How to Overcome Avoidant/Restrictive Food Intake Disorder (ARFID)

Definition of ARFID

Avoidant/Restrictive Food Intake Disorder (commonly known as ARFID) is an eating disorder characterized by an individual’s avoidance and/restriction of many foods leading to the intake of a limited variety and volume of food. It was recently added to the DSM-5 to replace and expand upon the previous diagnosis of feeding disorder in infancy and early childhood. It is more commonly present in childhood and adolescence. But it can also occur in people of any age, gender, and background. Due to its symptoms resembling “picky eating” it is often left undiagnosed.

While more research on ARFID must be done, the prevalence is between 0.5% to 5% among the general population. Today, we’ll take a deeper look at ARFID, the signs to look out for, and the steps to overcoming it.

Causes

Unlike other eating disorders, those suffering from ARFID typically do not limit their food intake due to body image-related issues. Instead, common triggers for ARFID may include lack of interest for food and sensory sensitivities that cause strong aversions to the food’s characteristics such as the food’s texture, smell, and/or taste.

Another possibility is that a past trauma related to or involving a certain type of food occurred. For example, becoming ill, vomiting, or choking while eating a specific food. Due to this, an intense fear of eating that food may develop.

Warning Signs and Consequences of ARFID

A person with ARFID may experience serious physical and psychological consequences.

Those warning signs and symptoms may include:

Lack of appetite and interest in food
Anxiety when presented with “fear” foods
Weight loss
Growth failure in children and adolescents
Avoiding particular foods- can be for several reasons (Smell, taste, color, texture etc.)
Frequent gagging or vomiting when exposed to certain foods
Fear of eating due to the possibility of choking and vomiting

Nutritional deficiencies including anemia and vitamins B and C deficiencies
Fatigue, dizziness, difficulty concentrating, being cold all the time
Gastrointestinal issues such as bloating and constipation
Electrolyte imbalances resulting in irregular heart beat, low blood pressure and kidney issues
Social anxiety especially when food and meals are served
Low self-esteem and depression
A low food intake resulting from selective eating can also result in an irregular menstrual cycle or the loss of menses.

Steps to Overcoming ARFID

Once ARFID has been diagnosed, early intervention has been shown to play a key role in the treatment’s success. The goal of which, is to ensure the individual meets their nutritional needs to optimize their physical health. Another goal of the treatment is to decrease the anxiety and stress around food.

Treatment

Treatment will differ on a case-by-case basis. As we mentioned above, the cause(s) of the disorder will vary for each person. As such, the treatment should be catered to each person’s needs. Forcing the foods will not have a positive effect. It is important to respect the level at which the person desires to try new foods.

The process of overcoming ARFID requires a multi-disciplinary team, as there are mental, medical, and nutritional components involved. Among this team, would be a doctor to first address any weight and vital signs issues and nutrient deficiencies. A psychologist/therapist who specializes in eating disorders and a nutritionist who also specializes in eating disorders will also be involved.

They will decide which approach will be best depending on the individual and those interventions may include:

Cognitive Behavioral Therapy for ARFID

This is done by digging deeper to identify the beliefs and thoughts associated with the fear foods and replacing them with less anxiety-provoking thoughts.

Family-Based Therapy for ARFID (FBT-ARFID)

This approach teaches the family how to best support the individual suffering from ARFID. Meal planning strategies can be discussed to decrease stress that comes with the unpredictability of unplanned meals. Also, talking about how to offer meals in a positive eating environment can be helpful.

Gradual Food Exposure

The food exposure can be done in a gradual manner starting with the least fearful foods and focusing on one food at a time to make it less anxiety-provoking for the individual. This is also done at the pace of the latter in a non-pressure way. As the individual becomes less fearful and anxious around that specific food, the focus can be shifted to another food that the they feel comfortable trying.

Addressing Sensory Sensitivities

It is an option to work with an occupational therapist to improve tolerance of certain textures, smells, or tastes.

It is first important to fully understand the disorder so as not to invalidate the struggles of those suffering. Doing so will only make it more difficult for them to willingly expose themselves to their fear foods. Overcoming ARFID is possible with the proper guidance, care, and patience.

