Background

ARFID is one of the newly known eating disorders that manifest themselves through restrictions in food consumption. Because of such restrictions, the patient can get inadequate nutrition and lose weight. Where anorexia and bulimia are driven by other dangerous behaviors like the desire to be thin or to feel better, ARFID is not based on avoiding or wanting to lose weight. Sensory issues, negative potential consequences, and lack of interest in food steer it. This disorder is not a consequence age and can run through people of any stage, from the early childhood to adulthood. 

Epidemiology

There exist many different reports on prevalence, coming from various studies, and they’re mostly built on retrospectively classified cases – from 5% up to 14% among pediatric tertiary eating disorder patients. The results from a recent study found 8% of the patients complaining about ARFID during their opening evaluation. 

Anatomy

Pathophysiology

Biological factors: 
Genetics: Several research mention that ARFID might have a genetic predisposition, and that some people can become very vulnerable with the increased likelihood of developing ARFID if they have a close relative with it. 
Sensory processing issues: ARFID can cause children to display increased levels of sensitivity towards some key sensory features of foods like taste, texture, or smell. Consequently, they may struggle to swallow foods exhibiting unpleasant sensory characteristics. 
Psychological factors: 
Anxiety-disorders: People experiencing ARFID frequently have comorbid phobias that are triggered by swallowing, vomiting, or allergy reactions, causing the dietary restrictions.  
Negative past experiences: A choke on a past experience, gastrointestinal problems such as diarrhea, vomiting, or even developing a dislike of the food in daily life can create the issue of food aversion and avoidance in some individuals. 
Social factors: 
Family dynamics: With mealtime conflicts being observed in the family or with any feeding practices being done strictly/inflexibly, there are higher chances of ARFID development in children. 
Lack of social exposure to diverse foods: Limited exposure to various foods during childhood can make some individuals more apprehensive about trying new foods later in life. 

Etiology

Sensory Sensitivity: Overly sensitive people may be abhorred certain tastes, smells, colour or textures to begin with. 
Fear of Adverse Consequences: Fear of choking, or potential vomiting, and carrying with it other offshoots related with eating causes ARFID. 
Traumatic Events: Such experiences of shock, e.g. choking episodes, could lead to the formation of restricted eating. 
Anxiety or OCD: With an anxiety or another OCD, there is a increased chance of a person having severe impossibilities to try out some specific foods. 
Medical Conditions: In addition to ARFID can be various gastrointestinal disorders, allergic reactions, or other medical issues. 
Early Feeding Difficulties: Infancy and early childhood are very important to feeding. Such as swallowing that was difficult or vomiting can prevent problems during this stage. 
Family Dynamics: Factors of family dynamics, emotions such as fear of eating, and previous negative experiences in relation to food might possibly form an Atypical Anorexia Nervosa. 

Genetics

Prognostic Factors

Age of Onset: Better positive results for children are ensured in most of the cases where there is an early recognition and intervention in childhood. 
 
Severity of Symptoms: The symptoms severity & the extent of the decrease of functioning are 2 factors that influence the disease progression.  

Clinical History

Age group: ARFID is often revealed beginning in childhood, around 2 to 6 years old, but once an adult is involved it can be lifelong. 

Physical Examination

General Examination: 

Vital Signs 

Anthropometry: 

Height and Weight 

Body Mass Index (BMI) 

Malnutrition assessment 

Neurological Examination 

Psychosocial Assessment 

Age group

Associated comorbidity

Anxiety Disorders 

Autism Spectrum Disorder  

Gastrointestinal Conditions 

Mood Disorders 

Food Allergies or Sensitivities 

Nutritional Deficiencies 

Social Isolation 

Developmental Disorders 

Associated activity

Acuity of presentation

Nutritional Deficiency: The incidence of the nutritional deficiencies is more pronounced here and require nutritional modifications that might lead to dietary supplementation. 
 
Psychological Impact: A moderate disturbance psychosocial functioning, for instance, limiting attending social events or not being able to dine. 
 
Limited Range of Foods: Significant problems such as monotonous food choices or limited access to them. 
 
Avoidance Triggers: A strong food avoidance triggered by smell and other sensory aspects, the fear of eating certain foods or food groups, or due to past negative experience while having a meal. 

