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Avoidant/Restrictive Food Intake

Avoidant and Restrictive Food Intake Disorders (ARFID) often start in childhood, and initially mistaken for “fussy eating”. The key difference between fussy eating and ARFID is that ARFID leads to significant social or nutritional problems such as difficulties in managing body weight, nutritional health, and/or eating out. You might have a very narrow (less than 20) range of acceptable foods based on either

  bullet Dislike of the sensory characteristics of the food such as the colour, smell, texture (sauces, dry, smooth, crunchy changes in texture)
  bullet Perceived properties of the food for example worries about some foods food making you feel full, causing you to choke, vomiting, or feel nauseous. 
  bullet Or being “bad” for your health in some way (see Orthorexia below).

ARFID can be associated with other (sometimes undiagnosed) conditions such as Autism Spectrum Condition, particularly sensory problems. Extreme anxiety around vomiting is often linked to an episode of chocking or vomiting earlier in childhood, or ongoing stomach discomfort. In order to understand how this aversion to some foods has developed and is maintained, it is important to explore which characteristics of the food are problematic, and any associated beliefs, thoughts or concerns with eating the foods avoided.

A psychologist can help you to form a formulation (common understanding about how the problem developed, and what maintains it). Assessment and treatment by a multidisplinary team is usually best. For example a psychologist can assess phobias, distorted beliefs and underlying diagnoses such as ASC, a Specialist Dietitian can help to assess nutritional adequacy of the diet, and consider contributing factors such as Irritable Bowel Disorder.

A specialist OT can assess sensory processing difficulties. Treatment involves graded exposure work to gradually increase accepted of feared foods, alongside work on anxiety, thoughts, and managing any underlying conditions.

Binge-Eating Disorder

Binge eating disorder (BED) is the most common eating disorder, and often affect middle aged people and men as well as younger women. Typically you will experience a strong urge to eat that becomes overwhelming, and results in eating a large volume of calorie dense food in one sitting, leaving you with feelings of guilt or disgust. Where binge eating differs from overeating is the feeling of lack of control over the eating episode e.g. it was unplanned and not wanted.

BED disorder usually develops as a way of managing low self-esteem, critical thoughts, stress, loneliness, low mood or seemingly insurmountable problems that are leading to unhappiness. Dieting and food restriction are significant contributing factors, and often precede a binge eating episode. First line treatment is guided self-help ( GSH) in which you work through a structured workbook with a healthcare professional who has undertaken training in GSH. This will help you to understand what leads to binging episodes e.g. identifying thoughts, emotions and food patterns that may trigger binge eating.

To develop a regular pattern of moderate eating, self-control strategies, distress tolerance, problem-solving skills and explore concerns about body image and weight. If GSH is ineffective or not acceptable to you then ask for a referral to group for cognitive behavioural therapy specifically for BED(CBT-ED). Sometimes BED is a part of a more complex picture of trauma, or other mental health diagnosis, and in these cases seeing a psychologist to consider binge eating alongside other behaviours such as anxiety, self-harm, suicide, or drugs and alcohol misuse is essential; treating BED in isolation is unlikely to be successful.

Dieting can result in BED, and advise from a specialist eating disorders Dietitian is useful in addressing this. Extreme measures such as avoiding all non-diet foods and weighing foods are not long term solutions, and a psychologist or specialist Dietitian can help you to develop skills in self-control. If you are engaged in support from groups such as Overeaters Anonymous, or Compulsive Eaters Anonymous consider also seeking advice from an eating disorders specialist Dietitian and /or a psychologist.


Orthorexia Nervosa

This is a particular sub category of ARFID that is often a precursor for Anorexia Nervosa. You may holds strong beliefs about the characteristics of foods based on their health giving properties, and strongly avoids foods that you perceive are “unhealthy”. Usually you have developed the condition slowly over time; what starts as healthy eating gradually becomes more obsessive in nature.

The difference between healthy eating, and it’s more extreme version is that in Orthorexia the sufferer experiences very high anxiety if asked to eat food that is perceived as unhealthy, and develops strict rules that govern what can and cannot be eaten. These rules cannot be relaxed, even for social occasions such as birthdays or religious festivals. As a result you can become anxious about eating anything that is not perceived as “safe”, exert extreme control over all food eaten, and this often results in a diet that contains a very narrow range of foods, and makes eating out or socialising around food very difficult. If foods form the unsafe list are eaten it will result in anxiety, rumination and guilt.

Orthorexia can affect nutritional status, body weight and /or thinking e.g. you have difficulties concentrating, making decisions and are preoccupied with food. Assessment will involve understanding why the condition developed and what maintains it. Sometimes it is related to a past trauma associated with food, or disease e.g. seeing a relative die from heart disease, or underlying problems with anxiety and control.

Treatment involve seeing a psychologist who can help you to understand how the disorder developed, and the function it servers, and give you skills in managing anxiety and over control, and seeing a specialist Dietitian for impartial and scientifically based information about food. Gradually reintroducing feared food in a way that is manageable.


Pica

Pica is in essence eating items that are not usually considered foods/edible such as coal, paper and paint. This disorders usually develops over time, and can start in childhood, during pregnancy or illness.

There may be a biological, physiological, cultural or psychological reason for developing Pica. For example in some cultures it is normal to eat non-foods items during pregnancy for luck, or as a source of nutrients. Biologically having vitamin or mineral deficiencies such Iron deficiency Anaemia, or altered taste sensations in pregnancy can lead to cravings for non-food items.

Physiologically having hyposensitive taste buds (seeking/ linking strong flavours and tastes such as lemon), or altered sensory processing can again lead to oral stimulation via non-food items e g in conditions such as Autism Spectrum Disorder. There can also a more psychological function such as pleasure derived from chewing paper that was started in childhood as a way of self-soothing, and alleviating boredom that continues into adulthood. Sometimes this is maintained through relationships, reward or environmental triggers or self-punishment.

Assessment will help you to find out which of these factors contribute and maintain Pica. Treatment entails checking underlying conditions such as anaemia, or Autism Spectrum Condition, education around the health consequences associated with eating non-food items, learning alternative ways to self sooth or derive please, and managing urges to eat non-food items. A clinical psychological who specialises in eating disorders and an eating disorders Dietitian can help.



Other Specified Feeding or Eating Disorder (OSFED)

To be diagnosed as having OSFED you must present with a feeding or eating behaviours that causes you significant distress and impairment in areas of functioning such as being preoccupied with food, or problems shopping or eating out, but does not meet the full criteria for any of the other feeding and eating disorders. For example: Atypical Anorexia Nervosa (criteria are met, except that you don’t fear weight gain) or Binge Eating Disorder where you binge less frequently than once a week, or it’s been present for less than a few months.

Alternatively Night Eating Syndrome (Recurrent episodes of night eating) and chewing spitting disorder (where high calorie food is chewed but then spat out) fall into this category. Treatment for these disorders should be the same as the most closely resembled eating disorder in line with NICE guidance, but with an individual formulation (common understanding of why the problem developed and maintains) and treatment plan. A psychologist can assess and help you to formulate a treatment plan. If disordered eating patterns are linked to distorted beliefs and thoughts about food and body weight, advice form a specialist Dietitian should be sort.


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