At NutriVie Santé, our nutritionists who specialize in ARFID will help you or your loved ones have a healthier relationship with food.

This begins by helping you to understand them better. We will then work with you to help you meet your nutritional needs first with your safe foods and stabilize and maintain a healthy weight if weight restoration is needed. If the individual is ready to explore new foods, the nutritionist will use exposure therapy to help the individual try new foods at their pace and in the least anxiety-provoking way possible.

Our eating disorder dietitians also provide parents with the proper tools and advice to help them navigate the issue. Thus, enabling every parent to better support their child by removing the pressure to try new foods which could ultimately reinforce the issue. Whether for yourself or a loved one, recovery from ARFID is possible.

Our eating disorder nutritionists are available to help you at our treatment clinic. Feel free to contact us here or by calling one of our locations in Westmount (514-965-5175) or Dollard-des-Ormeaux (514-965-5175).

March 28, 2025/by Votre nutritionniste Jaimie Yue

Eating disorders, Healthy eating

Helping Your Teen with Anorexia: A Parent’s Guide

Anorexia is an eating disorder that is characterized by food restriction usually due to an intense fear of gaining weight or the desire to lose weight. It affects all races, gender identities, and body types.

While anorexia can affect people of all ages, it can be quite prevalent among teenagers. As a parent, helping your teen suffering from anorexia can undoubtedly feel overwhelming and confusing, especially, given the complexities of the disorder. The purpose of this article is to provide you with tips to support your teen throughout recovery from anorexia.

Educate Yourself About Anorexia

Anorexia is not merely about food restriction and body image issues. It is important to recognize that anorexia is a mental disease and not a choice. Therefore, it is not a question of a lack of willpower to eat more. It is extremely difficult for your teen to do so given that anorexia goes beyond food restriction and body image issues.

For instance, the root causes can go much deeper and may include:

lack of self-esteem
using restriction as a coping mechanism to deal with anxiet
perfectionism
identity crisis, among many other possibilities.

It is also important to note that weight is not a diagnostic criterion for anorexia. Your teen could be considered to be in the “normal” range for weight and still have some warning signs and symptoms of the eating disorder. To learn more about the signs and symptoms of anorexia, you can head over to this article.

Approach Your Teen with Compassion

If you discover that your teen has been restricting their food intake, the last thing you should do is blame them. Or, pressure them into eating. It can be incredibly easy for the concerns and worries you have to translate poorly. Instead, take a small step back to gather your thoughts and emotions.

Begin by trying to step into their shoes and look at the issue from their perspective. It is far from easy for someone to share such personal and intimate information with another person. This is especially true for teenagers who may not yet know how to process their emotions.

Reacting in a healthy and non-judgemental manner can provide your teen with a boost of hope. At this time, express your concerns while making a point to use “I” statements. For example, “I am worried as I see you struggling with food”, instead of “You are not eating enough and you should force yourself to eat more.”

It is important to acknowledge your feelings while showing your support and understanding. This will help to keep the lines of communication open, which, is an important part of treatment.

Seek Professional Help

Eating disorders like anorexia are considered both mental health disorders and medical illnesses. Thus, treatment should involve both medical and mental health professionals. These professionals should have experience specializing in treating eating disorders.

It is also recommended that an eating disorder nutritionist be involved. With the help of such professionals, your teen can become educated on how to eat better to meet their needs, decrease any fear associated with eating certain foods, understand the impacts of various nutrients on their body and address body image issues.

Through individual counseling, the eating disorder nutritionist can cover:

Thorough nutrition evaluation to assess your teen’s needs, eating habits and behaviours and triggers that maintain the eating disorder
Teaching about nutrition’s role in their health and body
Teaching how anorexia causes nutrition, mental, social and physical issues
Correcting/treating possible health problems created by poor nutrition
Setting regular eating patterns and the steps needed to avoid restricting
Meal planning and working towards weight restoration if needed
Follow-up sessions to go over any questions or concerns

Create a Supportive and Safe Environment at Home

Creating a recovery-positive home is one of the best ways to remain supportive. This can be done in many ways, including:

Encouraging your teen to speak openly about their body image and food struggles
Remaining flexible and compassionate
Avoiding conversations revolving around weight, appearance, size, physical activity, and dieting.
Complimenting non-physical/non-appearance-related qualities (i.e., kindness, humor, etc.)
Avoiding labeling foods as “good” or “bad”, “healthy” or “junk”
Creating a consistent meal schedule with the help of professionals to ensure the meals aren’t triggering or anxiety-inducing
Creating a positive space at mealtime by eating together without pressure or interrogations; striving for a positive family interaction
Being mindful of how you speak about yourself. Teens pick up on certain behaviors and beliefs. If you criticize your own body or eating habits, those thoughts and behaviours could be picked up by your teen.

Be Patient and Consistent

Recovery can be quite long and non-linear. This is why it’s important to normalize and accept the hurdles that come your way. A technique usually applied during meal support (but good to keep in mind at all times), is the 4 C’s.

- Calm: Your teen will pick up on your anxiety or other emotions. While this shows that you are also human, there is a time and place to fully release these emotions. Rather than make your teen feel more anxious, try your best to remain calm. Be sure to take some breaks if you feel you are at a breaking point.
- Consistent: “Consistency is key”. Once healthy changes have been made and rules are set to keep them in place, try to stick to them.
- Confident: Even when you may not feel the most confident, make sure your teen sees that you will not falter. Your confidence will provide your child the reassurance they need to continue fighting for themselves.
- Compassionate: Acknowledge that what your teen is going through is far from easy. As scared as you may feel, it is most likely an even scarier experience for them.

Take Care of Yourself Too

Experiencing caregiver burnout as the parent of a teen with anorexia is more than a fleeting emotion. It takes a toll on you mentally and physically. Combatting this burnout often requires significant changes in behavior, along with implementing self-care practices, and leaning on your support systems.

Support Systems

There are a few non-profit organizations which offer support and guidance for the loved ones of individuals suffering from an eating disorder. For instance, ANEB has offered support to those suffering from eating disorders and their families across Quebec for over 30 years. This includes support groups for families, online chat/text services, and many other free resources.

For more information, you may contact ANEB directly here. Or, feel free to book an appointment with one of our NutriVie Santé eating disorder dietitians to learn more about ways we can help you.

March 4, 2025/by Votre nutritionniste Jaimie Yue

Eating disorders, Healthy eating

5 Steps for Bulimia Recovery

What Is Bulimia Nervosa?

Before we begin, let’s define what exactly is Bulimia Nervosa? Bulimia nervosa is an eating disorder characterized by episodes of compulsive eating that are followed by compensatory behaviors such as vomiting, excessive exercise, fasting, and/or abuse of laxatives or diuretics.

It can lead to detrimental impacts on physical, mental, and emotional well-being. On the physical side, this may include but is not limited to digestive issues, dental problems, cardiovascular complications, and irregular menstrual cycle (or complete loss of periods).

On the psychological and emotional side, symptoms include intense feelings of guilt and shame after episodes of food compulsions and purging, anxiety around meal times, negative body image issues and increased isolation.

Since the binge-purge cycle can lead to damaging effects on several spheres of your life, it is important to take actionable strategies to break the vicious cycle. Here are 5 ways to break the binge-purge cycle:

1) Stop Restricting Food Intake To Stop The Binges

Often, binge-eating episodes occur when the body is deprived of food throughout the day. As the body doesn’t get enough food to meet its needs, it will give you the urge to eat to compensate.

While it may be very difficult to not skip meals and/or snacks and not eliminate some food groups, it is strongly recommended to eat regularly throughout the day, ensuring that each meal contains carbohydrates and proteins and that the food is satisfying for your taste buds while not being too anxiety-provoking. If you need help with this, one of our eating-disorder nutritionists is here to provide you with guidance.

2) Identify The Triggers For The Binges & The Compensatory Methods

Binge eating and compensatory methods are often used as coping mechanisms to deal with certain emotions and situations. Frequently, these urges arise in a way similar to waves which will reach a peak and the decline.

