Anorexia vs ARFID: What's the Difference?

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There is incredible confusion when it comes to distinguishing ARFID and anorexia from one another, as both involve eating a limited range of foods, nutritional deficiencies, and in many cases, weight loss. Understanding where these two eating “disorders” differ – and I’ll elaborate on why I don’t like the use of the word “disorder” later –  is critical if we are to properly support people with anorexia, ARFID, or both. In this post, you’ll learn what anorexia is, what ARFID is, and the prevalent yet dangerous misunderstanding between the two.

Many people know that these are different eating disorders, but how? Well a quick Google search (or if you’re feeling extra, you could even type the question into ChatGPT) of the “difference between ARFID and anorexia” will tell you that ARFID is categorized by restriction due to sensory issues, fear of adverse consequences, or a lack of interest in eating; while anorexia is associated with restriction due to the fear of gaining weight and becoming fat. Before we get into all the issues of this distinction, let’s back up and make sure we’re all on the same page regarding what anorexia is and what ARFID is.

What Is Anorexia?

According to the DSM-5 (Diagnostical and Statistical Manual of Mental Disorders, Fifth Edition) Anorexia Nervosa (AN) is defined as a serious mental health condition characterized by a significantly low body weight, an intense fear of gaining weight or becoming fat, and a distorted perception of body weight or shape.

I barely even know where to start with how stigmatizing this definition is. Right off the bat, we need to establish that you can have an eating disorder at any weight, shape, size and your BMI is completely arbitrary in determining whether or not you are “sick enough.” Not everyone with anorexia has a BMI that can be classified as “underweight.” Due to fatphobia and the rampant stereotypes in the healthcare system, people with anorexia at “normal” and higher weights suffer in silence due to invalidation of their illness. This type of anorexia is commonly known as “atypical anorexia,” which I will do a whole other post on, so stay tuned for the release of that! Regardless, common traits of anorexia include:

• Desire to lose weight
• Obsession with weight and food
• Distorted body image (not always)
• Obsession with exercise (not always)
• Hyperfocus on numbers (calories, steps, portion sizes, etc)
• Strict rules and routines around food 

Anorexia and Neurodivergence

The reason I denoted “not always” for a few of those traits is that, especially in neurodivergent individuals, anorexia often starts out as a means to gain a sense of safety and control in a neurotypical world, rather than being merely about a fear of fatness. (Undiagnosed) autistic and ADHD traits such as hyperfocus, a need for predictability and routine, difficulty with change, and special interests may morph into an unhealthy obsession with food and exercise, ultimately leading to a potential anorexia diagnosis. 

I was diagnosed with anorexia nervosa, depression, anxiety, and OCD when I was eleven years old, yet the entire course of my eating disorder did NOT involve fear of weight gain. I’ve never experienced body image issues and, quite honestly, despised the fact that I couldn’t get myself to take the actions necessary to gain weight. For me, the eating disorder was a safety mechanism, an escape into an alternate reality that shielded me from the responsibilities and perceived dangers of the big bad world that was not made for neurodivergent beings like me. In this sense, I believe it’s much more accurate to view eating disorders not as diseases or illnesses, but as adaptations. Shifting the traditional view of eating disorders from “problem” to an attempted “solution” to safety acknowledges the creativity of the human mind and nervous system in responding to adversity. It invites empathy and understanding, recognizing that ED behaviors serve a purpose in the context of traumatic experiences.

Another interesting point to make when it comes to anorexia in neurodivergent people is that a lot of the time, distorted body image will not be present. Obviously, this is quite the contradiction of the stereotypical graphic of a thin white female looking in the mirror only to see a larger version of herself staring back! Again, autistic and ADHD traits are often at the root of the food and exercise behaviors, rather than a desire to change one’s weight or shape. That being said, it’s worth mentioning another common overlap in the world of neurodivergence and eating disorders: gender identity.

Eating disorders and neurodivergence seem to be much more prevalent among the LGBTQIA+ community. People identifying as transgender (trans) or non-binary possess a gender identity that does not align with the sex assigned to them at birth (or any sex at all), which can contribute to a strong desire to change one’s appearance. Obviously, weight and shape play a major role in these feelings, which may be another important factor to consider when labeling someone with anorexia.

