3 days ago
When you're more than a fussy eater
'No, not even strawberries,' is something Mara says a lot.
She cannot eat oranges too – in fact, almost no other solid fruit or vegetables, and no cold cooked meat either.
She was breaking out in a sweat before her workplace's Christmas dinner, she says.
'For around 30 years, I thought I was just stupid when it came to food and was acting like a toddler.'
That was until she spotted a child with similar eating habits on Instagram.
'The mother described her child's behaviour with the word Arfid.
'I thought: Oh my God, that's me.'
Arfid stands for Avoidant/Restrictive Food Intake Disorder, a condition identified some years ago.
'It's crazy when you live with it your whole life and then suddenly have a name for it,' says Mara, now in her mid-30s.
Arfid is not just about being a picky eater.
'There's a difference between things I don't like and things I can't eat,' says Mara.
For example, she doesn't like marzipan, but simply can't stomach cooked ham.
She compares it to reality television shows when contestants have to try and eat insects or offal.
'In any case, I'm very relieved to know what I have,' says Mara, who is of normal weight.
She has since seen a doctor and is weighing whether to see a psychotherapist or a speech therapist who has been recommended for those with an aversion to certain solid foods.
Eating is a burden
Both adults and children can be affected by Arfid.
The condition can lead people to reject foods because of the way they smell or taste, or their consistency or appearance, says medical psychologist Dr Ricarda Schmidt from the Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy at the University of Leipzig in Germany.
Many children or adults who are affected do not feel hungry, are afraid of eating, or have little appetite.
'Eating is not a pleasure for them, but a burden,' she adds.
Sometimes, the aversion to food is so strong that children develop deficiency symptoms or lose weight, she says.
'These children eat so little or so restrictively that they develop physical and psychosocial impairments.
'For example, they avoid children's birthday parties or school trips because of the food.'
But the condition is more than just general fussiness or picky eating – a stage many children go through as they develop and which usually passes.
'Arfid is very stressful for the whole family,' says Dr Schmidt.
'Abnormalities often become apparent early on when eating, for example, during breastfeeding or when introducing complementary foods.'
Parents should consult a paediatrician to assess the physical consequences.
The paediatrician can also determine whether there are any gastrointestinal problems or food allergies.
'You have to assume that the doctor is not familiar with Arfid and will dismiss it as fussiness.
'However, fussiness passes, Arfid does not,' Dr Schmidt cautions.
You can also take practical approaches, for example, by making sure the atmosphere at the dinner table is relaxed, even if this can be difficult, she says.
'Parents should convey a sense of enjoyment around food and keep offering rejected foods in bowls on the table so that everyone can help themselves.'
A new food should be tried at least 10 times so that you can get used to it, she notes.
But it doesn't help to pressure children to eat vegetables, fruit, dairy products, or meat and fish.
Many people with Arfid do wish they could eat certain things.
'Some children would like to eat mashed potatoes, but can't overcome their disgust.'
Arfid involves rejecting foods because of their smell, taste, consistency or appearance. Mara cannot eat whole oranges, for example, but can manage orange juice without any pulp.
Not recognised by all
The US diagnostic directory has recognised Arfid since 2013, but some countries still don't.
The condition was included in the World Health Organisation's 2022 edition of the International Classification of Diseases (ICD-11) as an eating disorder, but not all countries have adopted this list either.
Doctors generally place the condition with other eating disorders.
Due to this inconsistent status, it is not clear how many people are affected by Arfid.
In Germany – one of the countries with little recognition of Arfid – young people with the disorder are often assumed to have anorexia, says University of Konstanz's Clinical Psychology and Psychotherapy in Childhood and Adolescence working group head Professor Dr Andrea Hartmann Firnkorn.
'But people with Arfid don't restrict their food because they want to lose weight.
'They also eat things like chips, pasta and chocolate rolls, for example,' adds the clinical psychologist.
Some of the people who are affected may be underweight, but others are a normal weight or are overweight, although they are often malnourished due to their unbalanced diet.
Potential causes and treatments
Little is known about the causes of Arfid.
A genetic predisposition could play a role, especially in those who are sensitive to smells, textures or flavours, or who have an aversion to many foods, says Dr Schmidt.
Fear of eating or other Arfid symptoms could also be triggered by early traumatic experiences, such as badly choking as a child, an allergic reaction, being intubated at an early age, or having suffered an illness involving difficulty swallowing.
An analysis of 77 studies – although fairly small studies without long-term observation – provides indications of possible therapeutic approaches, says a team led by PhD student Laura Bourne from Britain's University College London in the journal Psychiatry Research .
These include family-based therapy, cognitive behavioural therapy (CBT), and in some cases, the additional administration of psychotropic drugs.
Doctors would need to tailor the therapy to the individual involved, depending on their main problem and its severity.
Prof Firnkorn and her PhD student Julia Engelkamp have launched an online therapy programme at their university, which includes video therapy sessions and self-study modules in which families receive individual support.
'It's important that someone neutral comes in, because the topic of food has often become a battleground,' says Prof Firnkorn.
'We won't make Arfid disappear in 12 weeks.
'Other eating disorders such as anorexia or bulimia often require long-term therapy involving around 60 sessions.
'But we want to give families tools they can continue to work with.
'If children currently only eat three to four foods, it will take longer than the therapy to achieve a balanced diet with enough variety.'
It is important to take small steps.
'Maybe start with spaghetti and move on to a different type or brand of pasta, and don't add tomato sauce right away,' she says.
A sense of achievement is important.
'Help your child realise that they have managed to eat something different.'
Slow, but hopeful, progress
Mara's diet has also expanded over time.
'I've been able to eat dried tomatoes and olives for five years,' she says.
She has also been eating pumpkin and tomato soup for a long time, as long as everything is finely pureed, and she also drinks orange juice without pulp.
At the company Christmas dinner, she finally found something else she liked: hummus with pureed beetroot.
Meanwhile, she is watchful to avoid transferring the condition to her daughter.
She does not spoonfeed her baby food, but gives her soft pieces of food that she can pick up and eat herself.
With the now widespread method of baby-led weaning, where an infant determines when to stop breastfeeding, children choose for themselves what to eat from what is on offer.
'You offer something and the child decides for themselves what they want to eat.
'So far, my daughter eats everything and she has a big appetite.
'I hope it stays that way!' – By Simone Humml/dpa
