ARFID The Secret Eating Disorder

How Cannabis Can Help

Avoidant Restrictive Food Intake Disorder (ARFID) is a serious eating disorder, though much less talked about than other widely recognised and publicised eating disorders such as anorexia, bulimia and compulsive binge eating.

ARFID is when someone avoids certain foods, limits how much they eat or does both. Beliefs about weight or body shape, unlike anorexia or bulimia, are not reasons why people develop ARFID. Possible reasons for ARFID include:

• negative feelings over the smell, taste, or texture of certain foods
• a response to a past experience with food that was upsetting, for example, choking or being sick after eating something
• not feeling hungry or just a lack of interest in eating and, it is thought that ARFID can also be a symptom or sign of autism.

While ARFID is more often diagnosed in children and adolescents, it may occur in adults. This might include those who went untreated as children and have a long pattern of selective eating based on sensory concerns or feelings of disgust with new foods. While some eating disorders are more often found in females, ARFID is much closer to an even split, or possibly even more common in males than females. Untreated ARFID can lead to severe malnutrition and impact physical development as the individual ages.

Through exposure therapy, a person with ARFID can learn positive coping skills to overcome these specific fears. Other therapies that are known to help treat ARFID in adults are cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT), two common therapies that are used to treat eating disorders. However, new medicines like CBM’s (cannabis based medicines) can be incredibly helpful with this condition. At Integro Clinics we have seen considerable success in treating ARFID and other eating disorder patients with CBM’s.

CBM’s are medicines derived from cannabis that are used to treat medical conditions. CBM’s contain cannabinoids derived from the cannabis plant, including delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), or a combination of THC and CBD. Taking CBM’s either via oil (generally a mix of CBD and THC) or by vaping flower allows the human endocannabinoid system to become re-balanced and the effect of the active compounds is found to encourage appetite, help with anxiety, depression, and insomnia. All of which are very helpful to ARFID sufferers and will lead to a general improvement in their quality of life.

“Cannabis Medicines can not only be effective for appetite stimulation but also for managing the underlying anxiety that is part of the complex experience of living with ARFID. The ultimate management strategy for these patients is for cannabis medicines to effectively improve these symptoms so that the patient feels more in control and therefore more able to engage with longer term therapies to better understand the root cause of their condition”

Sophie Former Specialist Nurse Integro Medical Clinics

Patient Case Study

Dom, a patient who has been diagnosed with ARFID, has been dealing with his eating disorder for longer than he can remember, and it has continuously negatively affected different aspects of his life. For example, it has meant that friends have cut him off or he has to turn down going to social events because his fear and anxiety of having to deal with the eating of food there, was simply too stressful.

He gives us an in-depth insight into what it is like living with such a restrictive eating disorder and how cannabis medicines have helped him to manage the condition and feel comfortable enough to eat certain food in specific situations.

Q&A:

Q: In your own words, could you describe what ARFID is?

A: It’s a dislike of eating, you end up avoiding it as much as possible in all aspects of life. There’s a feeling of dread and it limits you to a very small, select amount of safe foods that you can eat without becoming very anxious. There are no direct rules, it’s more a fear of food, it seems like a phobia around the whole eating process. It’s embarrassing and difficult to explain to people.

Q: When did ARFID first manifest itself in your life?

A: It started even before I had a memory of it. It’s only recently that I’ve classified it as ARFID, but as long as I can remember I had issues with food. I was refusing to eat certain foods as a kid and I would hide food from the dinner ladies at school at 6 or 7 years old. I realise now it was of course affecting me even then.

Q: Did your parents or medical professionals try any form of intervention when you were a child?

A: To be blunt, no. I was very much seen as just a picky eater and being fussy. At that time society thought you should just force kids to eat. I would be told that I couldn’t leave the table until I had eaten and the battles that went on at that age were quite significant. There was never any medical intervention because at that time, for a young boy, there wasn’t such a thing as an eating disorder.

Q: How would you say it has affected you socially?

