Building a positive relationship with food and your body

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Selective Eating vs ARFID

Session 1

Introduction to ARFID (Avoidant/Restrictive Food Intake Disorder)

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WELCOME
TO SELECTIVE EATING VS ARFID

Welcome to Selective Eating vs ARFID! For people who may have Avoidant/Restrictive Food Intake Disorder (ARFID) or avoid/restrict certain food due to sensory experiences (colour, smell, taste, texture, temperature, etc.). Learn more about ARFID, a serious eating disorder, and develop ways to cope with food sensitivity, anxiety and fears. Use NHS-backed tools for managing ARFID.

The difference between selective eating and ARFID (Avoidant/Restrictive Food Intake Disorder).

Understanding hunger.

Managing anxiety around food.

You can download sessions once complete.

Brought to you by

East London
NHS Foundation
Trust

NELFT NHS Foundation Trust

- NELFT NHS Foundation Trust

https://www.nelft.nhs.uk/

- East London NHS Foundation Trust

https://www.elft.nhs.uk/

Selective Eating vs ARFID Introduction

Watch the video

Let's learn more about Avoidant/Restrictive Food Intake Disorder (ARFID)

We have created this material to support you in understanding more about your eating difficulties.

We also give you some strategies to put into practice and to improve your eating.

We encourage you to use this with someone that can support you and maybe can explain the information in a different way (it can be a parent or even a friend).

We understand that it might be overwhelming at first, so take your time to go through this.

What is ARFID?

People with ARFID eat a very limited variety or amount of
food and it causes problems in their lives.

These problems may be health related, like losing too
much weight, or not getting enough nutrients.

These problems may be social, like not being able to
eat meals with others.

Avoidant/Restrictive Food Intake Disorder (ARFID) is different from other eating disorders, like anorexia nervosa, because people with ARFID do not worry much about how they look, or how much they weigh.

Instead, people with ARFID might have one, two, or all three of these Important concerns:

1

1. Some people with ARFID find that some foods have strange or strong tastes, textures or smells, and they feel safer eating foods that they know well.

2

2. Others have had scary experiences with food, like throwing up, choking or an allergic reaction, so they may avoid the foods that made them sick, or stop eating altogether.

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3. Others don’t feel hungry very often, think eating is a chore, or get full very quickly.

What is ARFID?

It's important to understand that someone with ARFID is not just being “picky” or “stubborn”.

People with ARFID have underlying biological traits that initially made their eating habits a logical choice.

Once established, a pattern of food avoidance can become longstanding and highly resistant to change.

There are helpful steps you and your families can take that can interrupt these patterns of behaviour.

What is ARFID?

Things you might have noticed...

Sensitive to smell, look, taste, texture or all together.
Not feeling hungry, forgetting about eating, feeling full very quickly, not "liking" to eat, no interest in food or all together.
Anxious temperament.
Fear of eating because it might cause vomiting, choking, gagging or all together.

Negative feelings about food

Fear of new foods and not wanting to try new foods.
Smelling the food before trying.
Thinking that it won’t taste good anyway so it might be better not trying.
Thinking the food will make them sick/vomit/choke.
Not wanting to eat a food once eaten because it caused some reaction in the past (allergy/vomit/choke).

Health consequences

Weight loss.
Reduced hunger.
Vitamins and minerals deficiencies.
Difficulty with gaining weight.
Gut symptoms (i.e. upset stomach).
Feeling full quickly.
Constipation.
Not getting taller.

Acting differently around food

Not eating at the dining table.
Finding it difficult to eat at school.
Not eating in front of other people.
Not feeling hungry/not being able to say they are hungry.
Feeling uncomfortably full.
Sensitive to changes on how food looks.
Noticing small changes in food and its packaging.
Getting angry when they are forced to eat.

Flavour preferences
are partly genetic.

There may be
evolutionary
advantages to
food preferences.

Foods like fruits, vegetables, and meats were those most likely to be poisonous when our ancestors were hunting and gathering.

You may be a “supertaster” - meaning you could have been born with a high concentration of taste buds on your tongue and dislike bitter foods, like vegetables.

Why do people have different preferences to food?

How does a limited diet keep ARFID going?

Eating the same foods all the time makes new foods taste even more different. Certain nutrition deficiencies can change the way food tastes, making new food even less appealing.

Eating a very limited diet can also cause serious health problems. Eating preferred foods high in sugar and fat has been associated with diabetes and heart disease. Avoiding non-preferred foods, like fruits and vegetables, is associated with certain cancers.

Eating a particular food over and over may also make you tired of that food and stop eating it, further limiting your diet.

It may be hard to eat with others, causing you to miss out on opportunities to learn about new foods.

What happens when you
become more careful about
your eating after a negative
experience with food?

Negative experiences with food such
as choking, vomiting, an allergic
reaction, or pain after eating can be
traumatic.

These experiences might cause you
to limit your diet to prevent further
trauma.

You might even avoid any
food that reminds you of
the traumatic experience
or stop eating
altogether.

You may be using "safety behaviours" to try and prevent another traumatic experience from happening.

-Taking very small bites.
-Chewing for much longer than needed.
-Only eating at familiar restaurants.
-Not eating at all.

Safety behaviours prevent you from testing negative predictions about eating. The more you avoid eating, the scarier it becomes!

What happens when you eat a limited
volume of food?

How hungry you feel and how much pleasure you get from eating is partly due to your genes.

Eating too little can promote excessive fullness when you do eat an adequate amount because your stomach capacity decreases with chronic food restriction.

Eating without a regular schedule of meals and snacks can impact your hunger, especially if you go long periods without eating.

Eating very little can cause you to feel full quickly, even though you are not getting enough nutrients.

How does eating very little keep ARFID going?

Even if you are born with a smaller appetite than others, eating very little may further reduce your appetite. This is particularly true if you also limit food variety.

Eating a limited variety can decrease your ability to eat a sufficient volume of food because you get bored of eating the same things and then eat less of them.

You may experience low mood, irritability, anxiety, apathy, difficulty concentrating, or social isolation.

You may also experience medical problems such as; significant weight loss, problems with your bones, loss of muscle, decreased heart rate among others.

Understanding hunger

Over time, eating too little confuses your hunger and fullness cues.

The best way to increase your awareness of hunger cues is to keep track of how hungry you feel before you eat and how full you feel afterwards.

To begin shifting your hunger cues, you will need to start eating at a 3 or 4 (neither hungry or full), rather than waiting for a 1 (extreme hunger). You will also need to keep eating until a 6 or 7 (extreme fullness) rather than stopping at 4 or 5 (neither hungry nor full).