Chapter 3: An Intersectional Approach to Avoidant Restrictive Food Intake Disorder (Arfid): Case Analysis of a Transgender Identifying Individual

Avoidant/restrictive food intake disorder (ARFID) is characterized by a broad range of criteria associated with the consequences of prolonged and intense food restriction. It is marked by a disturbance in the feeding or eating behaviors that interfere with an individual’s day-to-day life. Those diagnosed with ARFID often experience significant weight loss, nutritional deficiency, or dependence on external feeding (American Psychiatric Association [APA], 2022). Unlike some other eating disorder (ED) diagnoses included in the DSM-5-TR, diagnostic criteria for ARFID do not include shape and weight concerns or guidelines for weight ranges indicating levels of malnutrition; however, the diagnosis is characterized by a failure to meet appropriate energy and/or nutritional needs (Zickgraf et al., 2019). Empirically and clinically, appropriate is understood as a relative term, distinguished by an individual’s current developmental and cultural context. It is essential for diagnosing clinicians to have familiarity with and an understanding of each patient’s sociocultural factors and ethnic values relevant to their experience of eating behaviors (Katzman et al., 2019). For example, food restrictions and traditions based on religious views must be taken into account. For children, adolescents, and emerging adults, life experiences, comorbidities, and intersectionality can complicate an ARFID diagnosis. This chapter will review the ARFID diagnosis, nuances in expression of the disorder, prevalence, and comorbidities. Intersectionality will be explored and then illustrated through a focus on ARFID among transgender individuals. A case study is presented to facilitate discussion on etiology, assessment, diagnosis, and treatment of ARFID with an individual who identifies as transgender. Questions for discussion and implications for future directions are included.