A: It’s hard to say without getting emotional. It’s affected me hugely. It’s stopped me from sharing and bonding with people. It stops you from going out for lunch with colleagues. It prevents you from going out with friends in the evening because most activities are meal-based. It then makes you feel like a burden on people. Whenever there is a check on where we are going, there is always the question “Is there something for Dom?” or “We can’t go there because there’s nothing for Dom.”. People start to cut you out after a while.

It also meant that normal situations with people could be tough. You’d go out drinking at university and that’s fine, but if you hadn’t eaten for two days, it’s pretty tough to keep up physically. To keep up with people who have a full and balanced diet can be very hard. Then you find yourself turning to stupid stuff as a substitute, like fizzy, sugary drinks, that make you feel full. I developed lots of unhealthy coping mechanisms over the years.

Q: When did you first discover that using cannabis could be helpful?

A: I first started smoking recreationally when I was 17 or 18. I found the whole social drinking culture difficult, because alcohol was very similar to food. For me the texture and the taste of alcohol was horrible. Again, it causes a similar shutdown in me like food.

When I first started smoking, I realised that it relaxed me. It meant that, around my friends, I was able to eat safe foods, which I had never been able to do previously. Usually, I would wait until I was home and then binge. But when I am relaxed, I would be able to eat pizza, or chips or junk food with my friends present. This really allowed me for the first time to be able to eat out with friends, which I could never imagine happening before.

Q: Were you smoking daily?

A: Not at first, it was maybe once a week in a very casual way. Smoking cannabis started to develop and occur more as my life became more about being outside of the home. I wasn’t able to retreat to my safe space at home and eat a lot of safe foods, meaning that I had to find some way to be able to eat outside. If we were smoking, we wouldn’t be going to restaurants so we could get takeaways, which was just much more relaxed, and I could order exactly what I wanted.

Q: When did you find out there was a medical classification for your condition and how did that lead you to medical cannabis?

A: I first found an actual classification around 3 years ago, but it wasn’t ARFID, it was classed as a selective eating disorder. I started reading about it in some of the American mental health journals, but they just seemed to be talking about teenage girls. It was the first time that I read anything that rang true with my experience with food.

That led to me discovering the term “ARFID”, about a year ago. Once I could classify it, I approached my GP, who already knew about the anxiety I had been suffering from for quite a while and she referred me to mental health services. Unfortunately, they did not have the capacity to see me, so I got screened out of the process.

At that point, I spoke to my GP again and she was aware that I had looked into medical cannabis and had been self-medicating with cannabis for a while. My GP was extremely helpful and referred me to Integro Clinic’s where I see Dr Bodani, who has really helped me.

Q: How do you take your medication?

A: I vape it, using the mighty medical vaporiser and I use the capsule that goes with it. Comparing it to street cannabis, that I smoked before, vaping medical cannabis has allowed me to regulate how much I’m taking and how often I am taking it, as there are actual dosage suggestions for it. A lot of my anxiety is gone, since it’s a prescribed medicine. It also helped me recognize how the different types of cannabis medicines make me feel. One combination helps me with eating, while the other relieves my anxiety. It’s been interesting to see how different combinations of THC and CBD affect different aspects of my condition. It’s been a fascinating last few months finding out about medical cannabis.

Q: In our society, there are a huge number of women with eating disorders and it’s becoming apparent that there are a growing number of men who also suffer with these conditions. Would you say there is a stigma that men face around admitting they have an eating disorder?

A: I would say men face a huge stigma, when it comes to eating disorders, men always get classed as fussy eaters. I do wonder, in my case, if I was a teenage girl hiding food, refusing to eat etc., if it would have been looked at differently at that time. Now, I think there is a lot more recognition of male eating disorders than previously. I’ve had a lot of one-to-one conversations with men who have expressed that they can’t eat certain foods or can’t eat something a certain way. To me, it seems that everyone has some sort of place on an eating disorder spectrum. In our society it is seen as very emasculating to have an eating disorder.

Integro Medical Clinics Ltd always recommends remaining under the care and treatment of your GP and specialist for your condition, while using cannabis-based medicines, and the Integro clinical team would always prefer to work in collaboration with them.

If you would like further information or to speak to one of our specialist doctors or our neuropsychiatrist, Dr Mayur Bodani, please contact Integro Clinics: