Hi, my name is Stephanie,
and today we're going to be talking about something that might seem like
just extremely picky eating at first, but might be something more.
If this sounds a little familiar, we did talk about food selectivity
before and same foods here on the channel.
And if you haven't watched that video, I suggest you do, so I'll try to link it
here for you.
I think the video is still quite relevant to this conversation
because we go over some reasons why some people might be pickier
with their food than what might be considered typical picky eaters.
However, we were talking about some terms that people used, including same food
and safe food, and online it seemed like they were being used interchangeably.
And so I kind of reflected that in my video.
However, same food and safe food are not the same thing.
And thank you to the people who let me know that in the comments.
So, when we're talking about safe food, we're specifically referring
to the condition ARFID that we're going over today.
Now, if you are sensitive to discussion of eating disorders just across the board,
this probably isn't the video for you because this is technically
an eating and feeding disorder.
So, today, we're going to be talking about ARFID, A-R-F-I-D
avoidant restrictive food intake disorder.
Please note that while many autistic people
can be quite picky eaters, ARFID does have
a pretty specific criteria for people to meet to be considered diagnosable.
So, that doesn't mean that if you're a picky eater or you maybe do
same food a lot that automatically puts you in ARFID,
and we will be going over the requirements and the diagnostic criteria.
One source does note that the co-occurrence rates of ASD
and ARFID have been noted to be anywhere from 3% to 13%.
So while this is clearly relevant, that doesn't mean that it's super
likely that just because you're autistic, that you have ARFID.
In fact, many of you may find yourself ranging from picky eater
to ARFID, somewhere in the middle there as an autistic person.
If you do have any concerns that you might have ARFID or
anything related to feeding and eating disorders,
I highly recommend that you talk to your doctor
and just consult with them to make sure that, you know,
everything is good for you and you can address things for your well-being.
So, as we've discussed before, a lot of changes happened in the DSM-5
when it was released in 2013,
and that's not limited to autism.
In fact, ARFID being a feeding and eating disorder
is actually new to this most recent publication of the DSM.
The following is a description of what the DSM-5 considers to be ARFID.
ARFID is characterized by avoidant or restrictive eating, resulting in one
or more of the following: significant weight loss or failure to achieve expected
weight gain, nutritional deficiency, dependance on enteral feeding or oral
nutritional supplements, and interference with psychosocial functioning.
While some people may be aware, and some sources do note, that autistic
people are at risk for also developing other types
of eating disorders that you may be more familiar with,
ARFID requires that the disorder is not due to abnormalities
in how one views their body weight or shape and cannot be explained
by a concurrent medical condition or mental disorder.
There's also a provision regarding lack of food and cultural practices.
ARFID has three main presentations, although do note that one
person can have more than one presentation of ARFID at the same time.
These presentations are avoidance based on the sensory
characteristics of food, fear of aversive consequences
associated with food intake, and lack of interest in food or eating.
So, avoidance based on sensory characteristics is really where
autistic over picky eating can really cross into ARFID.
When someone is reaching the point to where it is interfering with their weight,
their health, their nutrition and the psychosocial situation,
that's when we're starting to talk about ARFID, and not just
my kid has autism and they're really picky eating.
And on a personal note,
I do think that there are people who have ARFID but go undiagnosed
because their parents or they themselves just attribute it to autism,
because a lot of times autism gets used as a catch-all for everything.
So every problem someone has, oh, it's the autism.
And so sometimes people don't realize that there might be a different approach
to something because not just autistic people experience this.
And to be clear,
someone does not have to have autism or sensory processing disorder
to have this presentation of ARFID or any presentation of it in general.
The next presentation of ARFID is a fear of aversive consequences.
This can be like a fear of choking or dying or intense pain
or something of that nature, and this fear is so intense
that it can cause a physiological response.
In fact, one person reports that swallowing certain foods
or even thinking of swallowing them, leads to undesirable outcomes
like the throat involuntarily closing, retching and vomiting.
And this fear is oftentimes not unfounded.
