Greetings!
It's been a while. I'll blame COVID brain on my lack of writing over the past year. Can you believe it's been a year of this shit? And it looks like we're about to ride another wave, this time the variants B117 and P4.
I'm not here to write about COVID. I'm here to talk about food. Specifically, the psychology of eating. There's a lot of attention being given to this idea of "ARFID" or Avoidant Restrictive Food Intake Disorder, in patients with chronic digestive disease. This is a psychiatric diagnosis conceptualized mostly for children with sensory issues or similar concerns. The main questionnaire used to assess ARFID, the Nine Item ARFID Scale (NIAS), is only validated in children.
While I absolutely agree there are adults with chronic digestive disease who meet the criteria for ARFID, this whole thing makes me a bit twitchy. Here's why.
First: Did you ever drink too much tequila and puke and maybe have one of the worst hangovers of your life? And the thought of drinking tequila made you gag a little for the next 2 years?
Or have you ever eaten out at a restaurant and get food poisoning and decree you'll never eat [insert food that made you sick] again because you can't even look at it?
When I was pregnant both times, I had nausea for the entire first and part of the second trimester. I also had an intense food aversion to seafood. Maybe you've experienced that.
I won't know what exactly is going on until June 9th, when I have an upper endoscopy, something called an EndoFLIP, and an esophageal manometry. It's as fun as it sounds. Better? It's being done by my boss. Granted he's the esophagus expert guy, and we've done this once before around 3 years ago, but it's still a little weird.
In the meantime, every day I experience some degree of food impaction. Nothing like the one I mentioned earlier, where I had to make myself throw up some of the delicious salad that was just sitting there like a hairball in a clogged drain. But enough to feel it, to make my esophagus a bit sore, and to nuke my appetite.
The thing is, our brain is hard wired to make us feel ill if it thinks we're eating foods that will make us sick, or worse, kill us. This is a primal reflex, deeply seated in our reptilian brain and connected to the nausea and vomiting centers in the medulla oblongata. There's nothing conscious about this.
Now, while an esophageal food impaction that won't pass is a medical emergency, I'm not at major risk of dying from the food I'm eating. I'm also not worried because I understand what's going on, and I know worry won't help. I'm not afraid of food, per say. I'm just not interested any more. Which, by any standards, isn't a good reaction.
I'll feel hungry a few times during the day, but it can pass quickly or be replaced by nausea. A phenomena I learned from a very wise dietitian that is common. Some meals are ok, things go down without much incident. Then other times it sits there again, causing a discomfort that I can only describe as feeling like you need to let out an enormous burp and you can't. After 10...15...sometimes 30 minutes it passes. But its effects are I stop eating whatever I was enjoying just moments before. And my mind goes to a deadpan "Great." When I drink water you can literally hear it gurgling down. It provides some entertainment for my husband and I, at least.
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| My digestive system |
As of today, I have very little interest in food. I'm down only around 5 pounds so far and thanks to the pandemic, I have more wiggle room than I normally would. I am fundamentally aware of what's happening, not anxious, not afraid, yet my brain is saying "ya know, we can just skip that eating thing for a bit."
My primal instinct around the threat of food has kicked in and is generalized versus specific to tequila or a bad piece of seafood. And it's very hard to overcome that.
Is this ARFID? No. Does the current assessment of ARFID in adults with digestive disease take this into account? Not really. Should it? Absolutely.