A teenager who lived with a fear of food and felt unable to consume anything solid for over a year, drinking only hot chocolate, is now able to eat again.
August Grace, 18, from Gloucester, was diagnosed with Avoidant/restrictive food intake disorder (ARFID) as a child. But in October last year, her feelings around eating got progressively worse, with her unable to eat what she considered her solid 'safe' foods any more.
She was only able to consume up to two hot chocolates a day, which consisted of 400ml of milk and a spoonful of Cadbury's hot chocolate powder.
While she was drinking them every single day, even this was hard for Grace, as she was only doing it because she knew she needed to, and didn't enjoy it all.
"I was constantly stressed about when I'd have to have the next hot chocolate," she explains.
"I was only really having them because I had to have something."
Grace was aware that not eating was affecting her physically.
"I was always freezing cold, and my legs were like jelly," she recalls.
"I'd also recently got a Labrador, called Lilo, and I wasn't able to keep up with her and I felt so weak when I held her lead."
As well as the toll on her body, her fear of food also made things challenging socially and emotionally.
"Last Christmas was particularly difficult because I felt like I couldn't join in with my family," she says.
"I also felt like I was being rude because I couldn't stomach any of the food that had been made.
"For the past year, I've not eaten anything other than a couple of hot chocolates."
However, just under a month ago, things started to change for the better for Grace.
"I went to a therapy session with Felix, from The Heath, where he was able to help me overcome my fear," she explains.
During her therapy session, Grace was able to face her fears and try a selection of foods she'd been avoiding for the past year, sampling porridge, yoghurt, bread and watermelon.
"I was so surprised I was able to put those foods in my mouth and eat them after talking to Felix," she says.
"I was so hopeful the therapy would work because I was so sick of how I was living."
While a full recovery will, of course, take time, Grace noticed a breakthrough straight away.
"On the way home... I even stopped off for a Starbucks, which is something I'd never done before.
"We went via the drive-thru and I had a cookies and cream Frappuccino.
"It was so weird having a cold drink because I'd only ever had warm hot chocolate for the last year.
"I was so scared and anxious when I first got it, but after drinking some of it, it got easier, and I started to really enjoy it."
Since then, she's been trying to eat at least three times a day.
"So far, I've been eating porridge, bananas, grapes, baked beans and jacket potato," Grace says.
"I also managed to eat some chips last week which was great."
While she still has to challenge herself every day to try and eat more, Grace is feeling more positive than ever before. She's even found herself able to look forward to Christmas this year, hoping she'll be able to include herself more in the food-related celebrations.
"I'm hoping this year I'll be able to have more of a Christmas dinner," she says. "I'm especially looking forward to having some roast potatoes. I'm even excited to try different festive hot drinks and Christmas cookies."
Although grateful to be on the journey to recovery, Grace hasn't forgotten how tough her experiences of ARFID were.
"I went for so long without being supported, I felt so lost," she admits.
"There is a lack of support from services because I feel as though they aren't equipped to treat ARFID. Without Felix I would still be stuck."
"The therapy has totally changed my world and I’m excited to see how much more things will continue to improve as time goes on," she adds.
So while we may have heard of eating disorders such as anorexia and bulimia, what exactly are the signs and symptoms of ARFID?
What is Avoidant/restrictive food intake disorder?
ARFID is a condition where someone avoids certain foods or types of food, restricts their intake in terms of overall amount eaten, or does both, according to the eating disorders charity Beat.
Someone may avoid or restrict food for many different reasons. The most common, however, might be that they are hyper-sensitive to the taste, texture, smell or appearance of certain types of food, or can only eat things at a specific temperature, which can lead to 'sensory-based avoidance' or 'restriction of intake', the charity explains.
They might also have had a distressing experience with food, such as choking, vomiting or suffering bad abdominal pain, which can all fuel feelings of fear, anxiety and avoidance.
Some may experience general concerns about what might happen after eating that they find hard to explain, restricting what they eat to just 'safe' foods. This can lead to avoidance based on concern about the consequences of eating.
Sometimes they might not be able to tell they are hungry how others would, or simply have a poor appetite and low interest in food, making eating feel like a chore, rather than a pleasure.
Watch: Schoolboy who can only eat Dairylea has been helped thanks to being hypnotised
Due to the wide range of difficulties sufferers experience, ARFID is sometimes used an an 'umbrella' term. However, all people who develop it share traits of avoidance and restriction (in terms of the amount or types of food consumed).
The condition can affect adults, teenagers and children, interfering with everyday life, but it's important to remember that ARFID is different from anorexia, bulimia and other related conditions as someone's beliefs about their weight and shape are not part of the reason why sufferers avoid or restrict their food intake.
A diagnosis wouldn't be given at the same time as these other eating disorders, though could come before or after. It also wouldn't be given if another reason, like a medical condition that causes appetite loss or digestive problems, was behind the person's struggles.
Signs of avoidant restrictive food intake disorder
Again, signs of ARFID can differ, but as listed by Beat, some include:
Eating a reasonable range of foods but overall having much less food than is needed to stay healthy
Finding it difficult to recognise when you're hungry
Feeling full after only a few mouthfuls and struggling to eat more
Taking a long time over mealtimes/finding eating a ‘chore’
Missing meals completely, especially when busy with something else
Sensitivity to aspects of some foods, such as the texture, smell, or temperature
Appearing to be a 'picky eater'
Always having the same meals
Always eating something different to everyone else
Only eating food of a similar colour (e.g. beige)
Attempting to avoid social events where food would be present
Being very anxious at mealtimes, chewing food very carefully, taking small sips and bites, etc
Weight loss (or in children, not gaining weight as expected)
Developing nutritional deficiencies, such as anaemia through not having enough iron in the diet
Needing to take supplements to make sure nutritional and energy needs are met
Treatment for ARFID is not currently included in the NICE guidelines for eating disorders, but of course this doesn't mean it shouldn't be taken seriously or treated as valid.
Beat advises a GP should still make a referral to the relevant service, and young people may be treated by by their local community eating disorders service, generic Child and Adolescent Mental Health Services (CAMHS), community paediatric services, in the local acute paediatric service, or by a range of private practitioners.
Meanwhile, adults may be treated by specialist eating disorder services, general mental health services (especially those offering treatment for anxiety), hospital-based liaison work when the ARFID occurs in the context of a chronic medical condition, or by private practitioners.
If you're worried you or your child may have ARFID, make an appointment to talk to your GP, or speak to your family member to help encourage them to. While it may seem daunting, there is help out there.
For more information, visit Beat's website page on ARFID or see their helplines for each area of the UK. Contact the Samaritans on 116 123 if you're in need of urgent help outside of working hours, or always call 999 if someone is in immediate danger.
Additional reporting Caters.