Avoidant/restrictive food intake disorder: Difference between revisions

Avoidant/restrictive food intake disorder
Avoidant/restrictive food intake disorder
Other names	Selective eating disorder (SED)
Specialty	Psychiatry

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Avoidant/restrictive food intake disorder (ARFID) is a type of eating disorder in which people eat only within an extremely narrow repertoire of foods.^[1] It is a serious mental health condition that causes the individual to restrict food intake by volume and/or variety.^[2] This avoidance may be based on appearance, smell, taste, texture (because of sensory sensitivity), brand, presentation, fear of adverse consequences, lack of interest in food, or a past negative experience with the food, to a point that may lead to nutritional deficiencies, failure to thrive, or other negative health outcomes.^[2]^[3]^[4] The fixation is not caused by a concern for body appearance or in an attempt to lose weight.^[5]

Signs and symptoms

People with ARFID have an inability to eat certain foods. "Safe" foods may be limited to certain food types and even specific brands. In some cases, individuals with the condition will exclude whole food groups, such as fruit or vegetables. Sometimes excluded foods can be refused based on color. Some may only like very hot or very cold foods, very crunchy or hard-to-chew foods, or very soft foods, or avoid sauces.

Most people with ARFID will still maintain a healthy or typical body weight. There are no specific outward appearances associated with ARFID.^[6] Sufferers can experience physical gastrointestinal reactions to adverse foods such as retching, vomiting or gagging. Some studies have identified symptoms of social avoidance due to their eating habits. Most people with ARFID would change their eating habits if they could.^[6]

Associated conditions

The determination of the cause of ARFID has been difficult due to the lack of diagnostic criteria and concrete definition. However, many have proposed other conditions that co-occur with ARFID.

There are different kinds of 'sub-categories' identified for ARFID:^[7]

Sensory-based avoidance, where the individual refuses food intake based on smell, texture, color, brand, presentation
A lack of interest in consuming the food, or tolerating it nearby
Food being associated with fear-evoking stimuli that have developed through a learned history
Anorexia and bulimia often occur in individuals suffering from ARFID.^[8]

Autism

Symptoms of ARFID are usually found with symptoms of other disorders or with neurodivergence. Some form of feeding disorder is found in 80% of children that also have a developmental disability.^[9] Children often exhibit symptoms of obsessive-compulsive disorder and autism. Although many people with ARFID have symptoms of these disorders, they usually do not qualify for a full diagnosis. Strict behavior patterns and difficulty adjusting to new things are common symptoms in patients that are on the autistic spectrum.^[6] A study done by Schreck at Pennsylvania State University compared the eating habits of children with autism spectrum disorder (ASD) and typically developing children. After analyzing their eating patterns, they suggested that the children with some degree of ASD have a higher degree of selective eating. These children were found to have similar patterns of selective eating and favored more energy dense foods such as nuts and whole grains. Eating a diet of energy dense foods could put these children at a greater risk for health problems such as obesity and other chronic diseases due to the high fat and low fiber content of energy dense foods. Due to the tie to ASD, children are less likely to outgrow their selective eating behaviors and most likely should meet with a clinician to address their eating issues.^[10]^[11]

Anxiety disorder

Specific food avoidances could be caused by food phobias that cause great anxiety when a person is presented with new or feared foods. Most eating disorders are related to a fear of gaining weight. Those who have ARFID do not have this fear, but the psychological symptoms and anxiety created are similar.^[6] Some people with ARFID have fears such as emetophobia (fear of vomiting) or a fear of choking.

Anorexia nervosa

Though the physical symptoms may be similar, anorexia nervosa differs from ARFID because in ARFID the lack of food intake is not related to body image or weight concerns. Additionally, in a study analyzing the similarities between patients with AN and patients with ARFID, those with ARFID were significantly younger (10.8 vs 14.1 yrs old) with an earlier onset of illness (6.2 vs 13.7 yrs old) and a longer evolution time (61.2 vs 8.4 months). Also, a greater proportion of the ARFID patients were male rather than female (60.6% vs 6.1%).^[12]

Prevalence

Unlike most eating disorders, there may be a higher rate of ARFID in young boys than there is in young girls.^[13]

As of 2022^[update] there had been no study on the prevalence of ARFID. Gillian Harris, a psychologist at the UK University of Birmingham, said that her experience suggested that about one in 500 children were affected.^[14]

Speculative causes

Though the causes of ARFID are not very well known and rather speculative, there are some potential ones cited by both medical professionals and researchers:^[15]^[16]^[17]^[18]^[19]^[20]

sensory sensitivity (sensitivity to tastes, textures and the appearance of foods)
selective eating and fear of new foods
fear of certain foods causing pain and discomfort
fear of vomiting and/or gagging caused by new or "unsafe" foods
low appetite or disinterest in food
gastrointestinal problems when eating "unsafe" foods
other unexplained fears surrounding "unsafe" foods and feeling poisoned
autism spectrum disorder and anxiety disorders

Diagnosis

Diagnosis is often based on a diagnostic checklist to test whether an individual is exhibiting certain behaviors and characteristics. Clinicians will look at the variety of foods an individual consumes, as well as the portion size of accepted foods. They will also question how long the avoidance or refusal of particular foods has lasted, and if there are any associated medical concerns, such as malnutrition.^[7]

Criteria

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) renamed "Feeding Disorder of Infancy or Early Childhood" to Avoidant/Restrictive Food Intake Disorder, and broadened the diagnostic criteria. Previously defined as a disorder exclusive to children and adolescents, the DSM-5 broadened the disorder to include adults who limit their eating and are affected by related physiological or psychological problems, but who do not fall under the definition of another eating disorder.

