How does an RFT lens advance/add to ARFID treatment?

There is no gold-standard treatment for ARFID. As pointed out by Bryant-Waugh, “(t)reatment needs are likely to vary across individuals and, as a rule of thumb, are generally informed by the main areas of impact of the avoidance or restriction of food intake.”

In contrast to a manualized approach to treatment, RFT looks to understand why clients eat the way they do. It strives to identify and address the root influences and challenges that existed as the individual learned to relate to food and their bodies. In a recent study on outpatient ARFID patients (Zickgraf 2019), for instance, all experienced onset of avoidant eating before age 5, the overwhelming majority before age 3. It is critical to thoroughly assess individuals’ history of feeding and eating difficulties, as well as any therapies undertaken in order to provide informed individualized interventions.

Thus, in addition to sensory, oral-motor, metabolism, temperament, disgust, aversive experiences, anxiety, and other factors, the impact of feeding dynamics and early experiences should be considered in the development of avoidant, selective, and anxious eating.

Considering the factors at play opens opportunities for clinicians to use their skills in a responsive way with each client. The clinician’s “toolkit” may include motivational interviewing, DBT, CBT, nutrition counseling, emotion coaching, interoception support, and the healing power of the therapeutic relationship, improving outcomes and personal satisfaction for the dietitian.