ARFID

ARFID: Understanding Avoidant/Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder in which a person limits the amount or variety of food they eat. The key difference from many other eating disorders is that ARFID isn't driven by concerns about weight or body shape. Instead, restriction usually stems from sensory sensitivities, a lack of interest in eating, or fear of what might happen when eating, such as choking or vomiting.

ARFID is one of several conditions within the broader category of eating disorders. It's more than picky eating. ARFID can lead to weight loss, nutritional deficiencies, and growth problems in children, and it can make everyday situations like meals with family, school lunches, or social events very difficult.

ARFID was added as a formal diagnosis in 2013. Awareness has grown quickly since then, and effective, specialized treatments are now available for children, teens, and adults.

What Is ARFID?

Clinicians diagnose ARFID when a person's eating is restricted or avoidant enough to cause one or more of the following:

• Significant weight loss, or failure to reach expected weight or growth in children

• Significant nutritional deficiencies

• Dependence on nutritional supplements or tube feeding

• Significant interference with daily life, such as avoiding social situations that involve food

To meet criteria for ARFID, the eating problem can't be explained by a lack of available food or cultural practices. It also can't be better explained by another medical or mental health condition. Most importantly, it doesn't involve the fear of weight gain or body image disturbance seen in anorexia nervosa.

Types of ARFID

ARFID often shows up in one or more of three main presentations. Many people have a combination.

Sensory sensitivity. People may be highly sensitive to the taste, texture, smell, temperature, or appearance of food. They often eat only a small number of "safe" foods, sometimes only specific brands or preparations.

Lack of interest in eating. Some people have a low appetite, forget to eat, or find eating unrewarding. They may feel full quickly or see eating as a chore.

Fear of aversive consequences. Some people restrict eating because they fear choking, vomiting, gagging, pain, or an allergic reaction. This often begins after a frightening experience, such as a choking episode or a bad stomach illness.

Signs and Symptoms of ARFID

Behavioral signs may include:

• Eating a very limited range of foods, with the list sometimes shrinking over time

• Refusing new foods or foods with certain textures, colors, or smells

• Eating very slowly or very small amounts

• Avoiding meals, especially in social settings

• Fear or anxiety around eating, swallowing, or specific foods

• Relying on nutritional drinks or supplements

Physical signs may include:

• Weight loss or failure to grow as expected in children

• Fatigue, low energy, or dizziness

• Stomach discomfort or constipation

• Signs of nutritional deficiencies, such as anemia

Emotional and social signs may include:

• Distress or anxiety around mealtimes

• Avoiding parties, restaurants, school lunches, or family meals

• Embarrassment about eating habits

Who Develops ARFID?

ARFID often begins in childhood, but it can affect people at any age, including teens and adults. Some adults have had symptoms since childhood without ever receiving a diagnosis.

ARFID commonly occurs alongside other conditions, including:

• Anxiety disorders

• Autism spectrum disorder, often linked to sensory sensitivities

• ADHD

• Obsessive-compulsive disorder

• Gastrointestinal conditions

How ARFID Differs From Other Eating Disorders

ARFID is often confused with other eating disorders, but the motivation behind the eating behavior is different.

People with anorexia restrict food because of fear of weight gain and concerns about body shape. People with ARFID restrict for reasons unrelated to body image. ARFID is also very different from binge eating disorder and bulimia nervosa, which both involve recurring episodes of eating large amounts of food with a loss of control.

ARFID is also different from typical picky eating. Many children go through phases of selective eating and grow out of them. With ARFID, the restriction is persistent and severe enough to affect health, growth, or daily functioning.

Health Effects of ARFID

Without treatment, ARFID can lead to:

• Malnutrition and vitamin or mineral deficiencies

• Weight loss, or delayed growth and puberty in children

• Low energy and difficulty concentrating

• Weakened immune function

• Heart rhythm problems and other medical complications in severe cases

A medical evaluation is an important first step for anyone showing signs of ARFID.

Diagnosis and Assessment

Diagnosing ARFID usually involves ruling out medical causes of eating difficulties and understanding what's driving the restriction. A comprehensive assessment may include a medical exam, nutritional evaluation, and psychological evaluation. It may also involve specialists such as a gastroenterologist, speech-language pathologist, or occupational therapist.

Treatment for ARFID

ARFID treatment is tailored to the individual and to what's driving their restriction. Care often involves a team that may include a therapist, physician, registered dietitian, and feeding specialist.

Cognitive Behavioral Therapy for ARFID (CBT-AR)

CBT-AR is a specialized form of cognitive behavioral therapy developed specifically for ARFID. It helps people gradually expand the variety and amount of foods they eat. It also addresses fears and sensitivities through structured, step-by-step exposure to new foods.

Family-Based Approaches

For children and teens, parents play a central role in treatment. Family-based approaches help parents support regular eating, gradually introduce new foods, and reduce stress around mealtimes. Family therapy can also help families communicate and work together during recovery.

Feeding Therapy

Occupational therapists or speech-language pathologists may help with sensory sensitivities, oral motor skills, or swallowing concerns.

Nutritional Support

A registered dietitian can help restore adequate nutrition, address deficiencies, and create a plan for gradually expanding food variety.

Medication

There's no FDA-approved medication specifically for ARFID. A psychiatrist may consider medication to treat co-occurring conditions such as anxiety, or in some cases to support appetite.

Levels of Care for ARFID

Many people with ARFID can be treated in outpatient care. Those with significant weight loss, medical complications, or dependence on supplements or tube feeding may need a higher level of care, such as a partial hospitalization program, residential treatment, or medical inpatient care.

ARFID in Children and Teens

Because ARFID often begins early in life, it can affect growth, development, and school and social life. Early treatment helps prevent long-term nutritional and developmental problems. Specialized treatment programs for teens and pediatric feeding programs are designed to support young people and their families.

How to Support a Loved One With ARFID

If someone you care about has ARFID, avoid pressuring, bribing, or forcing them to eat. This can increase anxiety and make eating harder. Instead, keep mealtimes calm and low-pressure, offer safe foods alongside new ones without expectation, and seek help from a professional who specializes in ARFID.

Finding ARFID Treatment in California

Our California directory includes providers that treat ARFID and other eating disorders. Options range from outpatient therapists and dietitians to higher levels of care.

When comparing providers, look for specific experience with ARFID, access to evidence-based approaches such as CBT-AR, a multidisciplinary team, and experience working with your age group. With specialized support, people with ARFID can expand their eating, improve their health, and feel more comfortable around food.

If you or someone you love is in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or text HOME to 741741 to reach the Crisis Text Line.