Recognising and Responding to ARFID in Therapy

I used to think I was alone in my struggles with eating. For years, I battled silently with a little-known eating disorder called ARFID. It wasn’t until I sought therapy that I discovered there was a supportive community out there, ready to help me on my journey to recovery. In this blog post, I want to shed light on the vital role that therapists and families play in this process – and offer some guidance for any non-specialist therapists encountering ARFID in their therapy rooms.

ARFID is a type of eating disorder that involves an extreme avoidance or restriction of certain foods based on their smell, taste, texture, or colour. This differs from other eating disorders, such as anorexia or bulimia, as it is not driven by issues with body image or a desire to lose weight.

ARFID is often seen in children and teenagers but can also affect adults. The exact cause is unknown, but some individuals may develop the disorder following a negative or traumatic experience involving food, while others may have heightened sensory sensitivity. Others may develop ARFID due to fear of experiencing unpleasant effects after eating, such as choking or being sick.

This condition can be highly debilitating, affecting both physical health and emotional wellbeing. The extreme avoidance or restriction of food often results in malnutrition and weight loss. In severe instances, it may even necessitate hospitalisation due to the severity of the health complications.

The emotional impact of ARFID can be equally profound. Fear and anxiety around eating may create distress, often leading to self-imposed isolation, especially during social gatherings involving food. Participation in social activities can be limited, and interpersonal relationships strained.

I now specialise not only in working with clients with ARFID but also issues related to neurodivergence. I have come to notice that almost all my clients who suffer with ARFID are also neurodivergent, having many ADHD or ASD traits. This is no different to myself as I am ADHD and have a few comorbidities – including hypersensitivity, hypervigilance and impulsivity. So, possible neurodivergence is something to bear in mind when working with someone who presents with ARFID.

Tailoring the therapy to the specific needs of an individual with ARFID is key, and a comprehensive therapeutic strategy might well include the following:
 

• CBT, to aid clients in recognising and restructuring detrimental thought processes that result in adverse actions.
   
• Gradual exposure therapy, to help clients introduce feared foods incrementally into their diet.
   
• Nutritional counselling, to ensure the patient’s dietary requirements are fulfilled, helping to mitigate the physical health impacts of ARFID.
   
• Family therapy, particularly for children and teenagers, to integrate the client’s family into the healing process, creating a nurturing, supportive environment.
   

Educating families, to help them understand the complexities of ARFID and provide them with strategies to support their loved ones, is something therapists can play a significant role in. We can offer guidance on meal planning, establishing a positive eating environment, and fostering open communication around food-related issues. I personally always offer family members the opportunity to attend therapy sessions together, and actively involve everyone in the recovery journey.

Consistent oversight is essential, to gauge the efficacy of the therapy and make required modifications. I have also found it really important to extend ongoing encouragement to both the client and their family, assisting them to confront challenges and applauding their achievements. Progress might be slow and setbacks are part of the journey. We need to remain patient and supportive.

The goal, for ARFID therapists, is to help our clients return to a healthy, happy, and unrestricted relationship with food. Since recognising ARFID and not dismissing its impact are so important, it is a condition we should all be aware of – even if we decide to refer on to a specialist. I see recovery as ongoing; ARFID will always be part of my life, but the difference now is that I am equipped with the tools and support system necessary to navigate the challenges that come my way.