ARFID Treatment

Eating Disorder Programs for Adults with ARFID

Eating disorders are particularly challenging to treat because clinicians must implement any medical interventions needed as well as treat the underlying psychological issues that contribute to their development. Avoidant Restrictive Food Intake Disorder (ARFID) often affects the pediatric population, but adults can struggle with this too. What do you need to know about ARFID treatment and what options can you pursue to get help?

Emerald Isle Health & Recovery offers a robust treatment program for those who struggle with ARFID. From inpatient facilities to a partial hospitalization program to outpatient options, we offer everything you need to be successful long-term.

If you are ready to embrace recovery, here is what you need to know about the interventions available for the treatment of eating disorders like ARFID.

What is ARFID?

Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder like anorexia nervosa or bulimia that can affect a person of any age. It often manifests itself as extremely picky eating where the person may have little to no interest in consuming food. Most people with this disorder will have a list of safe foods that they feel comfortable eating.

As a result of their restrictive eating habits, it is common for people with ARFID to present to their doctors first for medical treatment related to malnutrition.

A common misconception about ARFID is that those who struggle with it are concerned about their body size, similar to anorexia nervosa. While both disorders focus on restrictive eating habits, those with ARFID have little concern regarding the size of their bodies. Instead, it is picky eating magnified often due to fear of eating, sensitivity to textures and tastes, or anxiety surrounding food.

Some symptoms of ARFID include:

• A short list of “acceptable” foods often sharing similar characteristics like color, texture, etc.
• Completely eliminating certain foods or food groups from the diet
• Requires certain food preparation in order to eat
• Nutritional deficiencies
• Extreme emotions or stress around meal times
• Issues with social engagements surrounding meals and eating
• Malnutrition and weight loss
• Possible co-occurring anxiety disorders

More than Picky Eating

Keep in mind that while it may present in a similar way to picky eating, Avoidant Restrictive Food Intake Disorder is more serious. It impacts almost every aspect of a person’s life and leads to a need for serious medical intervention. Those with this disorder are obsessive about what they can and cannot eat.

In order for a doctor to diagnose a case of ARFID, there must be proof that they have plenty of food available to them but have difficulty consuming it due to sensory or psychological issues. It leads to serious medical outcomes that may require tube feeding or supplementation to the diet in order to restore the body to a healthy state.

If restrictive eating is focused on a preoccupation with body size, it should be diagnosed as anorexia nervosa instead.

How to Treat ARFID

Because ARFID is still a relatively new diagnosis, there is still much research being done on what the most effective treatment plan should be. To date, there is evidence that a multi-pronged approach is likely the best option. This starts with traditional therapy like cognitive behavioral therapy, dialectical behavior therapy, and family therapy.

Once these options have been explored, it is worth considering whether supplementary therapy like speech therapy or occupational therapy could assist.

Cognitive Behavioral Therapy to Alter Thought Patterns

ARFID treatment is still advancing but a new type of cognitive behavioral therapy known as CBT-AR holds a lot of promise. The basic premise behind traditional CBT is that the client can learn to interrupt the pattern of their thoughts, feelings, and actions.

For example, your thoughts lead you to feel a certain way which triggers an action. You might have thoughts regarding eating which lead you to feel anxiety or fear which triggers you to skip a meal. This is a helpful therapy for most other eating disorders, and it seems to perform just as well for ARFID treatment.

Clients who undergo twenty to thirty sessions of CBT tend to have the best outcomes. They incorporate more new foods into their restrictive diets and end up gaining weight that puts them outside of medical risk.

Not to mention, this type of therapy also serves to create new thought patterns and behaviors. You will need something to replace the negative experiences you had previously, and this type of therapy holds the promise of being able to do just that. It takes time, effort, and plenty of hard work to implement these strategies, but it is possible to change your train of thought.

As far as treating ARFID goes, this is one of the most effective options available, and it is offered at Emerald Isle Health and Recovery.

Dialectical Behavior Therapy for Mindfulness

When you consider eating, how do you feel? Most adults with Avoidant Restrictive Food Intake Disorder are overwhelmed, anxious, or nervous about the process of eating. You may be afraid of choking, vomiting, or simply eating certain foods. Sitting with those feelings can be extremely challenging, and this is where dialectical behavior therapy comes into play.

One of the core tenets of DBT is mindfulness or the ability to bring your focus to the present moment. A therapist will walk you through exercises to help you focus on how you are feeling in the moment. Most importantly, the idea is that you should learn to observe your feelings without passing judgment on them, a form of radical acceptance. Feelings are not good or bad; they are just there to help you decide what the next right thing should be.

