From the Guidelines
Avoidant/Restrictive Food Intake Disorder (ARFID) should be managed with a multidisciplinary approach, including nutritional rehabilitation, psychological interventions, and sometimes medication, with cognitive-behavioral therapy adapted for ARFID (CBT-AR) as the first-line psychological treatment. ARFID presents as a persistent failure to meet nutritional needs, characterized by significant weight loss, nutritional deficiency, dependence on nutritional supplements, or marked interference with psychosocial functioning 1. Unlike anorexia nervosa, ARFID does not involve body image disturbance or fear of weight gain.
Key Components of Management
- Nutritional counseling to establish regular eating patterns and gradual food expansion
- Psychological interventions, such as CBT-AR, focusing on exposure to feared foods, cognitive restructuring, and skills development
- Family-based treatment may be beneficial, especially for younger patients
- Medications, such as SSRIs (e.g., fluoxetine 10-60mg daily or sertraline 25-200mg daily), may help with anxiety, while mirtazapine (15-45mg daily) may improve appetite and reduce anxiety 1
- Cyproheptadine (2-8mg three times daily) sometimes helps stimulate appetite in children
Importance of Early Intervention
Early intervention improves outcomes as ARFID can become chronic and lead to serious medical complications, including growth stunting, delayed puberty, and electrolyte abnormalities if left untreated 1. It is essential to screen patients with non-CIPO GINMD or DGBI for ARFID and Shape and Weight-motivated eating disorders (SWED) such as anorexia nervosa and bulimia 1. Parenteral nutrition should be avoided in both ARFID and SWED, other than in life-threatening malnutrition extremis as a temporary bridge to optimal eating disorder MDT management 1.
Multidisciplinary Approach
A multidisciplinary support team should be involved in the management of patients with severe or refractory functional dyspepsia, including those with ARFID 1. Early dietitian involvement is crucial to avoid an overly restrictive diet 1. The treatment approach should prioritize a comprehensive, culturally appropriate, and person-centered plan, incorporating medical, psychiatric, psychological, and nutritional expertise 1.
From the Research
Presentation of Avoidant/Restrictive Food Intake Disorder (ARFID)
- ARFID is a feeding and eating disorder characterized by avoidance or restriction of food due to fear, sensory sensitivities, and/or a lack of interest in food 2, 3, 4
- It can result in nutritional inadequacies, weight loss, and/or dependence on enteral feeds 3, 4
- Three clinical subtypes of ARFID have been described, including lack of interest in eating, avoidance of food intake, and sensory aversion 3
Management of ARFID
- There are currently no clear guidelines for the diagnosis and treatment of ARFID, but various therapeutic options have been suggested 2, 5
- A multimodal therapeutic approach incorporating elements of cognitive-behavioral therapy (CBT), family-based therapy (FBT), and pharmacological management may be effective in managing ARFID 3
- Other therapeutic options that have been used in young patients with ARFID include hospital-based re-feeding, tube feeding, and adjunctive pharmacotherapy 5
- The role of the dietitian in the management of a patient with ARFID is to monitor weight and height and nutritional status and analyze the foods that should be introduced into the food chain first 4
- Cognitive-behavioral treatment of ARFID, including a novel form of outpatient cognitive-behavioral therapy for ARFID (CBT-AR), is currently under study 5
- Psychological interventions for ARFID, including behavioral interventions, cognitive-behavioral therapy, and family therapy, have been delivered to support patients with ARFID, with common treatment components such as food exposure, psychoeducation, anxiety management, and family involvement 6
Treatment Components
- Food exposure and gradual introduction of new foods into the diet may be an effective component of ARFID treatment 3, 4
- Psychoeducation and anxiety management may also be important components of ARFID treatment, particularly in cases where anxiety or fear of food is a primary symptom 3, 6
- Family involvement and support may be crucial in the management of ARFID, particularly in cases where family dynamics or mealtime interactions contribute to the development or maintenance of the disorder 3, 6
- Pharmacological management, including the use of antidepressant medications or atypical antipsychotic agents, may be necessary in some cases of ARFID, particularly where co-occurring psychiatric conditions are present 2, 3