Like many eating disorder nutrition practices, this year we’ve seen an influx of complex, complicated and even atypical cases come to our virtual doorsteps. The pandemic has given us an opportunity to work with a more robust and complete picture of eating disorders that span the spectrum of age, gender, race and symptom presentation.
Among the variety, we’ve been presented with more clients with ARFID (Avoidant/Restrictive Food Intake Disorder) and sensory processing issues. We thought it would be helpful for us to untangle similarities and differences between the two.
These two issues are very much intertwined in eating disorder recovery and treatment; understanding their complexities and how they influence eating disorder behaviors is critical.
ARFID was recently added into the newest Diagnostic and Statistical Manual of Mental Disorders (DSM-V) classified as its own disorder under Feed and Eating Disorders:
ARFID is characterized “as an eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following”:
Significant weight loss (or failure to achieve expected weight gain or faltering growth in children)
Significant nutritional deficiency
Dependence on enteral feeding or oral nutrition supplements
Marked interference with psychosocial functioning
This eating disturbance is not attributable to concurrent medical conditions or not better explained by another mental disorder. It is not due to a lack of available food or by an associated culturally sanctioned practice. And more importantly for the distinction between ARFID and anorexia is that there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.” (https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t18/)
ARFID is classified as an eating disorder/ mental disorder. It is like anorexia as both disorders involve limiting the amount and /or types of food consumed. However ARFID does not involve any distress about body shape or size or fears of fatness, rather it is characterized by not consuming enough calories to grow and develop properly. The disorder manifests itself in children via stalled weight gain and vertical growth, and in adults by weight loss. Anorexia and ARFID both involve inability to meet nutritional needs where they share the same physical signs and medical consequences. (https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid)
There are two aspects of ARFID that map out the different processes that are happening. The first is a concern about aversive consequences of eating, such as the fear of choking or vomiting after eating. The second is avoidance based on the sensory characteristics of food such as texture.
Many children with ARFID also have co-occurring anxiety disorder and are at a high risk for other psychiatric disorders. Common treatment in ARFID ranges from family-based treatment, utilizing cognitive behavioral therapy, nutritional counseling and exposure therapy.
Sensory processing disorder is described as difficulty with organizing and responding to information that comes in through the senses. This can be oversensitive, under sensitive, or both. It is believed to be a disordered nervous- system- level processes of integrating and responding to sensory signals that interfere with an individual’s ability to flourish, function, and participate. Sensory processing disorder exists when sensory signals are either not detected or not organized into appropriate responses.
Sensory processing issues are NOT a diagnosis on their own. They often co-occur with two conditions: ADHD and autism and many experts believe sensory issues are a component of another condition or disorder.
Unlike ARFID, sensory issues aren’t officially recognized by the DSM and therefore not an official condition; meaning there are no formal criteria for diagnosis. Professionals may use sensory integration praxis test or the sensory processing measure to help treat and primarily work off what they see in behaviors and interactions.
There are two types of sensory processing challenges which individuals can have either one of or a mix of both: over sensitivity (hypersensitivity) and under sensitivity (hyposensitivitly).
In oversensitivity sounds, sights, textures, and tastes can create a feeling of sensory overload which can lead to sensory avoidance as a person may feel overwhelmed by people and places. Signs and symptoms of sensory avoidance are seeking out quiet spots in noisy, crowded environments, startled by sudden notices, avoiding touching or hugging people, strong reaction to texture or smell, refusing to try new food and having a limited diet.
In hyposensitivity a person may look for more sensory stimulation. Signs of sensory seeking are constantly touching objects, seeking out input like spicy or sour tastes and physical contact and pressure, often squirms and fidgets, constantly on the move, and invades other people’s personal space.
In processing sensory issues it does not need to be one or the other, one can be sensory seeking in certain situations and sensory avoiding in others depending on how one is coping or self-regulating at the time.
Treatment for sensory processing issues usually involves occupational therapists sensory integration therapy, sensory diet, and learning how to calm themselves and regulate behaviors and emotions.
(https://sensoryhealth.org/basic/subtypes-of-spd)
ARFID is more directly linked to nutrition deficiencies, one major component possibly linked to sensory issues. Sensory issues seem to be more on a spectrum of function disturbance and can manifest themselves in a multitude of ways, one of them being through taste and food.
Although it seems like ARFID and sensory processing issues vary dramatically in symptoms, functionality, and overall treatment the two disorders can certainly intertwine in a way that is important when thinking about eating disorders with a higher degree of complexity. It is important to understand that
ARFID and sensory processing issues can be presented together or separately and assessing and developing individualized treatment utilizing these different skills will benefit the individual in recovery.