Avoidant Restrictive Food Intake Disorder (ARFID) Simple Suggestions Series – Strategies to support you in challenging a fear (aversive consequences)

Produced in collaboration with:

• Bedfordshire and Luton Mental Health and Wellbeing Services provided by East London NHS Foundation Trust
• InsightEating and InsightHealth
• North East and North Cumbria Mental Health, Learning Disability and Autism Partnership

1. It’s a good idea to think about your motivation – your reason why. One way of doing this might be to write a list of the good and bad (pros and cons) aspects of change. Write your list as the pros and cons for continuing to avoid the situation or food you are worried about. As well as the pros and cons of working on challenging these fears. Try to think about the short- and long-term impact of avoiding something you’re scared of. For example: “avoiding a fear means I instantly feel better. But in the long term, I’m frustrated that I’m not moving towards my goals”.
2. Remember that the only way of breaking the fear of a negative outcome is by facing the fear. For example, “if I eat this, I will choke”, or “if I eat this, I will be sick”. It is best to do this by slowly exposing yourself to what you are worried about in a planned way. Your brain has something called neuroplasticity meaning that it can change. By eating the feared foods, you will slowly gain good experiences. This then helps you challenge the fear of aversive consequences. In other words, your brain ‘rewires’ with new information and your beliefs change.
3. It’s also a good idea to have a good understanding of your body’s response when you experience fear/worry/anxiety. This can be different for different people. Some people experience ‘flight’ meaning to run away, freeze, or ‘shutdown’. This can look like disconnecting or disassociating from the situation. Others experience ‘fight’ meaning to experience hyper-arousal, or verbal or physical outbursts. Each of these responses also feels different within your body. For example, it can cause a fast or slow heartrate, or make you feel sick. You could also feel hotter or colder, feel dizzy, notice changes to your vision or hearing, and many others. All these symptoms can feel very uncomfortable. This is especially true if you are hypersensitive and feel physical symptoms intensely.
   
   Understanding what happens to you when you are worried can help you to tolerate the symptom. It can also help you to prepare. For example, by having strategies ready to help you manage these difficult feelings.
4. It is helpful to identify a ‘rescue’ or safety strategy for if things become overwhelming for you. For example, some people go to sleep to help provide some relief. Others take prescribed medication to help with the challenge. Examples of these include anti-sickness tablets or anti-anxiety medications.
   

5. When changing one aspect, keep the rest of the day as “safe”, low sensory and low demand as possible to help reduce anxiety.
6. It is also helpful to understand something called the ‘anxiety curve’. This means understanding that the negative experiences in your body are only temporary. These experiences never stay at their very worst for too long. When your body is responding to these situations it is using a lot of a hormone called adrenaline. There isn’t enough of this hormone for these uncomfortable feeling to stay forever. So, hold in mind that: this difficult feeling/experience will pass.
7. Having a toolkit of basic strategies to support your worry response can be helpful. These will be different for each person so try to think about what sensory input or strategies relax you. Some examples might include dimming the lights or finding a quiet space. It could mean using tactile objects like fidget toys or throwing a ball against a wall. Abdominal breathing and using strong/grounding smells (like essential oils) can also help.
8. Finding where to start can feel dauting and overwhelming. one option could be to write yourself a list of situations/foods you are avoiding because of worry. For example, not eating a certain type or texture of foods that you worry would cause you to choke or become sick. After doing this:
   • Rate how much anxiety (worry) you think you will experience for each of your situations or foods. Use a scale of 0-10 (0 = no worry at all, 5 = quite worried and 10 = very worried)
   • Rearrange the list of situations into a ranked order with the lowest worry score at the top.
   • Start your exposures with the easiest situation on your list. Never start with the hardest.

9. Some people might struggle to make a list. For example, because all food textures that aren’t liquid feel like they are too hard. If this is the case, then it might be helpful to use a food chaining approach.
   
   Food chaining is the process of thinking about foods that are like the ones you are currently eating. For example, someone only consuming liquids might find that thin yogurt was similar. This could then be followed by thick yogurt then by cream cheese. This chaining strategy can help find new foods that don’t feel too different. This can be hard if you’ve eaten the same foods for a very long time and don’t know of many other food options. If this is the case, try asking a trusted person for their ideas of what could be a very close match to your usual foods. Remember though, they are only suggestions – you are in control of which you try and when.
10. It is important to start small, even if this feels too easy for you. Succeeding rather than failing is very powerful. Try not to feel disheartened if progress feels very slow – change does take a long time. Keeping a diary of your progress can be helpful for reminding you that you have made progress. You can also rate how much anxiety (worry) you feel with each of your challenges. Use a scale of 0-10 (0 = no worry, 5 = quite worried, and 10 =very worried).
    

11. Some people prefer to work through these challenges on their own. For others it can be helpful to have some support. This could be from a family member or a friend. Or it may be from a helpful online community, or a healthcare professional that you trust.
12. Remember that any progress towards challenging your fears is positive. Change takes a long time and often involves many steps. Each step towards your goal is an example of positive progress.
13. Remember that repeating food or situation exposures is important. Overcoming the fear of aversive consequences happens by using small and achievable steps. By completing a record of your worry, you should see that the worry score comes down over time until it feels safe.

For more advice and tools to support your journey please visit: www.bebodypositive.org.uk.

C.Ellison, RD, P.Falcoski RD and U.Philpot, RD (February 2024)