Another source notes that case studies show that many people with ARFID
have suffered from a traumatic incident as a toddler, a feeding issue as an
infant, an umbilical cord around the neck at birth, or even in-utero trauma.
This aversive
presentation does have a tendency to be linked with anxiety disorders.
One study noted that people that they considered to fit the aversive
profile had a 70% prevalence of anxiety disorders.
Another study found that 77% of those exhibiting
what they called the fear profile had a comorbid anxiety disorder.
Yet another paper urges practitioners to consider GI issues
or other issues as secondary reasons for someone to develop ARFID.
In that paper, they discuss a man who had pedundal
nerve entrapment due to a surgery he had to have.
The nerve entrapment ended up
causing a lot of pelvic pain, constipation, and painful bowel movements,
and he ended up developing the aversive form of ARFID.
Especially concerning the aversive or fear type, whatever you want
to call it, presentation of ARFID, it makes sense for foods
that are OK to eat to be called safe foods.
These could literally be foods that are considered not dangerous,
as in I'm not going to die if I eat this, thus it is safe.
So, while same foods and safe foods can overlap, for example,
you might eat the same safe food every single dinner for who knows
how long, that doesn't mean that they're necessarily the exact same thing.
Now, this third presentation is a lack of interest in eating.
Although it has been hypothesized
that major depressive disorder might be comorbid with ARFID
or might tend to be comorbid, a study that was going over the psychiatric
comorbidities with ARFID actually didn't find any evidence to support this claim.
So, an untested hypothesis coming from me
here is a possibility of issues with interoception.
For example, maybe not feeling the hunger feeling or not
much of it, or maybe feeling full all the time or way too often.
That might make someone uninterested in food,
but again, that's just a random thought from me.
ARFID is a serious condition
that can cause a lot of anxiety and medical complications.
One source mentions that it is very difficult to get someone
with ARFID to move outside of their very short list of safe foods.
And can you really blame someone who feels like
if they try something else, they might choke?
Or that they just can't open their mouth to eat it?
Having things you know you can eat is a lot easier
than trying things you're not sure if it's going to be OK to eat.
However, there are some recent treatments that have been able to show improvement
for some.
One treatment called SPACE-ARFID or supportive parenting for anxious
childhood emotions adapted for avoidant restrictive food intake disorder
was tested on a small group and saw positive outcomes.
Now, a very important aspect of treatment or therapy is how the condition
is approached because there is already a lot of anxiety, likely strife,
and other issues surrounding food and the adding pressure to someone
to change isn't going to really help because they're already receiving that.
They're, they can't help that they respond the way they do to these foods.
The thing is, if you add pressure, you might be making more anxiety
for the situation.
But if you're extremely accommodating, this can also cause more issues.
This is something they discuss
in the SPACE-ARFID program, where they emphasize supportive responses
that acknowledges and accepts the child's genuine distress, but also conveys
confidence in the child's ability to cope with and tolerate said distress.
The program focuses on the parent and their behavior rather than the child,
so that they can avoid parent child strife and putting more pressure
and anxiety and expectations on the child.
However, the study did exclude a lot of different diagnoses, likely to eliminate
too many variables, which excluded anyone with a diagnosis of ASD.
So, we don't know how that particular program might affect
autistic people who have ARFID.
Either way, it is encouraging to see that
there are treatment options being looked into, developed, etc.
for this condition.
I don't feel that this disorder has had much attention, and it's
kind of concerning considering a one large community study
reported a prevalence of 3.2% in those ages 8 to 13 years.
That's not just the autistic population that's in general.
I hope this video helped you understand what ARFID is and also help
to be a bit of a supplement to our earlier video and discussion on selective eating
and picky eating and autism, and maybe how all of these things
can affect each other. Thank you so much for watching.
If you enjoyed this video, go ahead and hit that like button
and let me know your thoughts on this in the comments below.
Did you watch the previous video?
Does that clear up anything with this video?
Did you already know about ARFID, all of that jazz?
Let me know in the comments.
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I try to upload every Thursday at 4:00 p.m.
Central Standard Time unless we're doing a live stream at the end of the month.
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Thank you so much for watching, and I hope you have a wonderful week. Bye!