Identifying the triggers can help devise a plan of action to help you “surf” the waves. Making a list of 5 things you can do instead of engaging in binges and compensatory methods can be an effective exercise.

3) Work On Decreasing The Compensatory Methods

As mentioned above, compensatory methods are damaging to the body. Being aware of those detrimental impacts could be a first step to motivate you to stop those behaviours.

However, since compensatory methods are hard to stop drastically, it is better to attempt to delay them gradually. For example, start by delaying the engagement in the behavior by 5 minutes. From there, gradually work your way up to longer periods of time. Doing so may offer the time needed to formulate a different method of coping with your emotions and give you the opportunity to break the autopilot mode of purging right after eating.

4) Try To Neutralize The Negative Body Image Dialogue

Focusing on weight and meeting unrealistic standards of thinness can lead to restriction which, in turn lead to binges and compensatory methods. When such thoughts and possibly negative self-talk come into the equation, try to change the narrative. The following are a few ways in which this may be accomplished:

Replace Negative Self-Talk

We’re still human; everyone experiences moments of insecurity. However, before these negative thoughts about your body become a loop in your head, try to neutralize the thoughts. For instance, if you have thoughts such as “my legs are fat and I hate them”, you can neutralize that thought by saying “my legs do not define me as a person or does not define my self-worth and value.”

Focus on Body Functionality

Rather than focusing on the appearance of your body, think about all your body enables you to do. For example, “My legs are strong and help me walk long distances”. Or, “My arms are the reason I can lift heavier objects.”

Curate Social Media Feeds

Social media can definitely be a trigger in reinforcing negative body image issues. If there are accounts that promote unrealistic or unhealthy body standards, unfollow them. Instead, try to find accounts about body neutrality and diversity and even accounts about your hobbies and interests that are non-body related.

5) Seek Professional Help

Help from a psychologist, doctor, and an eating disorder dietitian is highly encouraged for bulimia recovery. Each professional will help cover different components of the eating disorder and offer various treatment methods.

Psychologists

There are a range of psychological treatments available to help treat eating disorders. Some of the most effective therapies for bulimia include Cognitive Behavioural Therapy (CBT) and Dialectical behavioral therapy (DBT).

Treatment will vary depending on the patient, therefore speaking to a professional is advised.

Doctor

Having a doctor know the specific details of the case is integral in recovery. Because bulimia could have many detrimental impacts on physical health, a doctor will be able to monitor vital signs, weight changes and specific blood markers to offer the right plan of action on a case-by-case basis.

Bulimia Recovery Dietitian

The help of a licensed eating disorder dietician/nutritionist specialized in bulimia is undeniably important for bulimia recovery. They can help you or your loved one by creating a plan to make sure they eat enough to meet your needs, normalize fear foods by demystifying any belief around food, explain your body’s and metabolism needs and help you eat intuitively on the long term.

To help in your journey to healing your relationship with food, we at NutriVie Sante are here to support you! Contact us today to discover how we can begin the process together.

February 3, 2025/by Votre nutritionniste Jaimie Yue

Eating disorders, Healthy eating

Debunking Common Myths About Eating Disorders

Eating disorders are serious mental illnesses that could have several detrimental impacts on an individual’s physical, mental and social well-being. In fact, if left untreated, they could be fatal in some cases. For instance, anorexia nervosa has the highest mortality rate of all psychiatric disorders with approximately 5% of sufferers dying within 4 years of diagnosis. Therefore, prompt action is needed to diagnose individuals when warning signs and symptoms start to appear.

However, some common myths about eating disorders make it hard for sufferers to seek help or for their loved ones to recognize the red flags. Hence the importance of debunking those myths.

Myth: Eating disorders are just about body image and food

An intense fear of gaining weight leading to the need to exert excessive control on food can definitely be a trigger for eating disorders. However, at the core, eating disorders go beyond food and body image. They are complex disorders triggered by multiple factors: psychological, genetic and environmental.

For instance, if someone experiences a lot of anxiety, the eating disorder could be used as a coping mechanism to give them a sense of control or reassurance to deal with their emotions. In other cases, the individual could also suffer from low self-esteem and use food to control their body weight and shape in an attempt to increase their self-worth and value.

