her teenage years with her avoiding meals out and hid it from friends at school. It caused her embarrassment and caused her to be socially isolated. They went to numerous doctors who did not take her seriously, before turning to hypnotherapy. She came out of the session eating ham, olives and peppers and can finally eat a balanced meal. The article describe Hannah of being "obsessed with chicken nuggets" and referred to it as a "bizarre addiction", however it is quite the opposite with her having a limited range of safe foods.

Hannah Pound

Case study: Errin Godwin Whalley (Folder)

ARFID started for Erin when she was just a year old, following a severe allergic reaction which made her terrified to eat. Her only safe foods were sausages and pasta. She explains that people would have bad opinion of her parents and their parenting, with common expressions including, "give her to me for six weeks" and "oh they won't starve" assuming that it must have been her parents fault. Yet Felix Economakis explains that a child can develop ARFID independently of parenting. Erin refused food to the point where she needed tube feeding in order to survive. At age 11 she was the size of 6-year-old having stopped growing. She conquered her fear of food, by continuing with her safe foods and by exposing her to new food away from mealtime.

Errin Godwin Whalley

This has identified my interests and a created a presentation structure for me:

  • Definition of ARFID

  • Whether its considered a medical condition

  • Courses of treatment

  • Characteristics of the condition