A tradeoff between safety and freedom: Adults’ lived experiences of ARFID

Avoidant restrictive food intake disorder (ARFID) is characterized as a pattern of restrictive eating leading to significant medical and/or psychosocial impairment (American Psychiatric Association in Diagnostic and statistical manual of mental disorders, American Psychiatric Association, Washington, D.C., 2013). Most existing research on ARFID utilizes quantitative methodologies to study children and adolescents. As a result, the experiences of adults with ARFID have been underrepresented in research. To fill this gap, the current study examines the lived experiences of adults with a DSM-5 diagnosis of ARFID. Participants (n = 9) included adult women aged 20–42 (M = 27, SD = 6.2) recruited from social media advertising. Open-ended, semi-structured interviews were conducted. Data were analyzed using interpretative phenomenological analysis (IPA). One of three overarching themes identified by IPA will be discussed in this study: "A tradeoff between safety and freedom," which consists of two subthemes: (a) Ensuring safety from food unknowns and (c) Longing for Freedom. This overarching theme explores the influence of ARFID on an individual's sense of safety and freedom. This study is one of few to qualitatively examine ARFID, and the only to do so using IPA. Findings offer novel insights relevant to researchers and clinicians who treat adults with ARFID and who wish to increase consideration and understanding of patient lived experience in their work. Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder (ED) with serious medical and psychological consequences. There is little research that tries to understand the experiences of people with ARFID. We carried out a qualitative study on adults with ARFID to improve our understanding. We interviewed 9 adult women with ARFID who we recruited from social media. We asked them open questions meant to get them to reflect and share about what it is like for them to live with ARFID. We then looked at the transcripts from these interviews and identified major topics (or themes) that were talked about the most. This study examines 1 of the 3 total themes that we found. This theme is about how food restriction makes participants feel safe but also limits their freedom to go places and do things. Participants are caught between an impossible choice between safety and freedom. Overall, this study improves our understanding of what it is like to live with ARFID as an adult. All participants had difficulty tolerating uncertainty, something that people with other psychiatric disorders also experience. Therefore, general treatments that target core issues (like intolerance of uncertainty) may help people with ARFID, people with other psychiatric conditions, or people with both ARFID and other psychiatric conditions. This study also offers insights about the thoughts and feelings of people with ARFID which is new and unique. Qualitative research tends to form a baseline understanding of new or underexplored topics, and so findings from this study can contribute to the development of new assessment measures that ask people what they are thinking and feeling to help diagnosis them and eventually treat them. Lastly, this study helps clinicians and researchers to better understand people with ARFID and what they may be experiencing. This can lead to better outcomes for people with ARIFD.