What Residential Treatment for ARFID Involves and Why it is Helpful
Learn more about our program from our Director of Eating Disorder Programming, Dr. Anita Johnston, PhD, CEDS.
Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively new eating disorder diagnosis, but that does not mean that people haven’t been experiencing its symptoms for some time. In the past, ARFID may have been confused with any number of other disorders including Anorexia Nervosa, OCD, or simply “picky eating.” However, ARFID is a unique eating disorder that requires targeted treatment to address its complexities.
Residential treatment for ARFID may be recommended for a patient if their physical and psychological symptoms have led to malnutrition, marked distress, or are preventing them from engaging in school, work, or activities of daily life. ARFID residential treatment provides a robust and holistic care setting in which patients are able to address the medical and psychological aspects and impact of ARFID.
ARFID residential treatment is an effective way of treating ARFID because in the inpatient or residential setting, a patient is able to be supported by a multidisciplinary team of professionals who are equipped to work with the patient on the primary symptoms of the eating disorder, alongside co-occurring issues which continue to drive the disordered behaviors.
At our Maui location, we provide the Residential level of care. Residential is a term that refers to an inpatient treatment setting, but not one that provides the highest level of medical treatment that would be available in a hospital setting. Individuals in our program stay with us for anywhere from 45-60 days on average to fully immerse themselves in a treatment and recovery process. We provide 24/7 nursing support, consultations with physicians and psychiatrists, group and individual therapy, meal support, recreation, and more.
ARFID can be challenging to diagnose and treat for several reasons. In childhood in particular, ARFID can easily be dismissed or overlooked as “extreme picky eating.” Parents may become frustrated with their children and invoke negative consequences for their selectiveness around food. In these cases, it is often not until the child begins to show more significant symptoms such as weight loss or malnutrition that the parent(s) may seek additional support from a pediatrician or mental health professional.
For others, including adults, the disorder may hone in on specific textures, colors, or types of foods that are associated with a past traumatic event. This event could be directly related to the process of eating i.e. choking or vomiting, or it could be tied to a disturbing memory or trauma that occurred during a certain time in a person’s life. In this case, ARFID residential treatment can more effectively address the events and impacts of trauma while the individual is being exposed to food in a safe and supportive therapeutic setting.
Treating ARFID in the residential setting also important if the patient has begun to develop medical issues relating to ARFID such as: significant weight loss resulting in malnutrition; abnormal lab results, heart rate, or blood pressure, menstrual irregularities (amenorrhea), trouble sleeping; and other negative symptoms that are affecting an individual's health and overall quality of life. Within a residential treatment environment, these symptoms can be monitored by 24/7 nursing staff, doctors, and psychiatrists.
All patients entering our residential treatment for ARFID are required to complete a comprehensive medical and psychological assessment prior to admission. These assessments provide us with a detailed account of past and current issues and allow us to build an appropriate and responsive treatment plan that is individualized to the patient’s needs and personal goals. The medical clearance provides our medical team with a baseline for comparison and ensures that any medical symptoms of ARFID such as malnutrition, abnormal labs, GI upset, insomnia, and others can be addressed in the residential treating setting.
Throughout the course of one’s stay with us, the medical symptoms of ARFID are able to be monitored by our medical staff. Within a safe and controlled setting, patients are able to re-engage in consistent eating patterns that allow for nutritional stabilization and improved physical and mental health. Because ARFID can lead to nutritional deficiencies, our staff are qualified to assess and provide appropriate prescriptions and recommendations regarding medications, supplements, and vitamins to restore the patient's mind and body to optimal functioning.
ARFID, like all eating disorders, is considered biopsychosocial in nature. This means that there are biological, psychological, and social origins and impacts of ARFID.
When it comes to treating ARFID, exposure to new or “fear” foods is important. Facing what is frightening or off-putting, rather than avoiding it, is what leads us to overcome our fears and engage in healthy or normal eating. Routine exposure and exploration over time is necessary to achieve long-term recovery from ARFID. ARFID residential treatment allows for this type of repeated and supported exposure to a challenging variety of foods. Within the inpatient or residential setting, patients are able to plan and prepare for food exposures, practice healthy coping skills, work through challenges with a dietitian, therapist, and their peers, and slowly expand their comfort zone.