Therefore, for the treatment process, it is important to dig deeper to get to the root causes of the eating disorder and address the underlying issues. It certainly is not as simple as the individuals having to force themselves to eat in the case of restrictive eating behaviours or have more willpower to snap out of binge eating episodes.

Myth: Eating disorders affect only women

Eating disorders certainly do not discriminate according to gender. In fact, research has shown that about 25% of people who suffer from anorexia and bulimia are male.

Men are also subject to the societal pressure of conforming to a specific body image standard, namely that of being lean and muscular and could develop eating disorders in an attempt to reach those standards. However, due to the stigma that an eating disorder is a “female” medical condition, boys and men may find it hard to seek help as there is a fear of being perceived as too weak or vulnerable or because they just do meet the diagnostic criteria.

The most common eating disorders among men include: bigorexia (the obsession of gaining muscle mass through excessive exercise, obsessive and restrictive eating behaviours and use of supplements), anorexia, bulimia and binge-eating disorder.

Myth: You have to be underweight to suffer from an eating disorder

While weight could be a common symptom observed in people suffering from eating disorders, it is important to note that it cannot be used as a diagnostic tool as outlined in the DSM-V which is the reference book on mental health and brain-related conditions written by the American Psychiatric Association’s professional.

For instance, some individuals suffering from anorexia could experience weight loss but still be within the “normal” range for BMI. Also, for people suffering from bulimia, they may also appear to be at a “healthy” weight due to compensatory methods. Because of the diverse manifestations of eating disorders surrounding weight, it is important not to focus on the latter as it may lead to under-reporting or misdiagnoses.

Instead, there are other more accurate physical, psychological and behavioural signs and symptoms to watch out for. Here are some examples: fatigue, dizziness, irregular periods or loss of menses, decrease in vital signs (heart rate and blood pressure), anxiety and guilt around food, obsessive thoughts about body image, increased isolation, etc.

Myth: The onset of eating disorders only occurs during adolescence

Although eating disorders often develop during adolescence because it is a vulnerable period riddled with physical, emotional and social changes, people of all ages (children and adults included) can start suffering from an eating disorder at any period of their life. For instance, ARFID commonly develops in childhood.

Also, children as young as 5- or 6-year-old could suffer from anorexia or bulimia. In fact, research has shown that children could become conscious of different body types as young as 3-year-old. Hence, it is strongly advised to be careful when talking about food and body image even when children are young.

On the other hand, the onset of eating disorders could also happen later in life in adults. For instance, life events resulting in body changes such as pregnancy and postpartum or menopause could lead to an unhealthy relationship with food and body.

Myth: Recovery from eating disorders is not possible

Even if the road to recovery can be long and full of challenges, it is definitely possible to recover! To maximize chances of recovery, a multidisciplinary team is recommended. The healthcare professionals on that team should consist of a doctor to monitor vital signs and weight, an eating disorder nutritionist to help the individual meet their nutritional needs and overcome their fear of eating certain foods as well as a psychologist to address underlying issues such as body image, anxiety, low self-esteem, etc.

Early detection and prevention are key. That is why it is important to break all the stigmas about eating disorders and to remember that they can affect individuals of all ages, gender and weight. It is also worthy to keep in mind that eating disorders are not just about food and that you CAN recover!

If you recognize some warning signs and symptoms in yourself or a love one but don’t know where to start to seek help, you can call the NEDIC helpline or the ANEB helpline. These are non-profit organizations providing a free and confidential phone line to offer support and address your struggles with food.

And of course, you can reach out to one of our eating disorder dietitians. In our one-on-one consultations, you can share your struggles related to food and your body in a safe and non-judgemental space. We will provide you with individualized recommendations to help you heal your relationship with food using a step-by-step approach as we are aware that it can be quite anxiety-provoking to let go of the control on food. And if you want to reach out for a discovery call before booking an appointment, feel free to do so and we will gladly take some time with you to discuss your needs, explain our approach and make sure our eating disorder therapists is the right fit for you. We are here to help, so don’t hesitate to contact us!

July 22, 2024/by Votre nutritionniste Jaimie Yue