It’s Not “Picky Eating”
It’s Not “Picky Eating”
Understanding ARFID in the BIPOC Community
Avoidant/Restrictive Food Intake Disorder (ARFID) is often misunderstood and underdiagnosed, especially in Black, Indigenous, and People of Color (BIPOC) communities. While eating disorders have historically been associated with white, affluent populations, ARFID affects individuals of all racial and ethnic backgrounds. However, cultural biases, systemic barriers, and limited research on BIPOC populations have contributed to gaps in diagnosis, treatment, and support. As mental health professionals, it is crucial to recognize the unique ways ARFID presents in BIPOC clients and to develop culturally responsive interventions.
What is ARFID?
ARFID is an eating disorder characterized by extreme food selectivity and avoidance, leading to nutritional deficiencies, weight loss (or failure to gain weight in children), and psychosocial impairments. Unlike anorexia nervosa or bulimia nervosa, ARFID is not driven by body image concerns but rather by sensory sensitivities, fear of aversive consequences (e.g., choking, vomiting), or a lack of interest in eating.
Individuals with ARFID may struggle with:
- A limited range of “safe” foods, often due to texture, smell, or taste aversions.
- Anxiety around mealtime or eating unfamiliar foods.
- Physical consequences such as malnutrition, fatigue, and digestive issues.
- Social isolation due to food-related distress.
The Underdiagnosis of ARFID in BIPOC Communities
Despite its prevalence, ARFID remains underdiagnosed in BIPOC communities for several reasons:
1. Cultural Stigma and Misconceptions
In many cultures, eating disorders are perceived as a “white” issue, leading to stigma or dismissal when BIPOC individuals present with symptoms. Families may interpret food avoidance as simply being “picky” or associate it with cultural food preferences rather than a medical condition.
2. Healthcare Disparities
Implicit bias within the healthcare system means that BIPOC individuals are less likely to be screened for eating disorders. Research shows that healthcare providers often underdiagnose or misattribute symptoms to other factors such as socioeconomic stressors or digestive issues rather than recognizing ARFID.
3. Lack of Representation in Research and Treatment Models
Most eating disorder research has focused on white populations, meaning that diagnostic criteria and treatment models may not fully capture the experiences of BIPOC individuals. As a result, ARFID in BIPOC communities may present differently or be accompanied by unique cultural food practices that are not considered in mainstream assessments.
How ARFID May Present Differently in BIPOC Clients
Understanding the cultural and familial context of food is essential in recognizing ARFID in BIPOC clients. Some key considerations include:
1. Cultural Food Practices and Selectivity
In BIPOC communities, food is deeply tied to cultural identity, family traditions, and social gatherings. A child who avoids traditional dishes may be perceived as disrespectful or ungrateful rather than struggling with ARFID. For example:
- A Latinx child refusing to eat arroz con pollo due to texture issues may be reprimanded rather than assessed for ARFID.
- A Black teenager avoiding collard greens and cornbread may be assumed to have a simple preference rather than an aversion rooted in ARFID.
2. Trauma and Food Insecurity
Many BIPOC individuals have historical and generational trauma linked to food scarcity, colonization, or forced dietary changes. Additionally, food insecurity remains prevalent in marginalized communities, making it difficult to distinguish ARFID from behaviors influenced by limited access to food. Some individuals may avoid food due to past trauma related to hunger, restrictive dieting, or unsafe eating environments.
3. The Role of Family and Community
In collectivist cultures, food is often a communal experience. A child with ARFID may experience increased pressure to eat at family gatherings, leading to heightened anxiety or shame. Parents may also feel guilt or frustration, believing their child’s food avoidance is a behavioral issue rather than a medical condition.
Culturally Responsive Strategies for Mental Health Professionals
To effectively support BIPOC clients with ARFID, mental health professionals must employ culturally responsive approaches. Here are key strategies to consider:
1. Use Culturally Inclusive Screening Tools
Standardized assessments should be adapted to consider cultural food practices and social dynamics around eating. Ask open-ended questions about food preferences, mealtime experiences, and any distress associated with eating. Incorporate culturally specific examples rather than relying on Western food norms.
2. Address Healthcare Bias and Advocacy
Mental health professionals should actively challenge biases in the medical field and advocate for their BIPOC clients. This includes:
- Educating healthcare providers on ARFID’s presentation in diverse populations.
- Encouraging pediatricians and dietitians to screen for ARFID in BIPOC children.
- Helping clients navigate the healthcare system and access appropriate resources.
3. Incorporate Family and Community in Treatment
Because food is often a family-centered experience in BIPOC communities, involving family members in treatment can improve outcomes. Strategies include:
- Educating caregivers about ARFID and its impact beyond picky eating.
- Collaborating with families to create mealtime strategies that reduce stress.
- Encouraging gradual exposure to new foods in a culturally respectful manner.
4. Trauma-Informed Care and Historical Context
Recognizing the intersection of trauma, food insecurity, and cultural history is critical. Use a trauma-informed approach by:
- Exploring any past negative experiences with food.
- Validating concerns around food safety or aversive eating experiences.
- Offering coping strategies that align with cultural practices.
5. Diversify Treatment Approaches
Traditional cognitive-behavioral therapy (CBT) techniques should be adapted to be culturally relevant. This may include:
- Incorporating mindfulness or spiritual practices common in the client’s culture.
- Using culturally familiar foods in exposure therapy.
- Encouraging storytelling and narrative therapy to process food-related experiences.
Moving Forward: Increasing Awareness and Research
The lack of research on ARFID in BIPOC communities highlights the need for greater awareness and inclusion in eating disorder studies. Mental health professionals can contribute by:
- Conducting research on ARFID’s presentation in diverse populations.
- Advocating for more inclusive diagnostic criteria and training programs.
- Educating the community about ARFID to reduce stigma and promote early intervention.
Conclusion
ARFID is not just a “picky eating” disorder—it is a serious condition that requires careful assessment and culturally competent intervention. In BIPOC communities, systemic barriers, cultural stigma, and healthcare disparities make recognition and treatment more challenging. As mental health professionals, it is our responsibility to bridge these gaps by providing inclusive, informed, and compassionate care. By acknowledging the unique experiences of BIPOC individuals with ARFID, we can move toward a more equitable and effective approach to treatment and healing.
