CBT for Avoidant Restrictive Food Intake (ARFID)
What is Avoidant/Restrictive Food Intake Disorder (ARFID)? ARFID is a condition in which someone is having trouble meeting their nutritional needs due to their behaviors around eating. This can be thought of as extreme “picky eating.” Individuals with ARFID generally are either underweight for their height or sometimes overweight, but not meeting their nutritional needs. Individuals with ARFID are generally concerned about the sensory profile of foods (e.g., disgusted by the taste, texture, smell, etc.), they have a low appetite or interest in food, and/or they are afraid of negative consequences of eating (e.g., choking). ARFID is considered an eating disorder, but these individuals do not report concerns with weight and body shape. Many experts consider ARFID to be more similar to an anxiety or obsessive-compulsive disorder. ARFID is often first diagnosed in childhood, but it can carry over into adulthood without intervention.
ARFID is a newly defined disorder and there is sparse research regarding best practices for treatment. Currently, the most supported treatment is called cognitive behavioral therapy for ARFID (CBT-AR). This manualized treatment was developed by eating disorder experts at Massachusetts General Hospital. The treatment is designed to last approximately 20 sessions over the course of a few months. Patients learn information about ARFID and strategies to help them increase their nutritional intake, gain weight (if necessary), and gain flexibility overall in their eating. For children and teenagers, CBT-AR is designed to be supported by caregivers. CBT-AR is also an appropriate treatment for adults with ARFID. Dr. Cameron Mosley, Ph.D. provides CBT-AR via telehealth and in person.
What about medication? Because this is a newly defined disorder, there is no evidence to suggest that any psychiatric medications are effective in treating ARFID. Sometimes individuals will be prescribed medications (e.g., cyproheptadine) or try to use THC to stimulate their appetite. In CBT-AR, individuals are taught skills to promote long-lasting change in appetite and eating.