While ARFID and picky eating may appear similar they are not the same thing. I prefer the more neutral sounding term ‘selective eating’. Selective, picky or fussy eating is typically a mild and developmentally normal behaviour, especially in young children. It usually doesn’t interfere significantly with health, growth or life and may be outgrown as children develop new tastes. It is often a preference-based issue driven by taste or mild sensory dislikes and may be influenced by developmental stages or cultural and family eating habits. Picky eaters may have a limited diet but still consume a wide enough range of foods to meet nutritional needs. They may eat "safe foods" within each food group (e.g., fruits, grains, proteins). Social situations involving food may cause mild discomfort but are usually manageable. Emotional distress is typically low or absent. It rarely causes weight loss or medical complications.
ARFID is a serious eating disorder that leads to significant nutritional deficiencies, health complications or social challenges. It can interfere with physical growth and weight maintenance and can cause distress. It can stem from deeper psychological or physiological factors, such as: Extreme sensory sensitivities (texture, smell, or appearance). Fear of adverse consequences (e.g., choking, vomiting). Lack of interest in eating or low appetite. It is frequently linked to neurodivergent conditions (e.g., Autism, ADHD). ARFID often involves an extremely limited diet, sometimes restricted to a few foods (e.g., only plain pasta or crackers). Avoidance often extends to entire food groups, leading to severe nutritional gaps. Social situations (e.g., dining out or eating with peers) can cause intense anxiety or embarrassment. Avoidance behaviors may lead to isolation and strained relationships. Emotional distress about eating is often severe and may involve panic attacks or meltdowns. It can result in malnutrition, weight loss, stunted growth (in children), and other medical issues such as anaemia or gastrointestinal problems and may require medical intervention.
Current treatment approaches are primarily focused on psychotherapy, nutritional rehabilitation, and multidisciplinary care. These include CBT-AR, which is CBT specifically adapted for ARFID, which is one of the most well supported approaches. It focuses on addressing the underlying cognitive, emotional, and behavioural factors that contribute to restrictive eating patterns. This includes exposure therapy and cognitive restructuring - helping the individual identify and challenge distorted thoughts around food, eating, and their body image.
Nutritional rehabilitation focuses on restoring healthy eating habits and addressing any nutritional deficiencies resulting from restrictive food intake. A registered dietitian works with the individual to increase variety and quantity of food in a controlled, supportive manner. The dietitian may work closely with the person to ensure they receive adequate calories and nutrients. For children or adolescents with ARFID, it's essential to track physical development (growth charts, weight gain, etc.) to ensure nutritional needs are being met. Structured meals and snacks are often recommended to ensure regular intake and reduce avoidance behaviors.
Family-Based Therapy (FBT), also known as the Maudsley Approach, is commonly used for children and adolescents with eating disorders, including ARFID because the family plays a central role in the treatment process, especially in encouraging regular eating habits.
Sensory Integration Therapy (SIT) is particularly helpful for individuals with sensory sensitivities to food, which is common in ARFID. This therapy helps individuals gradually tolerate different textures, smells, and tastes of food. Techniques might include: Desensitization and therapeutic play.
Medical intervention may be necessary for individuals with ARFID who have significant nutritional deficiencies, weight loss, or health complications due to insufficient food intake.
ARFID often requires a team-based approach that includes a combination of specialists, such as therapists, dietitians, doctors, and psychologists creating a treatment plan.
So when I work with someone with ARFID based difficulties in private therapy practice, I'm always assessing and making sure that I am the appropriate level of support for someone. If I feel you need further support with a wider team, I will speak with you about this directly. In private practice, I have a network of dietitians I work with, and if I feel you need further support, we can discuss how best this would work for you.
Hi, I’m Becky Grace Irwing, I’m a BABCP Accredited CBT & EMDR qualified Therapist and qualified Mental Health Nurse. I spent 8 years as a Mental Health Nurse and 3 years as a CBT Therapist. I have worked across many mental health services for 14 years including acute, forensic and CAMHS services as well as University Mental Health and Disability Services and a London talking therapies service. I have a background history as a Fitness and Yoga Instructor of 10 years, and worked in the fitness industry from the age of 17 to 35.
I specialise in Eating Disorders, Neurodiversity and complex trauma issues and the link between those. I have a lived experience of binge eating for nearly 30 years, recovered for 7 years. I have ADHD and self diagnosed with Autism.
I’m also a dog Mum of two sausage dogs, human first, like to knit and I’m sustainability conscious.
My career highlights are being nominated for student nurse of the year for the Nursing Times and working in University Mental Health Services for 4 years; I loved working with students who were neurodivergent with a complex background of mental health and disability difficulties the most.
I'd love to hear from you for a free 20 minute introduction call to see how I can help you.
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