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A different way to understand 'fussy eating' and eating weird stuff. Avoidant/restrictive food intake disorder (ARFID) is defined by the DSM-5 as an eating or feeding disorder characterised by a persistent and disturbed pattern of feeding or eating that leads to a failure to meet nutritional/energy needs.
Pica is a compulsive eating disorder in which people eat nonfood items. Dirt, clay, and flaking paint are the most common items eaten. Less common items include glue, hair, cigarette ashes, and feces. The disorder is more common in children, affecting 10% to 30% of young children ages 1 to 6. It can also occur in children and adults with intellectual and developmental disabilities. On rare occasions, pregnant women crave strange, nonfood items. For these women, pica often involves eating dirt and may be related to an iron and zinc deficiency.
ARFID & AUTISM
Eating problems are common autistic individuals. Difficulties such as only eating a very few foods, going a long time without eating and extreme anxiety about foods and mealtimes are frequently reported. These problems are not always understood and as a result, parents/carers and the individuals themselves often report feelings of stress, helplessness and blame. For some, these problems can be managed relatively easily with the right support, for others the eating issues can have a lasting and debilitating impact leading to weight loss and/or malnutrition, increased social withdrawal and stigma. Many autistic people meet the criteria for a diagnosis of ARFID. This can lead to a better understanding of the eating challenges and more support and professional help.
IS ARFID DIFFERENT IN AUTISTIC PEOPLE?
There are many similarities in the eating patterns of autistic people with ARFID and those who have ARFID but no additional autism. These include: Sensory sensitivities, high anxiety around foods/eating situations and lack of interest in food. However, in autistic individuals (both children and adults) these issues can be more severe and more resistant to treatment. This is simply due to the additional difficulties and differences having autism places on the person. For example, sensory issues can be heightened and more complex; routines and rituals around foods can be more inflexible and rigid due to additional anxiety about change and the autistic person often has more problems recognising and responding to internal body states such as hunger or being full (known as ‘interoception’).
Autistic people also have extra difficulties communicating and interacting with others (often called ‘social-communication’ difficulties). This means it can be harder for them to explain their difficulties with food, it can be harder for family and friends to understand and manage the issues and harder for the individual to participate in treatment, particularly if this is offered in a group or is a ‘talking therapy’.
WHAT OTHER EATING PROBLEMS MIGHT AUTISTIC PEOPLE HAVE?
In addition to having an ARFID style pattern of eating it is increasingly recognised that autistic individuals are at risk of developing other eating problems or disorders such as Anorexia Nervosa (AN) or Bulimia Nervosa (BN). Typically these eating disorders often appear for the first time in adolescence or early adulthood (whereas ARFID is often more obvious in earlier childhood) and often lead to serious weight loss and other physical and mental health problems. For more information about these types of eating problems and where to find support see: www.beateatingdisorders.org.uk
Given that these type of eating disorders are generally more common in females; autistic girls and women appear to be more at risk. In addition, for some autistic girls and women controlling eating is a way of managing overwhelming feelings of anxiety. This can be particularly true during adolescence where physical changes such as puberty and social and academic pressures can cause anxiety to spiral out of control. As a result, it is very important that such anxiety and associated eating problems are recognised early and given the right support. For more information about these types of eating problems and where to find support see:
In addition to having ARFID some autistic people display ‘Pica’ which is the medical term for eating non-foods. Commonly eaten items include: Paper, cloth, wood, plastic, stones, earth, metal and faeces. Pica carries serious health risks with only 1 episode having the potential to lead to significant harm. For more information about these types of eating problems and where to find support see: https://network.autism.org.uk/knowledge/insight-opinion/james-frankish-and-pica
We don’t know what causes pica and there may even be different types of pica behaviour. For autistic people managing sensory needs and supporting anxiety appear to be important as is controlling access, wherever possible, to potentially dangerous pica items. Doing so can help keep the individual safe and possibly even reduce the individual engaging in pica. For more information about these types of eating problems and where to find support see: https://network.autism.org.uk/knowledge/insight-opinion/understanding-and-managing-pica
*This information came directly from the ARFID website. Credit for content is theirs. https://www.arfidawarenessuk.org/the-link-with-autism-1
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