Avoidance/Restrictive Food Intake Disorder (ARFID) isn’t your classic body-image related eating disorder. The sneaky thing about ARFID is that it can take hold in any “normal” kid. As a society, we’re geared to thinking that eating disorders only occur in people with body image issues; this likely plays a major role in why kids with ARFID are able to fly under the eating disorder radar of their parents, teachers, family, and friends, at least until their weight is so low and their growth so poor that it becomes an undeniable issue.
Although identifying and diagnosing may seem to be the trickiest part about ARFID, I find the hardest part is getting the family on board with treatment. My take on this is as follows: The kids I’ve helped overcome ARFID were pretty normal kids with pretty normal families, no major trauma histories, always performed well in school, sociable, in their parents’ eyes, great kids. I field request after request to test this, test that, check another scan, bloodwork just one more time. The parents start to let go of their normal kid and have to accept a child with significant treatment needs, and that’s no easy task.
What I’ve come to identify as the typical pattern for these parents lines up almost perfectly with the 5 Stages of Loss and Grief. The family denies there’s a problem at all – my kid is just a picky eater, it’s just a phase, they must be in a growth spurt, there just can’t be something wrong with my totally normal kid. Then there’s the anger and frustration when the phase doesn’t pass, the child fails to maintain weight and growth velocity, and the ante to ‘just get this kid to eat’ rises, so the parents end up arguing with their child at every meal. When the arguing fails to produce results, the bargaining for behavior change shows up; we’ll buy you this, let you do that, eat this – get that. But with ARFID, bargaining just circles back to the arguing. When this fails, the family gets depressed and feels broken, and that’s when they come for formal treatment.
When the family finally accepts the diagnosis, is involved and engaged in treatment, and takes the techniques used within our center home, treatment progress at a swift pace with stable results.