Once you learn to identify that your feelings are not good or bad, you can move forward by replacing those thoughts with ones that better serve you. It starts with the identification of your feelings but eventually segues into ARFID treatment as you embrace the uncomfortable feelings that surface around eating.

Not to mention, DBT can help in other areas of your life that have been impacted by eating disorders. Beyond emotional control, it can also improve your relationships that may have become strained due to your eating disorder. You may experience greater resiliency in the face of stress.

Family Therapy

When it comes to the treatment of other eating disorders, family therapy is an important piece of the puzzle. More research still needs to be done regarding ARFID and family-focused therapy, but it may prove to be extremely helpful. Treating ARFID with family therapy allows the person with an eating disorder to feel supported by those closest to them.

An important piece of the puzzle here is that family members should be able to approach the eating disorder and behaviors in a nonjudgmental way. A trained family therapist will help all parties to view the Avoidant Restrictive Food Intake Disorder as a separate entity, something apart from the person who is struggling with extremely picky eating.

When viewed this way, it is easy for the rest of the family to focus on the mental health and physical health of the person struggling. The goal would be to get the person to a healthy weight and then continue to reinforce healthy eating patterns once the client returns to a home setting.

Speech Therapy for Swallowing

One unexpected therapy that could assist in ARFID treatment is speech therapy. Many people who struggle with this disorder find that they are actually afraid of eating which can be linked to fear of choking, vomiting, or swallowing. ARFID is an eating disorder characterized by this fear. Speech therapists can help allay this fear in one key way: by working with clients on swallowing.

Speech therapists are not only there to help people learn to speak more clearly. Much of the work they do also pertains to swallowing. A person with Avoidant Restrictive Food Intake Disorder can benefit from some of this swallowing work until they find that they are no longer fearful or anxious surrounding this action.

If you struggle with a fear of swallowing, speech therapy may be a scary prospect at first. However, it will help you to gain the confidence you need to treat ARFID and curb your weight loss. Combined with other therapies, you can expand your list of preferred foods eaten and gain the weight to be medically stable.

Occupational Therapy for Sensory Sensitivity

If swallowing is not the primary culprit behind your Avoidant Restrictive Food Intake Disorder, then it might be worth considering working with an occupational therapist. Oftentimes, those who have a comorbid autism spectrum disorder will have sensitivities surrounding the textures of certain foods. This is what solidifies their unhealthy eating patterns, but it can be overcome with therapy.

Unlike mental health professionals, occupational therapists will focus exclusively on how a client interacts with food. They are there to assist with daily functioning, and eating is a huge part of how you make it from day to day. One of the first things to tackle will be tactile aversions to certain foods and any sensory sensitivity that a person may experience.

From here, they will work on helping to develop new behaviors which include eating a wider array of foods.

Medication Management for Weight Gain

An eating disorders program may also choose to incorporate medication management into a robust and full treatment plan. This should be done under the care of an experienced doctor who can carefully monitor progress through inpatient or intensive outpatient treatment.

Doctors have several ways of approaching the medication piece of a treatment plan, starting with appetite stimulants. When a person feels hungrier, they are more likely to override their aversion to food and to eat, mitigating weight loss. Even if they only consume their “safe” foods, it can be a great way to promote weight gain in someone who is severely underweight due to restrictive eating.

Another approach to medication could include anti-anxiety prescription medication. Many people with this eating disorder have severe anxiety surrounding mealtime and eating for a variety of reasons. Whether their fear is swallowing, vomiting or something else entirely, a bit of pharmaceutical help for their anxiety can quell fears long enough to permit them to eat.

Some psychiatrists and doctors may also prescribe antipsychotics to their patients because they are known to increase appetite and promote weight gain.

Medical Treatment Necessary for ARFID

While all of the above therapies can be extremely helpful and necessary in the treatment of Avoidant Restrictive Food Intake Disorder, the reality is that many people will also need a team of doctors and specialists to combat their severe weight loss. Losing weight is not the ultimate goal of ARFID, but it is an unintended side effect due to the fear surrounding eating. As a result, many clients need a medical treatment team.

