An Eating Disorder That’s Not About Body Image
“Please tell me I need food to live.”
Yes, I have said that to my friends on multiple occasions in my college cafeteria. When I say it, I am only half-joking.
I’m not a psychologist, so I won’t diagnose myself, but I see many similarities in my thoughts and behavior to Avoidant/Restrictive Food Intake Disorder (ARFID).
In 2013, this disorder was added to the DSM-V, which is The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. As a result, it is not well-known, but it is still prevalent.
Reasons for Avoiding Food
Unlike most eating disorders, ARFID is not related to a distorted body image or fear of gaining weight. Instead, the reasons for avoiding food are more related to “mental blocks or physical hindrances.” The DSM-V defines ARFID as “an eating or feeding disturbance.”
What exactly does that mean? Well, one way in which this disturbance manifests itself is in an “apparent lack of interest in eating or food.” I see this in my own life. Sometimes I find myself walking around my college cafeteria for 10 minutes, consumed with dread, because I know that I need to eat but do not want to.
This disturbance could also present itself by “avoidance based on the sensory characteristics of food.” Certain smells make my appetite vanish (again, college cafeteria). Certain textures or tastes make me gag.
Lastly, the disturbance could show itself through “concern about aversive consequences of eating.” I remember gagging or vomiting from certain foods, usually vegetables, so eating those foods terrifies me. I do not want to gag or vomit any more than I have to.
Because of the food-avoidance behaviors, ARFID is also accompanied by certain physical symptoms.
Symptoms of ARFID
Someone struggling with ARFID is consistently deficienti in energy and/or nutrition. This means that the person exhibits at least one of the following symptoms:
The person may lose a significant amount of weight or fail to gain weight as s/he should, or the person may depend on “nutritional supplements or tube feeding.” Further, the person may have a nutritional deficiency like anemia, which is where the anemic’s “blood does not carry enough oxygen to the rest of [his or her] body.” Signs of nutritional deficiencies include “fainting, dizziness, dehydration, constipation, [and] dull or yellow skin.” Lastly, the person’s psychosocial functioning may be impaired.
Basically, ARFID is more than being a picky eater. It means that the person’s health is in danger.
This eating disturbance does not have an underlying cause such as medical issues, cultural practices, or lack of resources. Therefore, the symptoms cannot be traced to a medication, medical issue, or lack of access to nutritious food.
Personally, I may have a slight nutritional deficiency that would need to be confirmed by a blood test; otherwise I would not be diagnosed with ARFID. The physical symptoms must accompany the mental reasons for avoiding food in order for a person to be diagnosed with ARFID.
Prevalence of ARFID
Those diagnosed with ARFID are 80 percent female. ARFID is especially common among children and is, in fact, “the second most common eating disorder in children 12 years and younger.” However, people of other ages can also be diagnosed with ARFID. In settings that treat eating disorders, 8 to 14 percent of people are diagnosed with ARFID. It’s not as rare as you may think.
People with ARFID are also more likely to also have an anxiety disorder than those with anorexia nervosa. In fact, those diagnosed with ARFID have a high likelihood of developing another disorder, particularly “anxiety disorders and depression.”
ARFID in Real Life
ARFID takes different forms. A person with ARFID often takes very small portions, and it may be difficult for him or her to digest different kinds of food. S/he may be a slow eater or have difficulty concentrating, which is a sign of insufficient nutrition. S/he may skip meals by claiming not to be hungry.
Sometimes when I am sitting at a table full of people, I see them enjoying their food and wish I could do the same. Immediately that thought is followed by a suffocating sense of guilt because you are supposed to want to eat.
Eating should bring you joy. ARFID brings only shame.