Frequently Asked Questions

What is ARFID?

ARFID is an acronym for Avoidant Restrictive Food Intake Disorder. ARFID is a feeding and eating disorder where someone restricts the amount they eat or avoids certain foods. ARFID is not related to a desire to lose weight and not everyone with ARFID is underweight. People with ARFID might eat a very limited variety of foods, which can make it hard to get enough nutrients, affecting growth, energy, and health. ARFID is not just picky or fussy eating and although it often begins in childhood, it can affect people of all ages.

A number of things can drive the food restriction/avoidance such as sensory-based avoidance, lack of interest in food/eating, and fear of the aversive consequences. Every person with ARFID is unique and work hard to understand people as individuals so that we can provide the most effective treatment.

How do I take an accurate height at home?

Without shoes on, stand against the wall, feet parallel, heels against the skirting board/wall. Place a ruler on the head to indicate the level on the wall. If able to, as the individual to take a deep breath in and out. Now mark the wall with a pencil which can later be erased. You can then use a tape measure to measure floor to the mark to give you the height reading.

How do I take an accurate weight at home?

The best time to take an accurate measure is first thing in the morning, wearing light clothing, after using the toilet and prior to having any food/drink. Place weighing scales on a hard, flat surface. You can check the accuracy of your home scales by weighing something you know the weight of e.g. a full bag of sugar or flour

What is your cancellation policy?

There is a 48 hour notice period for cancellations. If 48 hours notice is not given then the full fee is charged, regardless of the reason for cancellation. For further information please see our Terms and Conditions.

Why haven’t I heard of ARFID before?

ARFID is a new diagnosis that was introduced in 2013 when it was included in a manual that describes the different criteria for diagnosing mental health conditions (DSM-5). However, ARFID is not a new disorder and may have previously been known as Feeding Disorder of Infancy or Early Childhood or Eating Disorder Not Otherwise Specified.

Do you involve parents in treatment?

We usually try and involve parents as much as possible in treatment, but this may vary depending on the age of the individual and the difficulties they are experiencing. This is something that we would think with you about during the assessment and throughout treatment.

Can I get help from the NHS?

Depending on your situation you may be eligible for NHS care. You should book an appointment with your GP or another healthcare professional to discuss this further. It may be helpful to take some notes with you about what you are worried about, how long this has been going on for, and the impact of the difficulty.

What is the evidence-based treatment for ARFID?

There are currently no evidence-based treatments recommended for ARFID published by the National Institute for Health and Care Excellence (NICE) and current consensus recommendations include a multidisciplinary, multi-modal approach to assessment and treatment.

At present no single psycho‐behavioural treatment modality emerges as superior to any other in the treatment of ARFID, but family‐based, behavioural, and CBT‐based approaches appear to show greatest promise overall.

Treatment for ARFID is based on the factors driving and maintaining the difficulties with eating and will always focus on reducing and managing physical and nutritional risk in the first instance.

Do you accept private healthcare insurance?

Unfortunately, we are not currently able to accept private health insurance to fund assessment or treatment sessions.

What prices do you charge?

Our prices can be found here.

Do you offer in-person appointments?

Currently we are not offering face-to-face appointments. If you require sessions in person, please discuss this with us as we may be able to arrange this for an additional cost.

Can you effectively assess and treat eating disorders virtually?

Having worked in the NHS through the Covid-19 pandemic providing psychological assessments and treatment we are confident that virtual working can be effective. There have also been numerous studies following the pandemic highlighting the effectiveness of online psychological therapies.

Can you guarantee treatment will work?

Psychological interventions are never guaranteed to be effective and various factors e.g. individual motivation as well as wider physical, psychological, social and systemic factors. However, a comprehensive assessment which enables a clear understanding of the factors which are maintaining the difficulties will ensure treatments are appropriately tailored to individual need.

The most effective treatment is goal focused. We will ensure that personalised goals are set at the start of treatment and reviewed each session. We will review progress every 6-8 sessions to consider if we should continue.

Different treatment approaches may be more or less effective depending on an individuals age and abilities, which may change over time and with their development. We will be transparent with you about the outcomes we are likely to achieve.

What is the diagnostic criteria for ARFID?

There are two manuals of mental health diagnoses, both which similarly detail the diagnostic criteria for ARFID:

Diagnostic and Statistics Manual 5 (307.59; DSM-V, American Psychiatric Association, 2013)

A. 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 nutritional supplements.
Marked interference with psychosocial functioning.

B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.

D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another mental disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

ICD-11 (6B83; World Health Organisation, 2019)

Avoidant-restrictive food intake disorder (ARFID) is characterised by avoidance or restriction of food intake that results in:

the intake of an insufficient quantity or variety of food to meet adequate energy or nutritional requirements that has resulted in significant weight loss, clinically significant nutritional deficiencies, dependence on oral nutritional supplements or tube feeding, or has otherwise negatively affected the physical health of the individual

significant impairment in personal, family, social, educational, occupational or other important areas of functioning (e.g., due to avoidance or distress related to participating in social experiences involving eating).

The pattern of eating behaviour is not motivated by preoccupation with body weight or shape. Restricted food intake and its effects on weight, other aspects of health, or functioning are not due to unavailability of food, not a manifestation of another medical condition (e.g. food allergies, hyperthyroidism) or mental disorder, and are not due to the effect of a substance or medication on the central nervous system including withdrawal effects.

Essential (Required) Features:

Avoidance or restriction of food intake that results in either or both of the following:

The intake of an insufficient quantity or variety of food to meet adequate energy or nutritional requirements that has resulted in significant weight loss, clinically significant nutritional deficiencies, dependence on oral nutritional supplements or tube feeding, or has otherwise negatively affected the physical health of the individual.

Significant impairment in personal, family, social, educational, occupational or other important areas of functioning (e.g., due to avoidance or distress related to participating in social experiences involving eating).

The pattern of eating behaviour is not motivated by preoccupation with body weight or shape.

Restricted food intake and consequent weight loss (or failure to gain weight), or other impact on physical health or related functional impairment, are not due to unavailability of food; are not a manifestation of another medical condition (e.g., food allergies, hyperthyroidism) or mental disorder; and are not due to the effects of a substance or medication, including withdrawal effects.

Additional Clinical Features:

A variety of reasons may be given for restriction of food intake, such as lack of interest in eating, avoidance of foods with certain sensory characteristics (e.g., smell, taste, appearance, texture, colour, temperature) or concern about perceived aversive consequences of eating (e.g., choking, vomiting, health problems), which in some cases is related to a history of aversive food-related experience such as choking or vomiting after eating a particular type of food. In many cases, however, there is no identifiable event that preceded the onset of the disorder.

Some individuals with Avoidant-Restrictive Food Intake Disorder present with a longstanding lack of interest in food or eating, chronically low appetite, or a poor ability to recognize hunger. In other cases, restriction of food intake may be more variable and significantly affected by emotional or psychological factors. This latter pattern may be associated with high levels of distractibility or with high levels of emotional arousal and extreme resistance in situations in which eating is expected. Individuals with this pattern, especially children, often require significant prompting and encouragement to eat.

Individuals with Avoidant-Restrictive Food Intake Disorder generally do not experience any difficulties eating foods within their preferred range and may therefore not be underweight.

Avoidant-Restrictive Food Intake Disorder can negatively impact family functioning, such that mealtimes may be associated with increased distress (e.g., infants may be more irritable during feedings, children may try to negotiate what food is present or how much they need to consume at mealtimes).

Diagnostic criteria for ARFID