The Adaptive Eating Spectrum™️

Just as neurodivergence and gender exist on a spectrum, I propose that we start seeing eating disorders as a spectrum of adaptive eating behaviors rather than a pathological form of food avoidance. Not only would this view go a long way in reducing the stigmas and stereotypes surrounding eating issues, but it would open the door to conversations about an individual’s unique sense of safety and trust. It would eliminate the need to “cure” eating behaviors that are not necessarily disordered, so that instead, we can focus on what really matters: discovering a life in which you can find safety in a healthy way.

As I explain in my book Rainbow Girl, when I discovered I’m neurodivergent, the course of my eating disorder suddenly made sense. I didn’t have anorexia due to the stereotypical belief that I was “afraid of becoming fat,” but because it acted as a mask for undiagnosed autism and ADHD. Controlling my food and exercise gave me a sense of safety and trust at a time when I couldn’t access that safety and trust elsewhere.

Perhaps not surprisingly, ARFID is also a manifestation of distrust and safety. Whether this lack of assurance is caused by trauma, specific sensory preferences, and/or a general distrust of non-safe foods, engaging in what society has labeled as “avoidant and restrictive behaviors” is a way to avoid perceived danger.

What Is ARFID?

In contrast to anorexia’s roots in control – which manifests as having strict rules and routines around food, exercise, and the numbers attached to these entities – the DSM-5 defines ARFID (short for Avoidant Restrictive Food Intake Disorder) as a feeding or eating disorder is characterized by a persistent disturbance in eating or feeding. This disturbance can result in significant weight loss, nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, and marked interference in psychosocial functioning.

In general, ARFID is understood to differ from anorexia, bulimia, and other “typical” restrictive eating disorders in that the eating difficulties are not rooted in a desire for thinness, but rather driven by other factors – factors such as sensory sensitivities, fear of negative consequences, or a lack of interest in eating.

These three factors also form the foundation of the three ARFID subtypes:

1. Sensory-Based ARFID: Individuals with this presentation may have strong aversions to certain textures, tastes, colors, or smells of foods. They may find it challenging to tolerate a wide variety of foods due to sensory sensitivities.
2. Fear-Based ARFID: Some individuals with ARFID may have a significant fear of negative consequences associated with eating, such as choking, vomiting, or experiencing gastrointestinal discomfort. This fear can lead to avoidance of certain foods or food groups.
3. Lack of Interest ARFID: This subtype involves a general disinterest or lack of motivation to eat, which can result in inadequate food intake and nutritional deficiencies. Individuals with this subtype may not experience strong aversions or fears related to specific foods but may simply lack the desire or appetite to eat.

Due to the strong overlap of ARFID traits and autistic traits, there is some debate in the ARFID community about whether it’s truly a “disorder” or merely an eating difficulty as a result of the autistic experience. After all, isn’t fear of negative consequences quite an impressive adaptation if you’ve had traumatic food encounters in the past? Nonetheless, ARFID can be incredibly debilitating, as it quite literally restricts your ability to have a peaceful relationship with food (which is often part of building relationships with people, as well).

Supporting Someone with Anorexia and ARFID

It goes without saying that both anorexia and ARFID pose challenges to all aspects of an individual’s wellbeing. Not only will people affected by one or both disorders experience nutritional deficiencies, gastrointestinal issues, and weight loss as a result of their limited diet, but they tend to live in constant fear. Fear of food-related consequences for sure, but also fear of judgment from others. The avoidance of criticism (not to mention the compound effect of judgment of neurodivergent traits) often leads to difficulty eating around others, if at all.

Which leads to the ultimate question…

How can you best support yourself or a loved one with anorexia and/or ARFID? While everyone is unique and will therefore have different support preferences, two words are universally important: trust and safety. Any type of eating disorder – or rather eating adaptation, or whatever labels you want to use – is rooted in a lack of trust and safety, which may be the core reason for why feeding and eating difficulties are so common among neurodivergent people in the first place. I’ve said this before and will say it again: no treatment for eating disorders works. it’s all about creating an environment safe enough for an individual to trust that they can do the work. So instead of asking what the best form of support is, let’s ask: how can I create more safety and trust?

I hope this post has aided in forming greater understanding on this often complicated topic. Traversing these complexities are difficult for anyone, let alone those of us in the spectrum of neurodiversity. If you need further assistance navigating your journey and these topics, please don’t hesitate to reach out and book a 1-on-1 coaching consultation with me here!