The DSM-5 defines the following diagnostic criteria:^[21]

Disturbance in eating or feeding, as evidenced by one or more of:
- Substantial weight loss (or, in children, absence of expected weight gain)
- Nutritional deficiency
- Dependence on a feeding tube or dietary supplements
- Significant psychosocial interference
Disturbance not due to unavailability of food, or to observation of cultural norms
Disturbance not due to anorexia nervosa or bulimia nervosa, and no evidence of disturbance in experience of body shape or weight
Disturbance not better explained by another medical condition or mental disorder, or when occurring concurrently with another condition, the disturbance exceeds what is normally caused by that condition

In previous years, the DSM was not inclusive in recognizing all of the challenges associated with feeding and eating disorders in 3 main domains:^[7]

Eating Disorders Not Otherwise Specified (EDNOS) was an all-inclusive, placeholder group for all individuals that presented challenges with feeding
The category of Feeding Disorder of Infancy/ Early Childhood was noted to be too broad, limiting specification when treating these behaviors
There are children and youth who present feeding challenges but do not fit within any existing categories to date

The prevalence of ARFID compared to picky eating

Children are often picky eaters, but this does not necessarily mean they meet the criteria for an ARFID diagnosis. ARFID is a rare condition, and though it shares many symptoms with regular picky eating, it is not diagnosed nearly as much. Picky eating, which can exhibit symptoms similar to those of ARFID, can be observed in 13%-22% of children from ages 3-11,^[22] whereas the prevalence of ARFID has "ranged from 5% to 14% among pediatric inpatient ED [eating disorder] programs and as high as 22.5% in a pediatric ED day treatment program".^[23] There is potential for misdiagnosis given the similarity with picky eating and the prevalence of that condition, especially in cases where ARFID does not affect the person with the condition severely.

Differences from picky eating

There are some key differences from picky eating that set ARFID apart.

First, ARFID is not a condition that is created by one's conscience, it is a subconscious condition that prohibits the person suffering from the condition from eating certain foods to the point where they will refuse to eat anything and starve themselves if not given options of what their sub-conscience has deemed "safe foods".^[24] What also makes ARFID special is that due to its subconscious nature, it cannot be combatted through bribery (e.g. offering a child something as a reward for eating an "unsafe" food), reason nor shouting and threatening.^[25] It is also believed that using those methods can lead to the condition or the anxieties associated with it worsening.^[18] When it comes to ARFID, eating or not eating certain foods is not a preference, but rather a necessity.

Second, ARFID can run deeper than just eating alone. It is documented that people with ARFID can have a particular anxiety towards trying new foods, but in some cases, the sufferer can also be scared of new experiences as a whole or novel situations where food is present.^[26] This, however, is a more rare complication and is not very widely documented. Given that some data suggests that ARFID may be associated with other psychological disorders, like anxiety disorders and autism spectrum disorders,^[27] these effects could be derived from those links.

Third, ARFID used to be associated with Anorexia Nervosa and Bulimia Nervosa due to its tendency to create issues with weight and nutrition,^[28]^[27] especially for children. While it is now known that cases of ARFID where there is more extreme weight loss or gain occur rather rarely, malnutrition among sufferers is common,^[29] and any of these symptoms can set ARFID apart from the aforementioned conditions as well as picky eating.

Difficulties surrounding diagnosis

As mentioned before, picky eating and ARFID share a lot of symptoms, and the symptoms covered in the DSM-5 are broad, which can be both a detriment and an advantage: Dr Stephanie G. Harshman, of the neuroendocrine unit at Massachusetts General Hospital has been quoted saying: “The broad definitions used among DSM-5 criteria for [avoidant/restrictive food intake disorder (ARFID)] provide substantial flexibility in a clinical setting,”^[30]. It can be detrimental, as a broad scope can lead to false positive diagnoses of ARFID, though as an advantage it is better than the DSM-IV description which landed people suffering from ARFID in the "EDNOS" (eating disorder not otherwise specified) category and made it more difficult for people suffering from the condition to reach potential treatment.^[27]

A discriminating quality that was once considered to classify ARFID differently from picky eating was weight loss or gain, but given that this is not a universal feature of ARFID,^[29] that is no longer the case. Additionally, if weight loss or change (or more extreme malnutrition) are present, this can point towards the patient having Anorexia Nervosa or Bulimia Nervosa, and can also lead to a false negative diagnosis.^[31]

Due to the relative novelty of the DSM-5 and it's new inclusion of ARFID, not everyone is familiar with the condition, making it more difficult to detect and diagnose. There is evidence that medical professionals who had diagnosed ARFID in a patient prior to meeting another patient with ARFID were more likely to detect and diagnose it than those who had not.^[32]

Treatment

For adults

With time the symptoms of ARFID can lessen and can eventually disappear without treatment. However, in some cases treatment will be needed as the symptoms persist into adulthood. The most common type of treatment for ARFID is some form of cognitive-behavioral therapy. Working with a clinician can help to change behaviors more quickly than symptoms may typically disappear without treatment.^[6]

There are support groups for adults with ARFID.^[33]

For children

Children can benefit from a four stage in-home treatment program based on the principles of systematic desensitization. The four stages of the treatment are record, reward, relax and review.^[6]

In the 'record stage', children are encouraged to keep a log of their typical eating behaviors without attempting to change their habits as well as their cognitive feelings.
The 'reward stage' involves systematic desensitization. Children create a list of foods that they might like to try eating some day. These foods may not be drastically different from their normal diet, but perhaps a familiar food prepared in a different way. Because the goal is for the children to try new foods, children are rewarded when they sample new foods.
The 'relaxation stage' is most important for those children that suffer severe anxiety when presented with unfavorable foods. Children learn to relax to reduce the anxiety that they feel. Children work through a list of anxiety-producing stimuli and can create a story line with relaxing imagery and scenarios. Often these stories can also include the introduction of new foods with the help of a real person or fantasy person. Children then listen to this story before eating new foods as a way to imagine themselves participating in an expanded variety of foods while relaxed.^[6]
The final stage, 'review', is important to keep track of the child's progress, both in one-on-one sessions with the child, as well as with the parent in order to get a clear picture of how the child is progressing and if the relaxation techniques are working.

For both adults and children

A suitable treatment for older children and adults alike is CBT-AR (Cognitive Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder), in which around 90% of participants have found high levels of satisfaction with the programme.^[34] While the rate of remission to this type of programme is said to be around 40%,^[34] it has seen higher efficacy among children and young adults compared to adults, and greater family involvement has also been seen to help.^[34]

The treatment is broken up into 4 stages and aimed to help "reduce nutritional compromise and increase opportunities for exposure to novel foods to reduce negative feelings and predictions about eating".^[35] In a simplified format, the stages of this treatment are:^[35]

Psychoeducation regarding ARFID and CBT-AR, setting up a regular pattern of eating and self-monitoring.
Psychoeducation about nutrition deficiencies, selecting new foods to help aid the loss of those deficiencies.
Figuring out the root cause(s) of the patient's ARFID (mentioned above in the Speculative causes section), bringing in 5 new foods to examine, describe their features and try tasting them throughout the week, lastly exposure to the foods in the sessions.
Evaluating progress and compiling a relapse prevention plan.