Like other eating disorders, serious weight loss can trigger other problems. Some of the medical symptoms of ARFID can include:

• Severe weight loss
• Lack of menstruation in females
• Low iron
• Low thyroid levels
• Slow heart rate
• Muscle weakness
• Weakened immune system

As you can imagine, these health issues can pose serious problems for your lifestyle and could pose a medical emergency. This is why seeking medical treatment is crucial. As with eating disorders like anorexia nervosa, it may be necessary to use tube feeding until some of the behavioral issues surrounding eating habits can be addressed.

One of the first things that a doctor will need to address is nutritional deficiencies. A dietician may work with someone to come up with a meal plan that implements as many of these missing nutrients as possible in a way that feels safe and comfortable for the client.

Keep in mind that while the medical aspect of treatment is often necessary, it should not be done in a vacuum. It is best to enlist the help of a team of professionals who can address both the physical and mental health aspects required in ARFID treatment.

Inpatient Treatment Options for ARFID

While some people may have great gains with outpatient treatment, Emerald Isle Health and Recovery also offers an inpatient treatment solution. This is a more intensive treatment plan that allows you to focus solely on your recovery from Avoidant Restrictive Food Intake Disorder.

You do not have to worry about going to work, dealing with challenging relationships or even making your own meals. Everything is taken care of for you in a residential treatment setting like the one we offer.

While it is extremely helpful for those with any type of eating disorder, it is ideal for those who have dual diagnosis with another condition. Whether this is anxiety, depression, substance use, or some other mental health condition, inpatient treatment can get to the root of the struggle. You will receive personalized care for any issues that present and cause problems, contributing to your eating disorder and poor mental health.

It also works best if you live in a home that does not actively support your recovery. By taking a break from these challenging relationships and working on solidifying them in family therapy, you may be able to alter the environment in order for you to return home healthier than ever.

Of course, inpatient treatment is also suggested for those who are a little more resistant to the idea of therapy for their eating disorder. It gives you plenty of time and space to explore why you may be resistant to treatment and uncover any other mental health concerns that might surface while going through therapy.

Outpatient Therapy for Less Restrictive Recovery

For some people, our inpatient program can feel too restrictive and may not be as beneficial as an outpatient therapy approach. Outpatient therapy allows you to come to Emerald Isle during the day and return to your own bed at night. There are two different levels of outpatient therapy: a traditional outpatient and a partial hospitalization program.

A partial hospitalization program is the first stepping stone away from inpatient treatment. You will attend sessions all day long ranging from group therapy to individual therapy to medication management. It provides a strict structure for the daytime hours, allowing you to more easily focus on your recovery. However, you will still return home at the end of the day.

This can prove challenging for many of our clients, as they will need to cope with strained family dynamics and their eating habits on their own. That being said, it is a great step-down option for those who have graduated from inpatient treatment and may need a bit of additional support to rejoin their families at home.

On the other hand, outpatient treatment allows you to come and go as you please. As long as you attend all scheduled sessions (individual, group, family, and/or medication management), you can set your own schedule. This is the least restrictive setting for the treatment of ARFID and we often recommend that you pursue one of the other two levels of treatment first before segueing into this program.

Recovery from ARFID is Possible

While it may sound like the treatment of Avoidant Restrictive Food Intake Disorder is challenging, there is a lot of promise in this field. As new research is consistently performed, we will have new approaches that indicate future success in the treatment of this relatively new eating disorder. One thing to note is that the treatment outcomes for ARFID tend to be quite high.

When compared with other long-term eating disorders like anorexia nervosa, the outcomes for ARFID tend to be better. In one important research study, researchers compared the recovery outcomes of patients with both disorders to see which ones had better long-term recovery. Those subjects with ARFID had a 77 percent recovery rate while those with anorexia nervosa had only a 43 percent recovery rate.

This indicates that it can indeed be successfully treated. In fact, many cases show that this is true. The key is to seek treatment for ARFID as early as possible for the best outcomes both medically and psychologically. Early treatment can also improve psychosocial functioning.

Seeking Treatment for ARFID at Emerald Isle

The good news is that there is help and healing for all eating disorders, including those that are new to the Diagnostic and Statistical Manual (DSM) used to diagnose mental health issues. ARFID is challenging to address because it has both medical roots and psychological underpinnings that solidify these restrictive or avoidant eating patterns. Emerald Isle Health & Recovery can help.

Whether you need intensive care through residential treatment or want to try to get healthy while you remain at home, we have a level of care suitable for you. If getting healthy and overcoming your eating habits is a priority for you, reach out to us today to determine what level of care might best suit you and get started on a path to a new life with our help!