Differential Diagnoses

Anorexia Nervosa 

Obsessive-Compulsive Disorder 

Autism Spectrum Disorder  

Gastrointestinal Disorders 

Post-Traumatic Stress Disorder 

Avoidant Personality Disorder 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Medical Assessment and Management: 
Assessment: Undertake a comprehensive medical evaluation and nutritional survey, to know the exact cause of the condition. 
Medical Management: A medical management will be provided, including cater to the deficiencies in nutritional intake, treating medical complications, and recording weight and checking physical health often. 
Nutritional Rehabilitation: 
Nutritional Counselling: Work with a dietician to develop an eating plan based on food preferences and aversions and suitable to the way how energy expenditures are distributed over a day. 
Exposure Therapy: Grounded on the food you fear most and then progressively increase forward to ones that are relatively less fearful. 
Psychological Intervention: 
Cognitive Behavioral Therapy (CBT): Elucidate the thoughts and behaviors that exacerbate ARFID and help the problem develop coping strategies for managing eating-related anxiety. 
Exposure Therapy: Slowly acquaint with the purposefully feared food, with the goal being to overcome restrictions to various food groups. 
Family-Based Treatment (FBT): Get involve the family, especially parents, who seem to be very important back-up and also the parents have to control over the adolescent’s eating habits, which will useful for adolescents. 
Mindfulness-Based Therapies:  Use mindfulness meditation to reduce anxiety and increase awareness of hunger and fullness cues. 
Occupational Therapy: 
Sensory Integration Therapy: Introduce sensitive individuals to food by progressively presenting them with different textures, aromas, and colours in a conducive environment. 
Medication: 
Review a possibility of medication for all conditions that are co-occurring like anxiety or depression, but for ARFID condition, it’s not typically the first type of treatment. 
Support Groups: 
Group Therapy: Allow to ARFID people to share experiences, understand the condition, relate and form a community with a feeling of belonging. 
Education and Support for Caregivers: Education and Support for Caregivers. 
Education: Educating and supporting caregivers through education and support would allow them to understand ARFID and how they should best assist their relative in the process of their recovery. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

lifestyle-modifications-in-treating-arfid

Nutritional Supplementation: 
Supplements: Take supplements like nutritional powders or shakes that will be used to give them the right amount of vitamins when they are not able to take the nutrients from regular meals. 
Multivitamins: If the food the individual eats does not provide necessary nutrients, then it is important for the person to take multivitamins. Find some time to visit a healthcare professional. 
Gradual Exposure Therapy: 
Desensitization: Commence with feeding traditional foods in a sensitizing manner. Do it gradually, & after that increase the exposure. 
Therapeutic Support: 
Therapeutic Environment: Facilitate visit to a therapist or counsellor (who is well versed in eating disorders). 
Support Groups: Join the group of support that can facilitate sharing experiences and coping methods. 
Family Support: Engage relatives in a treatment process that is active. Bring them to Awareness about ARFID and render better assistance. 

Effectiveness of benzodiazepines in treating ARFID

Alprazolam: Alprazolam, a benzodiazepine, has shown to be more successful in increasing calorie intake in anorexic patients. Nevertheless, considering that individuals with ARFID (avoidant/restrictive food intake disorder) frequently report feeling more anxious than those with anorexia nervosa. 

role-of-management-in-treating-arfid

Assessment and Diagnosis:  

Perform a medical evaluation to know the acuteness and type of the condition.
The health service should initially undergo medical and nutritional status assessment.
Entirety of other medical conditions to know the exact cause.

Stabilization:

Take care of any urgent superficial, medical, or nutritional issues that may be present.

Establish regular eating patterns.

Eat slowly, chew thoroughly to ensure proper digestion, and introduce tolerated foods one at a time to the diet.
Treatment: 

Cognitive behavioral therapy (CBT) or family-based treatment (FBT) could be part of the treatment plan. 

 Exposure therapy is intended to systematize evading food through small contact with them.

Nutritional counselling for the purpose of varied balanced diets.
Maintenance:
Follow-up therapy sessions will be provided to reinforce the progress and tackle the potential hurdles.
Periodic monitoring of both the physical and psychological state.

Make the special considerations for treatment of co-morbid issues such as anxiety or depression. 

Medication

Future Trends

Media Gallary

References

Avoidant Restrictive Food Intake Disorder: A Narrative Review of Types and Characteristics of Therapeutic Interventions – PMC (nih.gov)