This is set to take place over 20-30 sessions ranging from 6 months to a year.

More can be learned about the treatment in the book "Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults" by Jennifer J. Thomas and Kamryn T. Eddy.

References

^ American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 334–334. ISBN 978-0-89042-555-8.
^ ^a ^b Thomas JJ, Becker KR, Kuhnle MC, Jo JH, Harshman SG, Wons OB, et al. (October 2020). "Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for children and adolescents". The International Journal of Eating Disorders. 53 (10): 1636–1646. doi:10.1002/eat.23355. PMC 7719612. PMID 32776570.
^ Schöffel H, Hiemisch A, Kiess W, Hilbert A, Schmidt R (January 2021). "Characteristics of avoidant/restrictive food intake disorder in a general paediatric inpatient sample". European Eating Disorders Review. 29 (1): 60–73. doi:10.1002/erv.2799. PMID 33089950. S2CID 224820574. Free to read, but not save.
^ Fisher MM, Rosen DS, Ornstein RM, Mammel KA, Katzman DK, Rome ES, et al. (July 2014). "Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a "new disorder" in DSM-5". The Journal of Adolescent Health. 55 (1): 49–52. doi:10.1016/j.jadohealth.2013.11.013. PMID 24506978.
^ Cañas L, Palma C, Molano AM, Domene L, Carulla-Roig M, Cecilia-Costa R, et al. (March 2021). "Avoidant/restrictive food intake disorder: It's the same thing as anorexia nervosa". European Eating Disorders Review. 29 (2): 245–256. doi:10.1002/erv.2815. PMID 33306214. S2CID 228101446.
^ ^a ^b ^c ^d ^e ^f ^g Nicholls D, Christie D, Randall L, and Lask B (2001). "Selective Eating: Symptom, Disorder or Normal Variant". Clinical Child Psychology and Psychiatry. 6 (2): 257–70. doi:10.1177/1359104501006002007. S2CID 143755950.
^ ^a ^b ^c Bryant-Waugh R (July 2013). "Avoidant restrictive food intake disorder: an illustrative case example". The International Journal of Eating Disorders. 46 (5): 420–3. doi:10.1002/eat.22093. PMID 23658083.
^ "Avoidant/Restrictive Food Intake Disorder (ARFID)". Archived from the original on 2017-01-10. Retrieved 2019-04-25.
^ Chatoor I, Hamburger E, Fullard R, Rivera Y (1994). "A survey of picky eating and pica behaviors in toddlers". Scientific Proceedings of the Annual Meeting of American Academy of Child and Adolescent Psychiatry. 10: 50.
^ Schreck KA, Williams K, Smith AF. A comparison of eating behaviors between children with and without Autism" Journal of Autism and Developmental Disabilities 2004; 34: 433-438.
^ Evans, Erin Whitney (2013). "Selective Eating and Autism Spectrum Disorder". Behavioral Health Nutrition. Academy of Nutrition and Dietetics. Archived from the original on 2013-07-19.
^ Cañas L, Palma C, Molano AM, Domene L, Carulla-Roig M, Cecilia-Costa R, et al. (March 2021). "Avoidant/restrictive food intake disorder: Psychopathological similarities and differences in comparison to anorexia nervosa and the general population". European Eating Disorders Review. 29 (2): 245–256. doi:10.1002/erv.2815. PMID 33306214. S2CID 228101446.
^ Nicely, Terri A; Lane-Loney, Susan; Masciulli, Emily; Hollenbeak, Christopher S; Ornstein, Rollyn M (2 August 2014). "Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders". Journal of Eating Disorders. 2 (1). doi:10.1186/s40337-014-0021-3. ISSN 2050-2974. Studies have shown a higher prevalence of boys with selective eating, as well as a high degree of co-morbid anxiety
^ "ARFID: 'My son's not a picky eater; he's scared of food'". BBC News. 1 January 2022.
^ "WHAT IS ARFID?". ARFID Awareness UK. ARFID Awareness UK. Retrieved 27 January 2022.
^ He, Jinbo; Zickgraf, Hana F.; Ellis, Jordan M.; Lin, Zhicheng; Fan, Xitao (March 2021). "Chinese Version of the Nine Item ARFID Screen: Psychometric Properties and Cross-Cultural Measurement Invariance". Assessment. 28 (2): 537–550. doi:10.1177/1073191120936359. ISSN 1073-1911.
^ Thomas, Jennifer J.; Lawson, Elizabeth A.; Micali, Nadia; Misra, Madhusmita; Deckersbach, Thilo; Eddy, Kamryn T. (August 2017). "Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment". Current Psychiatry Reports. 19 (8): 54. doi:10.1007/s11920-017-0795-5. ISSN 1523-3812. PMC 6281436. PMID 28714048.{{cite journal}}: CS1 maint: PMC format (link)
^ ^a ^b Campbell, Leah. "ARFID: The Eating Disorder Masquerading As Picky Eating". Forbes. Retrieved 27 January 2022.
^ Murray, Helen Burton; Kuo, Braden; Eddy, Kamryn T.; Breithaupt, Lauren; Becker, Kendra R.; Dreier, Melissa J.; Thomas, Jennifer J.; Staller, Kyle (June 2021). "Disorders of gut–brain interaction common among outpatients with eating disorders including avoidant/restrictive food intake disorder". International Journal of Eating Disorders. 54 (6): 952–958. doi:10.1002/eat.23414. ISSN 0276-3478.
^ "What Is ARFID?". WebMD. Retrieved 27 January 2022.
^ American Psychiatric Association. (2013). Highlights of Changes from DSM-IV-TR to DSM-5. Retrieved May 14, 2014, from "Archived copy" (PDF). Archived from the original (PDF) on 2013-10-19. Retrieved 2013-10-23.{{cite web}}: CS1 maint: archived copy as title (link)
^ Mascola, Anthony J.; Bryson, Susan W.; Agras, W. Stewart (2010). "Picky eating during childhood: A longitudinal study to age 11-years". Eating Behaviors. 11 (4): 253–257. doi:10.1016/j.eatbeh.2010.05.006. Retrieved 27 January 2022.
^ Norris, Mark L.; Spettigue, Wendy J.; Katzman, Debra K. (2016). "Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth". Neuropsychiatric Disease and Treatment. 12: 213–218. doi:10.2147/NDT.S82538. Retrieved 27 January 2022.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ Campbell, Leah (11 June 2018). "ARFID: Eating Disorder Mistaken for Picky Eating". Healthline. Retrieved 27 January 2022.
^ "What is Arfid & what to do about it". National Centre for Eating Disorders. National Centre for Eating Disorders. 3 September 2019. Retrieved 27 January 2022.
^ "ARFID". Beat Eating Disorders. Beat Eating Disorders. Retrieved 28 January 2022.
^ ^a ^b ^c Fisher, Martin M.; Rosen, David S.; Ornstein, Rollyn M.; Mammel, Kathleen A.; Katzman, Debra K.; Rome, Ellen S.; Callahan, S. Todd; Malizio, Joan; Kearney, Sarah; Walsh, B. Timothy (July 2014). "Characteristics of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: A "New Disorder" in DSM-5". Journal of Adolescent Health. 55 (1): 49–52. doi:10.1016/j.jadohealth.2013.11.013.
^ Becker, Kendra R.; Keshishian, Ani C.; Liebman, Rachel E.; Coniglio, Kathryn A.; Wang, Shirley B.; Franko, Debra L.; Eddy, Kamryn T.; Thomas, Jennifer J. (March 2019). "Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa". International Journal of Eating Disorders. 52 (3): 230–238. doi:10.1002/eat.22988. ISSN 0276-3478. PMC 7191972. PMID 30578644.{{cite journal}}: CS1 maint: PMC format (link)
^ ^a ^b Bryant-Waugh, Rachel (July 2013). "Avoidant restrictive food intake disorder: An illustrative case example". International Journal of Eating Disorders. 46 (5): 420–423. doi:10.1002/eat.22093.
^ "Clearer guidelines needed for avoidant/restrictive food intake disorder diagnosis". www.healio.com. 20 September 2021. Retrieved 2022-01-28.
^ Becker, Kendra R.; Keshishian, Ani C.; Liebman, Rachel E.; Coniglio, Kathryn A.; Wang, Shirley B.; Franko, Debra L.; Eddy, Kamryn T.; Thomas, Jennifer J. (March 2019). "Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa". International Journal of Eating Disorders. 52 (3): 230–238. doi:10.1002/eat.22988. ISSN 0276-3478. PMC 7191972. PMID 30578644.{{cite journal}}: CS1 maint: PMC format (link)
^ Coelho, Jennifer S.; Norris, Mark L.; Tsai, Stephen C. E.; Wu, Yuwei J.; Lam, Pei‐Yoong (April 2021). "Health professionals' familiarity and experience with providing clinical care for pediatric avoidant/restrictive food intake disorder". International Journal of Eating Disorders. 54 (4): 587–594. doi:10.1002/eat.23438. ISSN 0276-3478.
^ Wang, S. (2010, July 5). No Age Limit on Picky Eating. Wall Street Journal. Retrieved April 2, 2013, from https://www.wsj.com/articles/SB10001424052748704699604575343130457388718
^ ^a ^b ^c Thomas, Jennifer J.; Becker, Kendra R.; Breithaupt, Lauren; Murray, Helen Burton; Jo, Jenny H.; Kuhnle, Megan C.; Dreier, Melissa J.; Harshman, Stephanie; Kahn, Danielle L.; Hauser, Kristine; Slattery, Meghan (March 2021). "Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder". Journal of Behavioral and Cognitive Therapy. 31 (1): 47–55. doi:10.1016/j.jbct.2020.10.004. PMC 8375627. PMID 34423319.{{cite journal}}: CS1 maint: PMC format (link)
^ ^a ^b Thomas, Jennifer J.; Wons, Olivia B.; Eddy, Kamryn T. (November 2018). "Cognitive–behavioral treatment of avoidant/restrictive food intake disorder". Current Opinion in Psychiatry. 31 (6): 425–430. doi:10.1097/YCO.0000000000000454. ISSN 0951-7367. PMC 6235623. PMID 30102641.{{cite journal}}: CS1 maint: PMC format (link)