‘Ai Pono’s approach to treating ARFID within the residential setting is particularly effective because we offer a small, homelike setting with a high staff to patient ratio. This means that those struggling with particular foods or meals can receive the individual support needed leading up to, during, and following mealtimes.
Because we know that ARFID can develop in patients of different ages for a variety of reasons, our intimate setting allows for truly individualized treatment plans that can be responsive to each patient’s unique needs. Our patients receive four individual sessions per week (three with a Primary Therapist and one with a Registered Dietitian) in order to work through personal challenges as they arise.
At ‘Ai Pono, we also specialize in treating co-occurring trauma or PTSD. Because the origins of ARFID are often attributed to some form of trauma, addressing these traumas within a safe environment is vital to the ARFID treatment and recovery process. Treating ARFID in a residential program allows patients to make real time observations of the relationship between their trauma and the experience of eating. It takes time to “untrain” the brain from making negative connections between food and feelings or experiences. Working through this process within a residential treatment program provides significantly more opportunities for reflection and change.
All of our therapists at ‘Ai Pono Hawaii utilize a trauma-informed approach. We have several therapists on our team who are trained in EMDR, brainspotting, and/or somatic approaches to trauma healing. We utilize a genuinely holistic approach to treating trauma and eating disorders that allows patients to see and understand that their behaviors regarding food and eating are symptoms of deeper, unmet needs. Once these needs are identified, we can then work through learning and practicing alternative and sustainable coping skills and methods in order to end the eating disorder and work towards post-traumatic growth.
We believe that full recovery from an eating disorder is possible and that all people struggling deserve a life of freedom, balance, and wholeness.
Those struggling with ARFID may become easily overwhelmed or overstimulated in larger, unfamiliar treatment environments. The Residential Program at ‘Ai Pono provides 24/7 nursing support within a homelike setting on the beautiful island of Maui, Hawaii. Many women travel to us from all over the United States (and world!) to get away from the stressors of their everyday life and focus solely and completely on their recovery. In this serene setting, the hard work of recovery is able to take place without immediate feelings of overwhelm or overstimulation.
At ‘Ai Pono Hawaii, we have all the benefits of a intensive, residential setting including 24/7 medical support, safety and containment, a multidisciplinary team, 4x individual sessions per week, intensive group therapy, and meal support, but we also maintain a connection with the outdoor environment. Positioned between the ocean and nearby Iao Valley National Park, patients are able to immerse themselves in nature on a regular basis. We also utilize our outdoor spaces for individual and group sessions wherever possible. This exposure to the natural environment of Hawaii allows our residents to feel safe and grounded and provides a foundation from which to do the deeper work of trauma healing alongside treating their eating disorder.
Hawaiian Cultural Groups
Ukulele Lessons
Narrative Therapy/Storytelling
Full Moon Letting Go/Intention Setting Gatherings
Mindfulness/Mindful Walking
Beach and other Outdoor Excursions
Visits to Local Cultural Sites
Horticultural Therapy
These unique offerings provide patients with a truly holistic experience and ample creative outlets through which to examine and process the deeper meaning behind their eating disorder.
When one enters a Residential Treatment Center for ARFID, we always recommend a “step-down” approach to aftercare. This means that an individual would be encouraged to continue care in an outpatient (Partial-Hospitalization or Intensive Outpatient) setting. Transitioning through the appropriate levels of care is particularly helpful for those with ARFID as it allows the individual to continue to practice exposure and an “all foods fit” approach while still receiving significant therapeutic support when challenges do arise.
For those who chose to remain in Hawaii after their residential treatment for ARFID, ‘Ai Pono offers Intensive Outpatient and Virtual Intensive Outpatient Programs. If someone wishes to transfer back to their home setting following treatment, we provide detailed aftercare planning to ensure a smooth transition directly into a supportive environment so that there is no lapse in treatment. All participants of our Residential program depart with a four-week cycle of menus that they have worked on developing with our dietitian throughout the course of their stay.
It’s important to remember that ARFID does not discriminate. This means that anyone, regardless of age, gender, or other factors can develop ARFID.
Since the diagnosis of ARFID is relatively new, eating disorder professionals are working hard to create educational opportunities for loved ones and individuals struggling with ARFID to find information and support. ‘Ai Pono strives to serve as an informational resource for families and patients struggling with ARFID. We encourage you to reach out to us today if you feel you or someone you know identifies with the symptoms of ARFID and we will do our best to find you the help that you need.
