Yesterday was quite an unusual day for fieldwork, as I was able to observe an initial evaluation session with a young client who was being treated for an eating disorder. When my classmate/fieldwork partner and I initially heard the diagnosis, I think both of us immediately jumped to conclusions about the client we would be seeing. This is probably due partly to our own personal experiences both in and out of the OT clinic, but also by the dominant narratives about people with eating disorders that are shown in popular media. In my experience, I have really only seen shows and read narratives of young (middle school to high school age), Caucasian females with disordered eating habits. However, the client we saw fit few of these stereotypes!
Instead of the “scary skinny” young girl we might have expected to see, our client was a tall, talkative 16 year old male who was classified as obese in his medical records. He was an agreeable and intelligent young man who expressed himself clearly, and whose goals included being able to go to restaurants with friends and find something on the menu that he felt comfortable eating. “Josh” had a repertoire of only 10-15 foods that he would eat (like hot dogs, pepperoni pizza, cucumbers, and ranch dressing), and reportedly he would rather “go hungry” than eat a non-preferred food. In addition to his limited diet, Josh was dealing with a somewhat unstable home situation, gastroesophageal reflux disease, and crippling anxiety about his performance in school that frequently caused him to miss multiple days out of school at a time. Josh was being seen at the OT clinic because he had been diagnosed with Avoidant/Restrictive Food Intake Disorder (ARFID), and here is a brief description of the disorder from Sheppard Pratt’s Center for Eating Disorders website:
ARFID was introduced as a new diagnostic category in the recently published DSM-V. The ARFID diagnosis describes individuals whose symptoms do not match the criteria for traditional eating disorder diagnoses, but who, nonetheless, experience clinically significant struggles with eating and food. There are many types of eating problems that might warrant an ARFID diagnosis – difficulty digesting certain foods, avoiding certain colors or textures of food, eating only very small portions, having no appetite, or being afraid to eat after a frightening episode of choking or vomiting. And most of all, individuals with ARFID may have problems at school or work because of their eating problems – such as avoiding work lunches, not getting schoolwork done because of the time it takes to eat, or even avoiding seeing friends or family at social events where food is present.
Although the other components of the disorder are also very significant, an occupational therapist is most likely to become involved when the client’s disorder disrupts his or her engagement in occupations like eating in new surroundings, going to school, or “seeing friends or family at social events where [non-preferred] food is present,” which are examples of the real occupational performance issues that Josh faced as a result of his eating disorder. Continue reading