External links

[DSM5-1] American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 334–334. ISBN 978-0-89042-555-8.

[:2-2] Thomas JJ, Becker KR, Kuhnle MC, Jo JH, Harshman SG, Wons OB, et al. (October 2020). "Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for children and adolescents". The International Journal of Eating Disorders. 53 (10): 1636–1646. doi:10.1002/eat.23355. PMC 7719612. PMID 32776570.

[3] Schöffel H, Hiemisch A, Kiess W, Hilbert A, Schmidt R (January 2021). "Characteristics of avoidant/restrictive food intake disorder in a general paediatric inpatient sample". European Eating Disorders Review. 29 (1): 60–73. doi:10.1002/erv.2799. PMID 33089950. S2CID 224820574. Free to read, but not save.

[4] Fisher MM, Rosen DS, Ornstein RM, Mammel KA, Katzman DK, Rome ES, et al. (July 2014). "Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a "new disorder" in DSM-5". The Journal of Adolescent Health. 55 (1): 49–52. doi:10.1016/j.jadohealth.2013.11.013. PMID 24506978.

[5] Cañas L, Palma C, Molano AM, Domene L, Carulla-Roig M, Cecilia-Costa R, et al. (March 2021). "Avoidant/restrictive food intake disorder: It's the same thing as anorexia nervosa". European Eating Disorders Review. 29 (2): 245–256. doi:10.1002/erv.2815. PMID 33306214. S2CID 228101446.

[nicholls-6] ^ ^a ^b ^c ^d ^e ^f ^g Nicholls D, Christie D, Randall L, and Lask B (2001). "Selective Eating: Symptom, Disorder or Normal Variant". Clinical Child Psychology and Psychiatry. 6 (2): 257–70. doi:10.1177/1359104501006002007. S2CID 143755950.

[:0-7] Bryant-Waugh R (July 2013). "Avoidant restrictive food intake disorder: an illustrative case example". The International Journal of Eating Disorders. 46 (5): 420–3. doi:10.1002/eat.22093. PMID 23658083.

