By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Avoidant Restrictive Food Intake Disorder vs. Anorexia and Bulimia.
How is Avoidant Restrictive Food Intake Disorder (ARFIDO) different from all those eating disorders people have come to know? And did we really need another eating disorder diagnosis?
Proposed for the new DSM-5 and looking like a for-sure new recognized eating disorder is ARFIDO. ARFIDO has some differences from past eating disorders. Given the many possible bad relationships with food people could become involved with, my take is yes this one is different from either Anorexia Nervosa or Bulimia and it has been needed for some time.
The way we have been looking at eating disorders has had some flaws for a while now. McFarland et al in 2008 wrote an interesting article on eating disorder relapse. The topic of relapse and relapse prevention has been an important part of substance abuse treatment for a long time. Recently we have been looking at the issue of relapse related to mental health issues.
In his article, McFarland reported that they ended up including all the people with an eating disorder in the relapse study because people with an eating disorder move between disorders often enough to prevent saying someone has one and only one eating disorder.
We also are told in this article that the majority of people in treatment for an eating disorder, up to 60% of those treated in outpatient, did not meet the criteria for one of the official diagnosis and ended up in the leftover category Eating Disorder Not otherwise specified (NOS).
Creating a new disorder (ARFIDO) is supposed to reduce the number of people who were ending up in that vague NOS land.
People with ARFIDO are different from those with anorexia nervosa or bulimia in several important ways. (I have taken liberties with the new DSM-V criteria here for sake of explanation.)
1. They do not have the characteristic distorted body image.
Ask a person with anorexia what they think about their current weight and they will tell you they are fat. Show them their reflection in the mirror, bones sticking out and all and they will still say they look fat. They see themselves at fat and no facts, not even the scale and the standard weight charts, will change that perception.
People with ARFIDO do not necessarily think they are fat.
They know they are thin, abnormally thin, but they like it that way. They become proud of their ability to stay thinner than most. They will keep up the dieting even when they know they are developing a health problem or nutritional deficiency because they like being one of the thin ones.
2. They don’t especially like food, food is the enemy.
People with ARFIDO will avoid many or all foods. They may need to resort to nutritional supplements to keep their weight above the critical go-to-hospital point.
3. They avoid putting on weight as they grow or in adulthood lose excessive amounts of weight.
They will continue avoiding food even when they know they are making themselves sick by their intentional starvation. Like Pieter Pan, they do not want to grow up or get larger.
4. This is not the result of starvation or lack of resources. People with ARFIDO do this on purpose. The will harm their health to look thin while living in a home with a full refrigerator.
5. Because they are so good at avoiding eating, people with ARFIDO do not have the need for the extreme measures we see in Anorexia Nervosa or Bulimia.
That is my understanding of this new diagnostic category at the current point in time. The new DSM will be out early next year and we can all get the full details then.
The update I read at the APA site was May 14-2012. They also note that when this is all done they expect there to be three subtypes of ARFIDO, A People who do not eat and are not interested in eating B People who will only eat food with certain sensory characteristics, C People who won’t eat because of an aversive experience.
Other posts about eating disorders and the new DSM-V proposals will be found at:
So do you think that this creation of ARFIDO will improve recognition of poorly recognized eating disorders? Do you believe you or someone you know has had an episode of Avoidant Restrictive Food Intake Disorder? If you recovering from or have you had a relapse to Avoidant Restrictive Food Intake Disorder would you care to leave a comment?
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