Perhaps the aspect of ARFID that’s most difficult to understand for many people is that it's entirely unrelated to body image or how someone feels about their weight. Like anyone else, I wish I was fitter at times and get bummed out about my less-than-perfect body parts, but that isn’t what has been preventing me from eating.
Most eating disorder and mental illness treatments are based on remedying bad habits that have developed as a result of the disorder. The behaviors that lead me to eat restrictively have become part of my daily life, and it’s scary to commit to changing the routines that are so second nature and easy for me.
Before starting ARFID treatment, all I knew about my poor eating habits and tendency to let myself be hungry for extended periods of time is that they stemmed from anxiety and depression. It was suggested that my disordered eating was a subconscious form of self-harm. In the past five weeks of ARFID treatment, I've learned a lot regarding how I think about food and eating -- both consciously and subconsciously.
As far as I understand it, there are three main sources of ARFID, although most people (myself included) developed avoidant or restrictive eating because of multiple. According to the DSM definition, someone must show a lack of interest in eating/food, whether it’s due to sensory characteristics such as certain textures or smells, concern about negative consequences of eating or a physical lack of interest in eating/food to be diagnosed with ARFID. My diagnosis is based on a hybrid of the lack of interest one and the negative consequences one.
Even though I’m working on changing these behaviors in treatment, I’m going to speak about them in the present tense.
A faction of people with ARFID simply aren’t interested in food, don’t feel a desire to eat or have a problematically small appetite. For as long as I can remember, I’ve never felt the same joy when I eat as most people do. Sure, there are certain foods I love and find delicious, but I don’t really look forward to meals. I’ve had the mindset that I eat to survive, although not in such dramatic, black and white terms. Oftentimes, nothing sounds good to me. There are a handful of foods (pizza and bagels are two) that I can almost always muster an appetite for, but I have a hard time being enticed by other foods. Even when it’s a dish I generally enjoy or something I picked out for myself, I probably won’t feel interested. Within a list of things I want to accomplish within a particular day, eating is low priority. I’m usually better about keeping up with meals when I’m spending time with people who eat like normal adults, but when left to my own devices for a day, I put eating off for as long as possible.
Here’s generally how it goes: I have to put something in my stomach in the morning before taking my antidepressants, so I always start my day with a breakfast-type snack. When the feeling of hunger sets in later in the morning, I ignore it as best as I can because nothing sounds appetizing to me and I don’t want to deal with it. I have a physical appetite but not a mental appetite, which I know probably doesn’t make sense to most people. Eventually, once I start to feel hangry and can't think well, I eat a tiny snack to take the edge off and wait until I cross into the point of not being hungry anymore from postponing eating for so long. When the hunger comes back a while later, the cycle starts over. As a result of this frequent meal skipping, my body started asking for food less often and it became second nature to live with the feeling of hunger. Honestly, it still is.
So now we add the fear of eating’s negative consequences to the mix. In a textbook case of ARFID, people who restrict or avoid food for this reason do so because of a traumatic experience such as throwing up, choking or
food poisoning after eating it. In my case, I associate feeling full with being nauseous; I'm not super sure why. I end up not eating enough because I’m afraid I’ll feel too full or like I have to throw up. I don’t even finish small meals like a peanut butter and jelly sandwich, and I’m trying to learn why. Like I mentioned before, I have the physical feeling of hunger but mentally can’t bring myself to eat.
This delightful combo of post-noms bellyache paranoia and a general disinterest in eating led me to approach every meal time with the attitude of, “I’ll eat enough to get by.” And over the years, that's become the norm. So now I’m retraining my mind and body after years of unfinished meals and avoiding eating altogether whenever possible.
I finally made an appointment with a nutritionist at MGH to talk about how much I should be eating and how I can get all the nutrients my body needs. I’ll dive more into what the clinic treatment has involved next, but some of the goals I’m currently working on are eating more vegetables, eating at specific mealtimes seven days a week to help my body reset hunger cues, and finishing meals within a reasonable time limit instead of letting them sit in front of me for hours. Wish me luck as I somehow wake up for my daily 8:45 a.m. breakfast time slot on the Sunday after St. Patrick’s day!