[8] "Avoidant/Restrictive Food Intake Disorder (ARFID)". Archived from the original on 2017-01-10. Retrieved 2019-04-25.

[9] Chatoor I, Hamburger E, Fullard R, Rivera Y (1994). "A survey of picky eating and pica behaviors in toddlers". Scientific Proceedings of the Annual Meeting of American Academy of Child and Adolescent Psychiatry. 10: 50.

[10] Schreck KA, Williams K, Smith AF. A comparison of eating behaviors between children with and without Autism" Journal of Autism and Developmental Disabilities 2004; 34: 433-438.

[11] Evans, Erin Whitney (2013). "Selective Eating and Autism Spectrum Disorder". Behavioral Health Nutrition. Academy of Nutrition and Dietetics. Archived from the original on 2013-07-19.

[12] Cañas L, Palma C, Molano AM, Domene L, Carulla-Roig M, Cecilia-Costa R, et al. (March 2021). "Avoidant/restrictive food intake disorder: Psychopathological similarities and differences in comparison to anorexia nervosa and the general population". European Eating Disorders Review. 29 (2): 245–256. doi:10.1002/erv.2815. PMID 33306214. S2CID 228101446.

[13] Nicely, Terri A; Lane-Loney, Susan; Masciulli, Emily; Hollenbeak, Christopher S; Ornstein, Rollyn M (2 August 2014). "Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders". Journal of Eating Disorders. 2 (1). doi:10.1186/s40337-014-0021-3. ISSN 2050-2974. Studies have shown a higher prevalence of boys with selective eating, as well as a high degree of co-morbid anxiety

[14] "ARFID: 'My son's not a picky eater; he's scared of food'". BBC News. 1 January 2022.

[15] "WHAT IS ARFID?". ARFID Awareness UK. ARFID Awareness UK. Retrieved 27 January 2022.

[16] He, Jinbo; Zickgraf, Hana F.; Ellis, Jordan M.; Lin, Zhicheng; Fan, Xitao (March 2021). "Chinese Version of the Nine Item ARFID Screen: Psychometric Properties and Cross-Cultural Measurement Invariance". Assessment. 28 (2): 537–550. doi:10.1177/1073191120936359. ISSN 1073-1911.

[17] Thomas, Jennifer J.; Lawson, Elizabeth A.; Micali, Nadia; Misra, Madhusmita; Deckersbach, Thilo; Eddy, Kamryn T. (August 2017). "Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment". Current Psychiatry Reports. 19 (8): 54. doi:10.1007/s11920-017-0795-5. ISSN 1523-3812. PMC 6281436. PMID 28714048.{{cite journal}}: CS1 maint: PMC format (link)

[:02-18] Campbell, Leah. "ARFID: The Eating Disorder Masquerading As Picky Eating". Forbes. Retrieved 27 January 2022.

[19] Murray, Helen Burton; Kuo, Braden; Eddy, Kamryn T.; Breithaupt, Lauren; Becker, Kendra R.; Dreier, Melissa J.; Thomas, Jennifer J.; Staller, Kyle (June 2021). "Disorders of gut–brain interaction common among outpatients with eating disorders including avoidant/restrictive food intake disorder". International Journal of Eating Disorders. 54 (6): 952–958. doi:10.1002/eat.23414. ISSN 0276-3478.

[20] "What Is ARFID?". WebMD. Retrieved 27 January 2022.

[21] American Psychiatric Association. (2013). Highlights of Changes from DSM-IV-TR to DSM-5. Retrieved May 14, 2014, from "Archived copy" (PDF). Archived from the original (PDF) on 2013-10-19. Retrieved 2013-10-23.{{cite web}}: CS1 maint: archived copy as title (link)

[22] Mascola, Anthony J.; Bryson, Susan W.; Agras, W. Stewart (2010). "Picky eating during childhood: A longitudinal study to age 11-years". Eating Behaviors. 11 (4): 253–257. doi:10.1016/j.eatbeh.2010.05.006. Retrieved 27 January 2022.

[23] Norris, Mark L.; Spettigue, Wendy J.; Katzman, Debra K. (2016). "Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth". Neuropsychiatric Disease and Treatment. 12: 213–218. doi:10.2147/NDT.S82538. Retrieved 27 January 2022.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[24] Campbell, Leah (11 June 2018). "ARFID: Eating Disorder Mistaken for Picky Eating". Healthline. Retrieved 27 January 2022.

[25] "What is Arfid & what to do about it". National Centre for Eating Disorders. National Centre for Eating Disorders. 3 September 2019. Retrieved 27 January 2022.

[26] "ARFID". Beat Eating Disorders. Beat Eating Disorders. Retrieved 28 January 2022.

[:1-27] Fisher, Martin M.; Rosen, David S.; Ornstein, Rollyn M.; Mammel, Kathleen A.; Katzman, Debra K.; Rome, Ellen S.; Callahan, S. Todd; Malizio, Joan; Kearney, Sarah; Walsh, B. Timothy (July 2014). "Characteristics of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: A "New Disorder" in DSM-5". Journal of Adolescent Health. 55 (1): 49–52. doi:10.1016/j.jadohealth.2013.11.013.

[28] Becker, Kendra R.; Keshishian, Ani C.; Liebman, Rachel E.; Coniglio, Kathryn A.; Wang, Shirley B.; Franko, Debra L.; Eddy, Kamryn T.; Thomas, Jennifer J. (March 2019). "Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa". International Journal of Eating Disorders. 52 (3): 230–238. doi:10.1002/eat.22988. ISSN 0276-3478. PMC 7191972. PMID 30578644.{{cite journal}}: CS1 maint: PMC format (link)

[:22-29] Bryant-Waugh, Rachel (July 2013). "Avoidant restrictive food intake disorder: An illustrative case example". International Journal of Eating Disorders. 46 (5): 420–423. doi:10.1002/eat.22093.

[30] "Clearer guidelines needed for avoidant/restrictive food intake disorder diagnosis". www.healio.com. 20 September 2021. Retrieved 2022-01-28.

[31] Becker, Kendra R.; Keshishian, Ani C.; Liebman, Rachel E.; Coniglio, Kathryn A.; Wang, Shirley B.; Franko, Debra L.; Eddy, Kamryn T.; Thomas, Jennifer J. (March 2019). "Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa". International Journal of Eating Disorders. 52 (3): 230–238. doi:10.1002/eat.22988. ISSN 0276-3478. PMC 7191972. PMID 30578644.{{cite journal}}: CS1 maint: PMC format (link)

[32] Coelho, Jennifer S.; Norris, Mark L.; Tsai, Stephen C. E.; Wu, Yuwei J.; Lam, Pei‐Yoong (April 2021). "Health professionals' familiarity and experience with providing clinical care for pediatric avoidant/restrictive food intake disorder". International Journal of Eating Disorders. 54 (4): 587–594. doi:10.1002/eat.23438. ISSN 0276-3478.

[wang-33] Wang, S. (2010, July 5). No Age Limit on Picky Eating. Wall Street Journal. Retrieved April 2, 2013, from https://www.wsj.com/articles/SB10001424052748704699604575343130457388718

[:3-34] Thomas, Jennifer J.; Becker, Kendra R.; Breithaupt, Lauren; Murray, Helen Burton; Jo, Jenny H.; Kuhnle, Megan C.; Dreier, Melissa J.; Harshman, Stephanie; Kahn, Danielle L.; Hauser, Kristine; Slattery, Meghan (March 2021). "Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder". Journal of Behavioral and Cognitive Therapy. 31 (1): 47–55. doi:10.1016/j.jbct.2020.10.004. PMC 8375627. PMID 34423319.{{cite journal}}: CS1 maint: PMC format (link)

[:4-35] Thomas, Jennifer J.; Wons, Olivia B.; Eddy, Kamryn T. (November 2018). "Cognitive–behavioral treatment of avoidant/restrictive food intake disorder". Current Opinion in Psychiatry. 31 (6): 425–430. doi:10.1097/YCO.0000000000000454. ISSN 0951-7367. PMC 6235623. PMID 30102641.{{cite journal}}: CS1 maint: PMC format (link)

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

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[34]

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@@ Line 54: / Line 54: @@
 {{As of|2022}} there had been no study on the prevalence of ARFID. Gillian Harris, a psychologist at the UK [[University of Birmingham]], said that her experience suggested that about one in 500 children were affected.<ref>{{Cite news |title=ARFID: 'My son's not a picky eater; he's scared of food' |author= |work=BBC News |date=1 January 2022 |url= https://www.bbc.co.uk/news/uk-england-leicestershire-59688396 }}</ref>
+== Speculative causes ==
+Though the causes of ARFID are not very well known and rather speculative, there are some potential ones cited by both medical professionals and researchers:<ref>{{cite web|title=WHAT IS ARFID?|url=https://www.arfidawarenessuk.org/copy-of-what-is-arfid-1|access-date=27 January 2022|website=ARFID Awareness UK|publisher=ARFID Awareness UK|language=en}}</ref><ref>{{Cite journal|last=He|first=Jinbo|last2=Zickgraf|first2=Hana F.|last3=Ellis|first3=Jordan M.|last4=Lin|first4=Zhicheng|last5=Fan|first5=Xitao|date=March 2021|title=Chinese Version of the Nine Item ARFID Screen: Psychometric Properties and Cross-Cultural Measurement Invariance|url=http://journals.sagepub.com/doi/10.1177/1073191120936359|journal=Assessment|language=en|volume=28|issue=2|pages=537–550|doi=10.1177/1073191120936359|issn=1073-1911}}</ref><ref>{{Cite journal|last=Thomas|first=Jennifer J.|last2=Lawson|first2=Elizabeth A.|last3=Micali|first3=Nadia|last4=Misra|first4=Madhusmita|last5=Deckersbach|first5=Thilo|last6=Eddy|first6=Kamryn T.|date=August 2017|title=Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment|url=http://link.springer.com/10.1007/s11920-017-0795-5|journal=Current Psychiatry Reports|language=en|volume=19|issue=8|pages=54|doi=10.1007/s11920-017-0795-5|issn=1523-3812|pmc=PMC6281436|pmid=28714048}}</ref><ref name=":02">{{cite web|last1=Campbell|first1=Leah|title=ARFID: The Eating Disorder Masquerading As Picky Eating|url=https://www.forbes.com/sites/leahcampbell/2020/12/14/arfid-the-eating-disorder-masquerading-as-picky-eating/|access-date=27 January 2022|website=Forbes|language=en}}</ref><ref>{{Cite journal|last=Murray|first=Helen Burton|last2=Kuo|first2=Braden|last3=Eddy|first3=Kamryn T.|last4=Breithaupt|first4=Lauren|last5=Becker|first5=Kendra R.|last6=Dreier|first6=Melissa J.|last7=Thomas|first7=Jennifer J.|last8=Staller|first8=Kyle|date=June 2021|title=Disorders of gut–brain interaction common among outpatients with eating disorders including avoidant/restrictive food intake disorder|url=https://onlinelibrary.wiley.com/doi/10.1002/eat.23414|journal=International Journal of Eating Disorders|language=en|volume=54|issue=6|pages=952–958|doi=10.1002/eat.23414|issn=0276-3478}}</ref><ref>{{cite web|title=What Is ARFID?|url=https://www.webmd.com/mental-health/eating-disorders/what-is-arfid|access-date=27 January 2022|website=WebMD|language=en}}</ref>
+* sensory sensitivity (sensitivity to tastes, textures and the appearance of foods)
+* selective eating and fear of new foods
+* fear of certain foods causing pain and discomfort
+* fear of vomiting and/or gagging caused by new or "unsafe" foods
+* low appetite or disinterest in food
+* gastrointestinal problems when eating "unsafe" foods
+* other unexplained fears surrounding "unsafe" foods and feeling poisoned
+* [[Autism spectrum|autism spectrum disorder]] and [[Anxiety disorder|anxiety disorders]]
 == Diagnosis ==
@@ Line 75: / Line 87: @@
 * There are children and youth who present feeding challenges but do not fit within any existing categories to date
+=== The prevalence of ARFID compared to picky eating ===
-Children are often picky eaters, but this does not necessarily mean they meet the criteria for an ARFID diagnosis.
+Children are often picky eaters, but this does not necessarily mean they meet the criteria for an ARFID diagnosis. ARFID is a rare condition, and though it shares many symptoms with regular picky eating, it is not diagnosed nearly as much. Picky eating, which can exhibit symptoms similar to those of ARFID, can be observed in 13%-22% of children from ages 3-11,<ref>{{cite journal|last1=Mascola|first1=Anthony J.|last2=Bryson|first2=Susan W.|last3=Agras|first3=W. Stewart|date=2010|title=Picky eating during childhood: A longitudinal study to age 11-years|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943861/|journal=Eating Behaviors|volume=11|issue=4|pages=253-257|doi=10.1016/j.eatbeh.2010.05.006|access-date=27 January 2022}}</ref> whereas the prevalence of ARFID has "ranged from 5% to 14% among pediatric inpatient ED [<nowiki/>[[eating disorder]]] programs and as high as 22.5% in a pediatric ED day treatment program".<ref>{{cite journal|last1=Norris|first1=Mark L.|last2=Spettigue|first2=Wendy J.|last3=Katzman|first3=Debra K.|date=2016|title=Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725687/|journal=Neuropsychiatric Disease and Treatment|volume=12|pages=213-218|doi=10.2147/NDT.S82538|access-date=27 January 2022}}</ref> There is potential for misdiagnosis given the similarity with picky eating and the prevalence of that condition, especially in cases where ARFID does not affect the person with the condition severely.
+==== Differences from picky eating ====
+There are some key differences from picky eating that set ARFID apart.
+First, ARFID is not a condition that is created by one's conscience, it is a subconscious condition that prohibits the person suffering from the condition from eating certain foods to the point where they will refuse to eat anything and starve themselves if not given options of what their sub-conscience has deemed "safe foods".<ref>{{cite web|last1=Campbell|first1=Leah|date=11 June 2018|title=ARFID: Eating Disorder Mistaken for Picky Eating|url=https://www.healthline.com/health-news/parents-may-mistake-picky-eating-for-a-more-serious-eating-disorder|access-date=27 January 2022|website=Healthline|language=en}}</ref> What also makes ARFID special is that due to its subconscious nature, it cannot be combatted through bribery (e.g. offering a child something as a reward for eating an "unsafe" food), reason nor shouting and threatening.<ref>{{cite web|date=3 September 2019|title=What is Arfid & what to do about it|url=https://eating-disorders.org.uk/what-is-arfid-what-to-do-about-it/|access-date=27 January 2022|website=National Centre for Eating Disorders|publisher=National Centre for Eating Disorders}}</ref> It is also believed that using those methods can lead to the condition or the anxieties associated with it worsening.<ref name=":02" /> When it comes to ARFID, eating or not eating certain foods is not a preference, but rather a necessity.
+Second, ARFID can run deeper than just eating alone. It is documented that people with ARFID can have a particular anxiety towards trying new foods, but in some cases, the sufferer can also be scared of new experiences as a whole or novel situations where food is present.<ref>{{cite web|title=ARFID|url=https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/arfid/|access-date=28 January 2022|website=Beat Eating Disorders|publisher=Beat Eating Disorders|language=en-gb}}</ref> This, however, is a more rare complication and is not very widely documented. Given that some data suggests that ARFID may be associated with other psychological disorders, like [[Anxiety disorder|anxiety disorders]] and [[Autism spectrum|autism spectrum disorders]],<ref name=":1">{{Cite journal|last=Fisher|first=Martin M.|last2=Rosen|first2=David S.|last3=Ornstein|first3=Rollyn M.|last4=Mammel|first4=Kathleen A.|last5=Katzman|first5=Debra K.|last6=Rome|first6=Ellen S.|last7=Callahan|first7=S. Todd|last8=Malizio|first8=Joan|last9=Kearney|first9=Sarah|last10=Walsh|first10=B. Timothy|date=July 2014|title=Characteristics of Avoidant/Restrictive Food Intake Disorder in Children and Adolescents: A “New Disorder” in DSM-5|url=https://linkinghub.elsevier.com/retrieve/pii/S1054139X13007714|journal=Journal of Adolescent Health|language=en|volume=55|issue=1|pages=49–52|doi=10.1016/j.jadohealth.2013.11.013}}</ref> these effects could be derived from those links.
