Treatment of selective eating disorders

Avoiding selective eating disorders (ARFID) is an eating disorder that limits the amount and type of food a person eats. Unlike other eating disorders, such as anorexia nervosa, people with ARFID do not restrict their diet because they want to change their appearance and weight.

People with ARFID may restrict their diet for several other reasons, such as being uninterested in eating or being afraid of disgusting consequences (such as choking or choking). vomiting), Or sensory sensitivity.

ARFID can have serious implications for a person’s physical and mental health.The· Eating disorders It can cause complications such as weight loss and delayed growth and development. People with ARFID may also experience results malnutrition Low heart rate, loss of menstruation, Electrolyte imbalance..

Since ARFID is a relatively new diagnosis, there is no standard treatment. Although there is extensive literature on the treatment of eating disorders in children, there are no randomized controlled trials evaluating the effectiveness of ARFID treatment in adolescents and adults.

Clinicians with patients with ARFID rely on their clinical experience and judgment, and the limited research available.

This is an overview of several options available for the treatment of ARFID.

Prescription drugs

Prescription drugs are usually not the first-line treatment for ARFID. Currently, there are no randomized controlled trials that support the use of prescription drugs to treat ARFID. Also, no drug to treat this disorder has been approved by the Food and Drug Administration (FDA).

However, based on their experience and reviews of available studies, clinicians Prescribe off-label use For patients with ARFID.

Drugs that may be off-label prescription for ARFID include:

• Cyproheptadine: this is Antihistamine It can stimulate the appetite. This can help babies and toddlers with ARFID who have lost interest in food and are underweight.
• Mirtazapine: This antidepressant is also known as RemeronMay be used to stimulate appetite and tend to lead to weight gain. Evidence supporting its use in ARFID is limited to case reports, although it may help reduce dietary fear.
• Lorazepam: This benzodiazepine is more commonly Ativan, May be prescribed to reduce dietary anxiety.
• Olanzapine: It is also known as an atypical antipsychotic Zyprexa.. It is sometimes used to reduce anxiety and cognitive rigidity that affect a person’s food beliefs, and it can promote weight gain.

Clinicians should also consider other medications a person is taking before deciding to prescribe off-label treatment. Many people with ARFID have different (co-occurring) mental health conditions.

The following are examples of concurrency conditions that a person with ARFID may have. Attention deficit hyperactivity disorder (ADHD). Stimulants used to treat ADHD have been shown to suppress appetite and exacerbate ARFID in both research and clinical practice. If a person has both ARFID and ADHD, the doctor will need to adjust the medication accordingly.

Medical

ARFID is considered a mental health condition like any other eating disorder, but it can be serious. Physical effects.. Treatment with ARFID is necessary to prevent the long-term health effects of weight loss and malnutrition.

An interdisciplinary team of medical and mental health professionals is recommended for the treatment of ARFID. You need a coordinated approach to building a team to support someone with ARFID, which may include:

• Nutritionist
• Gastroenterologist
• Doctor
• Mental health clinician
• Occupational therapist
• Vocal language pathologist

People with severe ARFID may need to be hospitalized or participate in a residential or partial hospitalization program. Treatment settings depend on the severity of food restrictions in a person, the level of malnutrition, and weight loss.Refeeding at Nutrition tube (Enteral nutrition) may be part of a person’s treatment.

A 2017 study found that ARFID can be successfully treated with a partial hospitalization program designed for common eating disorders. Compared to other patients with eating disorders Partial hospitalization programPatients with ARFID had similar improvements in weight and psychological health, but for a shorter period of time.

In some cases, dietary restrictions and refusals in ARFID patients are serious. In a 2015 study with patients with ARFID Anorexia nervosa People who were hospitalized due to malnutrition.

The results of this study showed that ARFID patients generally required longer hospital stays than patients with anorexia nervosa (8 days compared to 5 days) and were more likely to require feeding tubes.

Treatment

Once a person’s urgent physical needs are met and medically stable, treatment is often the next step in ARFID treatment. There are many types of treatments available, each offered by a different clinician.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of psychotherapy used to treat a variety of mental health conditions, including eating disorders. CBT helps trained therapists learn to identify distorted thought patterns, change their thinking, and ultimately change their behavior.

There is plenty of evidence to support the effectiveness of CBT in treating eating disorders, including anorexia nervosa, bulimia nervosa, and bulimia nervosa. Bulimia..

However, there is a lack of quality evidence regarding CBT as a treatment for ARFID. Very few case reports suggest that CBT may help some people in this condition.

CBT-AR

CBT-AR is a new special form of CBT being developed by the Massachusetts General Hospital Eating Disorders Clinical Research Program team. Currently in clinical trials.

The first survey of CBT-AR, published in 2020, found that 70% of participants who completed a round of CBT-AR were disqualified from ARFID diagnostic criteria.

With the philosophy of “Volume Before Variety”, the program includes 20 to 30 sessions. This method encourages patients to eat large amounts of their favorite foods for the purpose of weight recovery before introducing new foods.

Family-based treatment (FBT)

Family-based treatment (FBT) is a type of behavioral therapy commonly used for treatment. Eating disorders in children And the youth. FBT removes accusations from patients and their families and considers eating disorders as external forces. The entire patient’s family is treated together as a unit to deal with the patient’s eating disorder.

A small study of six ARFID participants found that all participants achieved their target weight after medical monitoring, medication, and treatment with FBT. However, more studies, especially randomized controlled trials, are needed to determine the true effectiveness of FBT in children with ARFID.

Occupational therapy

Occupational therapist Take a holistic approach to restoring health, well-being, and function through assessments and techniques designed to develop or restore meaningful activities and professions.

Occupational therapists complete a complete assessment of sensory, motor, developmental, environmental, cultural, and behavioral factors that can impair diet.

Children co-occurring with ARFID Sensory processing disorders, Autism Spectrum Disorders (ASD), or ADHD may work with an occupational therapist in an outpatient setting. Patients with eating disorders may also receive occupational therapy in residential or inpatient settings.

Interventions are personalized to people with ARFID, but include tactile play to facilitate verbal acceptance, food chain techniques, and social stories about self-sufficiency and diet. Operant conditioning,and Sensory diet..

Speech therapy

A Speech therapist (Speech-Language Pathologist) is another type of rehabilitation specialist who can be part of the ARFID treatment team.Speech therapists speak, hear, and swallow..

Speech therapists use a variety of interventions to work with people of all ages. For example, techniques such as pre-chaining, food chaining, and feeding programs for different consistency can help people swallow different textures more comfortably.

A word from Verywell

There is no standard treatment for ARFID, and quality research is limited to the effectiveness of the options available. There are no specific medications for ARFID, but clinicians may prescribe off-label use medications to help people with symptoms, such as antidepressants and appetite-stimulating medications.

The first step clinicians take to help someone with ARFID is to assess their health. If you are malnourished or have severe underweight, people with ARFID should be hospitalized or participate in a residential eating disorder treatment program. Feeding tubes may also be needed to help them gain weight and correct malnutrition.

Once a person with ARFID becomes medically stable, an interdisciplinary team of medical and mental health professionals will continue to assist in managing the condition and avoiding serious health effects.