Understanding Avoidant/Restrictive Food Intake Disorder (ARFID) from a Naturopathic Perspective

Avoidant/Restrictive Food Intake Disorder (ARFID) is a complex eating disorder characterised by a persistent avoidance or restriction of food intake. Unlike other eating disorders, ARFID is not driven by concerns about weight or body shape. Instead, it often stems from sensory sensitivities, fear of adverse consequences from eating (such as choking or vomiting), or a lack of interest in food. From a naturopathic standpoint, addressing ARFID requires a holistic approach that supports the body and mind through nutrition, lifestyle modifications, and individualised therapeutic interventions.

Aetiology: What Causes ARFID? There is no single cause of ARFID, but several biological, psychological, and environmental factors contribute to its development.

Biological and Psychological Factors

• ARFID is more common in individuals with developmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Research suggests that children with autism are five times more likely to have eating-related issues compared to their peers.
• Genetic predisposition plays a role, with ongoing studies examining hereditary factors in eating disorders.
• Some individuals experience heightened sensitivity to food textures, smells, or temperatures, making eating certain foods distressing or impossible.
• Dysregulated gut health, microbiome imbalances, and deficiencies in neurotransmitters such as serotonin and dopamine can contribute to food aversion and anxiety around eating.

Environmental and Trauma-Related Factors

• A past negative experience with food, such as choking or severe gastrointestinal distress, can lead to food avoidance.
• Family mealtime dynamics, cultural factors, and exposure to food-related trauma may contribute to restrictive eating patterns.
• Early feeding difficulties in childhood may persist into adolescence or adulthood, exacerbating restrictive eating habits.

Signs and Symptoms of ARFID: ARFID presents differently from person to person, but the following signs and symptoms are commonly observed:

Mental and Emotional Symptoms

• Intense fear or anxiety related to eating specific foods
• Avoidance of certain foods based on texture, taste, smell, or appearance
• No preoccupation with weight or body shape, but distress about food itself
• Heightened anxiety around mealtimes

Behavioural Symptoms

• Skipping meals or severely limiting food variety
• Eating only a narrow range of foods, sometimes referred to as “safe foods”
• Limited appetite or early satiety (feeling full quickly)
• Social withdrawal or avoidance of events where food is present

Physical Symptoms and Health Consequences

• Significant weight loss or failure to achieve expected growth in children
• Nutritional deficiencies leading to fatigue, anaemia, or weakened immunity
• Gastrointestinal issues such as constipation, bloating, or abdominal pain
• Dry skin, brittle nails, and hair thinning due to inadequate nutrient intake
• Hormonal imbalances, including irregular menstrual cycles
• Increased risk of osteoporosis and muscle loss

Diagnosis: How is ARFID Identified? A clinical diagnosis of ARFID is made based on the following criteria:

• Significant weight loss or failure to achieve expected weight gain
• Nutritional deficiencies leading to medical complications
• Dependence on enteral feeding (tube feeding) or oral nutritional supplements
• Significant interference with psychosocial functioning, such as difficulty in school, work, or relationships

ARFID is not diagnosed if the eating difficulties are better explained by a medical condition, another mental health disorder, food scarcity, or cultural practices such as fasting.

Naturopathic Treatment Approaches for ARFID: A holistic, naturopathic approach to ARFID focuses on restoring gut health, reducing anxiety, improving nutrient intake, and fostering a positive relationship with food.

Gut Health and Nutrient Support

• Probiotics and Prebiotics: Supporting the microbiome can help regulate digestion and neurotransmitter production, reducing anxiety around eating.
• Digestive Enzymes: Enzymes can aid in breaking down foods and improving digestion, particularly if there is food sensitivity or intolerance.
• Nutritional Support: Addressing deficiencies in zinc, magnesium, vitamin B6, and essential fatty acids can improve appetite and sensory processing.

Herbal and Nutritional Support for Anxiety

• Adaptogenic Herbs: can help balance stress hormones and reduce food-related anxiety.
• Calming Nervine’s: can support relaxation and digestive function.
• Amino Acid Therapy: can help with neurotransmitter balance, promoting a calmer response to food challenges.

Cognitive and Behavioural Interventions

• Cognitive Behavioural Therapy (CBT): Used alongside naturopathic treatment, CBT helps individuals identify and challenge fear-based thoughts around food.
• Gradual Exposure Therapy: Introducing small portions of feared foods in a safe and supported way can help retrain the brain’s response.
• Mindful Eating Practices: Encouraging relaxation and sensory awareness around food helps reduce mealtime anxiety.

Lifestyle and Environmental Modifications

• Mealtime Rituals: Creating a stress-free, enjoyable eating environment with consistent meal times can help build positive food experiences.
• Sensory Integration Therapy: Working with occupational therapists can support individuals with severe sensory sensitivities.
• Family Involvement: Educating families on supportive strategies and reinforcing positive eating behaviours is key in long-term success.

Seeking Help: Accessing Treatment and Support

Treatment for ARFID requires a multidisciplinary approach, including naturopaths, dieticians, psychologists, and occupational therapists. Early intervention improves long-term outcomes.

Steps to Take

1. Consult a Naturopath and Healthcare Team – A naturopath can assess nutritional status, gut health, and anxiety patterns while collaborating with medical professionals.
2. Integrate Holistic and Conventional Approaches – Combining naturopathic care with psychological support ensures comprehensive treatment.
3. Utilise Support Services – Organisations such as Eating Disorders Victoria (EDV) offer helplines, counselling, and peer mentoring programs.
4. Join Support Groups – Peer-led support groups provide a sense of community and shared experiences for those with ARFID and their families.

Final Thoughts

ARFID is a serious but treatable condition. A naturopathic approach that considers the whole person—mind, body, and environment—can be invaluable in recovery. If you or someone you know is struggling with restrictive eating, seeking professional guidance from a naturopath and a specialised healthcare team can be the first step toward healing.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.books.9780890425787

Diamantis, D. V., Emmett, P. M., & Taylor, C. M. (2023). Effect of being a persistent picky eater on feeding difficulties in school-aged children. Appetite, 183, 106483. https://doi.org/10.1016/j.appet.2023.106483 

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Koomar, T., Thomas, T. R., Pottschmidt, N. R., & Michaelson, J. J. (2021). Estimating the Prevalence and Genetic Risk Mechanisms of ARFID in a Large Autism Cohort. Frontiers in Psychiatry, 12.

Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current psychiatry reports, 19(8), 54. https://doi.org/10.1007/s11920-017-0795-5

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