+Third, ARFID used to be associated with [[Anorexia nervosa|Anorexia Nervosa]] and [[Bulimia nervosa|Bulimia Nervosa]] due to its tendency to create issues with weight and nutrition,<ref>{{Cite journal|last=Becker|first=Kendra R.|last2=Keshishian|first2=Ani C.|last3=Liebman|first3=Rachel E.|last4=Coniglio|first4=Kathryn A.|last5=Wang|first5=Shirley B.|last6=Franko|first6=Debra L.|last7=Eddy|first7=Kamryn T.|last8=Thomas|first8=Jennifer J.|date=March 2019|title=Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa|url=https://onlinelibrary.wiley.com/doi/10.1002/eat.22988|journal=International Journal of Eating Disorders|language=en|volume=52|issue=3|pages=230–238|doi=10.1002/eat.22988|issn=0276-3478|pmc=PMC7191972|pmid=30578644}}</ref><ref name=":1" /> especially for children. While it is now known that cases of ARFID where there is more extreme weight loss or gain occur rather rarely, malnutrition among sufferers is common,<ref name=":22">{{cite journal|last1=Bryant-Waugh|first1=Rachel|date=July 2013|title=Avoidant restrictive food intake disorder: An illustrative case example|journal=International Journal of Eating Disorders|volume=46|issue=5|pages=420–423|doi=10.1002/eat.22093}}</ref> and any of these symptoms can set ARFID apart from the aforementioned conditions as well as picky eating.
+=== Difficulties surrounding diagnosis ===
+As mentioned before, picky eating and ARFID share a lot of symptoms, and the symptoms covered in the [[DSM-5]] are broad, which can be both a detriment and an advantage: Dr Stephanie G. Harshman, of the neuroendocrine unit at Massachusetts General Hospital has been quoted saying: “The broad definitions used among [[DSM-5]] criteria for [avoidant/restrictive food intake disorder (ARFID)] provide substantial flexibility in a clinical setting,”<ref>{{Cite web|date=20 September 2021|title=Clearer guidelines needed for avoidant/restrictive food intake disorder diagnosis|url=https://www.healio.com/news/psychiatry/20210920/clearer-guidelines-needed-for-avoidantrestrictive-food-intake-disorder-diagnosis|access-date=2022-01-28|website=www.healio.com|language=en}}</ref>. It can be detrimental, as a broad scope can lead to [[False positives and false negatives|false positive]] diagnoses of ARFID, though as an advantage it is better than the [[DSM-IV]] description which landed people suffering from ARFID in the "EDNOS" (eating disorder not otherwise specified) category and made it more difficult for people suffering from the condition to reach potential treatment.<ref name=":1" />
+A discriminating quality that was once considered to classify ARFID differently from picky eating was weight loss or gain, but given that this is not a universal feature of ARFID,<ref name=":22" /> that is no longer the case. Additionally, if weight loss or change (or more extreme malnutrition) are present, this can point towards the patient having [[Anorexia nervosa|Anorexia Nervosa]] or [[Bulimia nervosa|Bulimia Nervosa]], and can also lead to a [[False positives and false negatives|false negative]] diagnosis.<ref>{{Cite journal|last=Becker|first=Kendra R.|last2=Keshishian|first2=Ani C.|last3=Liebman|first3=Rachel E.|last4=Coniglio|first4=Kathryn A.|last5=Wang|first5=Shirley B.|last6=Franko|first6=Debra L.|last7=Eddy|first7=Kamryn T.|last8=Thomas|first8=Jennifer J.|date=March 2019|title=Impact of expanded diagnostic criteria for avoidant/restrictive food intake disorder on clinical comparisons with anorexia nervosa|url=https://onlinelibrary.wiley.com/doi/10.1002/eat.22988|journal=International Journal of Eating Disorders|language=en|volume=52|issue=3|pages=230–238|doi=10.1002/eat.22988|issn=0276-3478|pmc=PMC7191972|pmid=30578644}}</ref>
+Due to the relative novelty of the [[DSM-5]] and it's new inclusion of ARFID, not everyone is familiar with the condition, making it more difficult to detect and diagnose. There is evidence that medical professionals who had diagnosed ARFID in a patient prior to meeting another patient with ARFID were more likely to detect and diagnose it than those who had not.<ref>{{Cite journal|last=Coelho|first=Jennifer S.|last2=Norris|first2=Mark L.|last3=Tsai|first3=Stephen C. E.|last4=Wu|first4=Yuwei J.|last5=Lam|first5=Pei‐Yoong|date=April 2021|title=Health professionals' familiarity and experience with providing clinical care for pediatric avoidant/restrictive food intake disorder|url=https://onlinelibrary.wiley.com/doi/10.1002/eat.23438|journal=International Journal of Eating Disorders|language=en|volume=54|issue=4|pages=587–594|doi=10.1002/eat.23438|issn=0276-3478}}</ref>
 == Treatment ==
@@ Line 90: / Line 119: @@
 # The 'relaxation stage' is most important for those children that suffer severe anxiety when presented with unfavorable foods. Children learn to relax to reduce the anxiety that they feel. Children work through a list of anxiety-producing stimuli and can create a story line with relaxing imagery and scenarios. Often these stories can also include the introduction of new foods with the help of a real person or fantasy person. Children then listen to this story before eating new foods as a way to imagine themselves participating in an expanded variety of foods while relaxed.<ref name="nicholls" />
 # The final stage, 'review', is important to keep track of the child's progress, both in one-on-one sessions with the child, as well as with the parent in order to get a clear picture of how the child is progressing and if the relaxation techniques are working.
+=== For both adults and children ===
+A suitable treatment for older children and adults alike is [[Cognitive behavioral therapy|CBT-AR]] (Cognitive Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder), in which around 90% of participants have found high levels of satisfaction with the programme.<ref name=":3">{{Cite journal|last=Thomas|first=Jennifer J.|last2=Becker|first2=Kendra R.|last3=Breithaupt|first3=Lauren|last4=Murray|first4=Helen Burton|last5=Jo|first5=Jenny H.|last6=Kuhnle|first6=Megan C.|last7=Dreier|first7=Melissa J.|last8=Harshman|first8=Stephanie|last9=Kahn|first9=Danielle L.|last10=Hauser|first10=Kristine|last11=Slattery|first11=Meghan|date=March 2021|title=Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder|url=https://linkinghub.elsevier.com/retrieve/pii/S2589979120300470|journal=Journal of Behavioral and Cognitive Therapy|language=en|volume=31|issue=1|pages=47–55|doi=10.1016/j.jbct.2020.10.004|pmc=PMC8375627|pmid=34423319}}</ref> While the rate of remission to this type of programme is said to be around 40%,<ref name=":3" /> it has seen higher efficacy among children and young adults compared to adults, and greater family involvement has also been seen to help.<ref name=":3" />
+The treatment is broken up into 4 stages and aimed to help "reduce nutritional compromise and increase opportunities for exposure to novel foods to reduce negative feelings and predictions about eating".<ref name=":4">{{Cite journal|last=Thomas|first=Jennifer J.|last2=Wons|first2=Olivia B.|last3=Eddy|first3=Kamryn T.|date=November 2018|title=Cognitive–behavioral treatment of avoidant/restrictive food intake disorder|url=https://journals.lww.com/00001504-201811000-00002|journal=Current Opinion in Psychiatry|language=en|volume=31|issue=6|pages=425–430|doi=10.1097/YCO.0000000000000454|issn=0951-7367|pmc=PMC6235623|pmid=30102641}}</ref> In a simplified format, the stages of this treatment are:<ref name=":4" />
+# [[Psychoeducation]] regarding ARFID and CBT-AR, setting up a regular pattern of eating and self-monitoring.
+# Psychoeducation about nutrition deficiencies, selecting new foods to help aid the loss of those deficiencies.
+# Figuring out the root cause(s) of the patient's ARFID (mentioned above in the [[#Speculative causes|Speculative causes]] section), bringing in 5 new foods to examine, describe their features and try tasting them throughout the week, lastly exposure to the foods in the sessions.
+# Evaluating progress and compiling a relapse prevention plan.
+This is set to take place over 20-30 sessions ranging from 6 months to a year.
+More can be learned about the treatment in the book [https://books.google.co.uk/books/about/Cognitive_Behavioral_Therapy_for_Avoidan.html?id=8Y92DwAAQBAJ&source=kp_book_description&redir_esc=y "Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults"] by Jennifer J. Thomas and Kamryn T. Eddy.
 == See also ==