Avoidant Restrictive Food Intake Disorder (ARFID) Simple Suggestions Series – Changing your eating environment

Produced in collaboration with:

• Bedfordshire and Luton Mental Health and Wellbeing Services provided by East London NHS Foundation Trust
• InsightEating and InsightHealth
• North East and North Cumbria Mental Health, Learning Disability and Autism Partnership

1. Eating in different places can be very challenging. So, it’s a good idea to think about your motivation – your reason why. Understanding why change is important to you can help to push you forwards when it feels scary. Reasons why can be different for everyone. Some examples might be so that you can join in with your friends and family, go on holidays, or have more flexibility. There are no wrong answers. The right answers are the reasons that make sense to you. Your reasons why can also change over time too. So, it’s helpful to keep checking in with yourself about what you are doing and why.
2. Try not to change too much at once. It is usually most helpful to work on food challenges or situation challenges. It is better not to work on both at the same time. This might mean eating your safe foods in cafés/restaurants as you adjust to changes in your environment. For example, seeking permission to bring your own food in or asking ahead for adjusted safe foods.
3. Finding where to start can feel dauting and overwhelming. You could start by writing a list of situations/locations which feel uncomfortable. Some examples might be eating in social spaces or eating in front of others. Or it may be eating in environments where food is being made. Another example could be eating in a different chair or using different crockery. All these are examples of significant goals for different people. Try writing each of your situations with as much detail as possible. For example, instead of writing ‘eat in a café’ try writing which café, when, and with who. You may also want to include which food/drink you feel comfortable with. Being very specific helps you to think about the strategies needed to help you achieve each goal.
   
   After doing this:
   • Rate how much anxiety (worry) you think you will experience for each of your situations. Use a scale of 0-10 (0 = no worry at all, 5 = quite worried and 10 = very worried)
   • Rearrange the situations list into a ranked order with the lowest worry score at the top.
   • Start your exposures with the easiest situation on your list. Never start with the hardest.

4. If the end situation feels too scary, break your goal down into smaller, more manageable steps. Using the café example above, this might mean that you only walk into the café but don’t eat in the first instance. In this way you are still exposing yourself to new situation and this is important. Small steps (small changes) are usually more manageable than big ones. This is especially true at times when your anxiety (worry) is high.
   

5. Try not to feel disheartened if progress feels very slow – change does take a long time. Keeping a diary can be helpful to remind you that you have made progress. It can also be helpful to rate how much worry you feel with each of your new food exposures. You can use a scale of 0-10 to do this (0 = no worry, 5 = quite worried, 10 = very worried).
   

6. Remember that repetition and repeating situation exposures is important. Consistent and structured repetition is the key to tolerating and accepting new environments. By completing a record of your worry, you should see that the worry score comes down over time until it feels safe.
   

7. Don’t be put off by feeling worried. Remember, you are learning to master anxiety rather than avoid it. The only way to over-come your worries is by repeated exposures to them, bit by bit. Over time you gain enough good experiences to challenge the fear of new surroundings.
   

8. It’s ok to change your mind through this process. If you decide there are new situations/places that you want to try, then it’s ok to change the list as you go along. This is your process, working on change that is important to you.
   

9. Reward yourself for your success. Overcoming change is challenging and difficult. Think about things or experiences that you enjoy. These can then be used as small rewards for your efforts.
   

10. Remember that success is not only achieving a goal of overcoming a new environment or change. Success is everything that you did that was challenging as part of that process. Even writing down your goal is a success! Remember to be kind to yourself and think-about / write-down what success looks like to you.

C.Ellison, RD, P.Falcoski RD and U.Philpot, RD (February 2024)