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Recovering From Avoidant/Restrictive Food Intake Disorder

By: Hannah de Groot MEd.

Hi queens, kings and non-binary royalty! I hope you are all doing as well as you can at this time. I realize that current events have been challenging for many, so I hope you have been practicing self compassion (for help on this, check this out!) and supporting your loved ones. This week I would like to spend time discussing Avoidant/Restrictive Food Intake Disorder, abbreviated as ARFID. ARFID is an eating disorder categorized by intense restriction. Similar to anorexia, people with ARFID limit the amount and/or types of food they consume. However, unlike anorexia, people with ARFID do not experience distress about their appearance, body shape, or fatness. Instead, restrictions are often placed on foods with specific textures, smells, shapes or colors, to name a few.

People with ARFID are often unfairly labeled as “picky eaters”. Since ARFID is not widely known, researched, or well understood, I can understand where this comes from. However, this label feels stigmatizing and unkind. ARFID is deeper than just being difficult or stubborn. Unfortunately, doctors and researchers do not know the cause of ARFID at this time. Like most mental illnesses, causes may be complex and multifaceted. For some, ARFID develops in response to a traumatic experience with food, such as choking or vomiting. For others, it may come up as a result of extreme sensitivity to taste or texture. ARFID is ultimately an anxiety disorder, and often occurs with other mental health diagnoses.

Symptoms of ARFID often look similar to those of anorexia. People with ARFID sometimes face severe weight loss, abnormal menstrual periods, alarming vital signs such as low heart rate, and low iron or thyroid levels. Also similar to anorexia, people with ARFID might struggle to eat in front of others. However, differing from anorexia, people with ARFID often have a lack of interest in food, and experience fears while eating.

Seeking treatment for ARFID is brave! Facing fears of any kind can be extremely challenging but super rewarding in the long term. Like most eating disorder treatment, treatment teams often consist of a therapist to manage the emotions from challenging fears, a dietitian to meet personalized nutritional needs, a psychiatrist for mental health medication, and a primary care physician for peripheral health concerns. Speech pathologists are also helpful additions to help with aversions to swallowing. A comprehensive team can help to be sure that clients are meeting their food intake goals, while also avoiding the development of health complications such as developmental delays, gastrointestinal issues and nutritional deficiencies.

At Recovered and Restored, we like to incorporate skills from multiple approaches in eating disorder treatment. When treating ARFID, exposure therapy and dialectical behavior therapy are a helpful combination. Exposure therapy is helpful for treating mental illnesses associated with high levels of anxiety. In ARFID treatment, a therapist will work closely with a client to compose a list of foods, and arrange them in a hierarchy of least-anxiety-provoking to most-anxiety-provoking. Next, the pair will use the fear hierarchy to expose the client to fear foods in a systematic way. Clients will typically start with foods that provoke the least amount of anxiety, and move on to foods higher up as they learn to tolerate the anxiety that comes up. Exposure therapy is considered the most effective form of treatment for ARFID.

Dialectical behavior therapy (DBT) can also be very effective for treating ARFID. DBT is comprised of four main pillars - mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. When treating ARFID, mindfulness and distress tolerance skills are utilized to manage anxiety and other challenging emotions that come up when facing fear foods. Emotional regulation techniques can be used to understand underlying reasons for restriction and avoidance. After becoming more comfortable with trying foods, interpersonal effectiveness skills can be used to empower clients to enjoy food in front of others.

When trying fear foods, challenging emotions are sure to come up. Immediate reactions to fear foods might be avoidance, anger, discomfort or frustration. While pushing these emotions away is a natural immediate reaction, learning to tolerate them is what sparks growth. Sitting with uncomfortable emotions is essential to the recovery process. That is where distress tolerance comes in! One helpful distress tolerance skill is called Half Smile. Half Smile was introduced by Marsha Linehan, the founder of DBT. Linehan said that experimental research shows that facial expressions can communicate mood to the brain. Half Smiling during times of distress can alter the brain’s perception of mood, thus easing the burdens of challenging emotions. To practice Half Smile, start by taking a deep breath, and relaxing your face from your forehead to your chin. Release any tension being held in your face. Next, turn the corners of your mouth upwards into half of a smile. Unless the smile feels genuine, feel free to stop when you notice tension forming in the corners of your mouth. The small smile signals to neurotransmitters in your brain that you are feeling happy, and will thus ease the intensity of your emotions.

Living with ARFID is hard, and so is knowing that someone you love is struggling! There are many ways that you can support a loved one who is living with ARFID. Most importantly, seek professional help. Treating ARFID can be challenging and emotionally taxing. For best results, find a treatment team who understands the unique needs of the client and can support their goals. When your loved one begins trying exposures, encourage them without judgment. Facing fears is scary, and everyone grows at their own pace. Encourage your loved one to continue trying, even when fears become overwhelming. Watching a loved one struggle can provoke a lot of emotional distress. If you are feeling overwhelmed by your loved one’s mental illness or need additional support, don’t hesitate to ask for help! Asking for help, no matter the circumstance, is a brave and honorable thing to do.

If you or someone you know is living with ARFID, we would love to help! We are trained in DBT and exposure therapy, and would be honored to be part of your healing process.

We have immediate openings right now for eating disorder therapy in:

Delaware, New Jersey, Florida, and Pennsylvania.

And recovery coaching worldwide.

Click here to get started with therapy today! :

Recovered and Restored is an eating disorder therapy center founded by Gabrielle Morreale. We specialize in helping teens and young women heal from eating disorders such as anorexia, bulimia, orthorexia, and binge eating disorder and treat disordered eating, anxiety, depression, and PTSD. We provide eating disorder therapy in the towns of Horsham, Upper Gwynedd, Lower Gwynedd, North Wales, Lansdale, Hatfield, Blue Bell, Doylestown, and nearby towns with eating disorder therapy. Also providing virtual eating disorder therapy in New Jersey, Delaware, and Florida. Some towns served virtually but are not limited to Pittsburg, Lancaster, Harrisburg, Center City, Cherry Hill, Haddonfield, Mount Laurel, Cape May, Avalon, Brick, Dover, New Castle, Bethany Beach, Marydel, and Oceanview.


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