What Is ARFID? Understanding Avoidant/Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent avoidance or restriction of food that leads to significant weight loss, nutritional deficiencies, or reliance on nutritional supplements. This occurs without the body image concerns seen in anorexia nervosa or bulimia nervosa.¹

Research estimates that ARFID affects roughly 0.5% to 5% of both children and adults, making it about as common as the eating disorders many people are more familiar with.¹

ARFID is often mistaken for picky eating, but it is more severe than the picky eating that many children and adults demonstrate. If you or a loved one is struggling with ARFID, effective treatments can help broaden the variety of foods someone eats and restore their nutritional health.²

What Is ARFID (Avoidant/Restrictive Food Intake Disorder)?

Avoidant/restrictive food intake disorder (ARFID) was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013, joining anorexia nervosa, bulimia nervosa, and binge eating disorder among the recognized eating disorders.¹

Unlike these three conditions, ARFID generally does not involve a pronounced concern about body size or shape.¹ Instead, someone with ARFID avoids or restricts food for one or more of three reasons:^1,3

• A general lack of interest in eating or food.
• Heightened sensitivity to a food's taste, texture, or smell.
• Fear of aversive consequences, such as choking, vomiting, illness, or an allergic reaction.

These three patterns can occur alone or in combination, and a person may exhibit one pattern more prominently than another.¹

ARFID vs. Picky Eating

Many children go through phases of picky or selective eating, and on its own, that's a normal part of development that usually fades with time.² ARFID is different. It's more severe, more persistent, and interferes with a person's nutrition, growth, or daily life in ways that ordinary picky eating doesn't.²

Children who don't outgrow typical picky eating, or whose picky eating is especially severe, appear more likely to develop ARFID.³ Rather than easing with age, as typical picky eating often does, food avoidance in ARFID tends to become more entrenched over time without treatment.² Unlike a passing phase, ARFID generally requires professional treatment and support.²

Signs and Symptoms of ARFID

ARFID can look different from person to person. ARFID symptoms can vary depending on a person's eating patterns and how long they've been getting inadequate nutrition. Common signs and symptoms include:

Physical Symptoms

• Weight loss or, in children, slower-than-expected weight gain or growth.³
• Nutritional deficiencies, which can affect energy, mood, concentration, and overall health.²
• Abdominal pain, constipation, acid reflux, or feeling full quickly after eating.³
• Fatigue, dizziness, fainting, or trouble concentrating caused by inadequate nutrition.²
• Feeling unusually cold, muscle weakness, or other signs of malnutrition in more severe cases.²
• In severe cases, relying on nutritional supplements or tube feeding to meet basic nutrition needs.¹

Emotional and Behavioral Symptoms

• Intense anxiety or distress around eating or mealtimes.^1,3
• Avoiding eating in front of others or in social situations.¹
• Eating only a limited number of foods, with the list of accepted foods becoming narrower over time.³
• Strong sensitivity to certain food textures, tastes, smells, or temperatures.¹
• Fear of choking, vomiting, stomach pain, or having another unpleasant experience while eating.^1,3
• Restrictive eating that is not driven by concerns about body weight or body shape.³

What Causes ARFID?

ARFID's exact cause isn't fully understood, but like other eating and feeding disorders, it likely develops from a combination of biological and environmental factors rather than a single cause.¹

Biologically, some people with ARFID have a heightened sensitivity to certain tastes (sometimes described as being a "supertaster”), which can make many foods feel intensely unpleasant.¹

Others have a naturally low interest in food, which researchers believe may relate to how the brain regulates appetite and hunger cues.¹

For some, ARFID develops after a frightening experience with food, such as a choking incident. This can create a fear of eating that's reinforced each time the person avoids the food that scared them.²

ARFID also commonly occurs alongside neurodevelopmental conditions, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Sensory sensitivities associated with autism can play a direct role in food avoidance.¹

People with ARFID are also more likely to have learning disabilities, obsessive-compulsive disorder (OCD), or anxiety disorders than people with other eating disorders.¹

Who Is at Risk for ARFID?

ARFID can occur at any age but is most often diagnosed during childhood, similar to pica, another eating disorder that tends to emerge during this period.¹ That said, ARFID isn't only a childhood condition. It can persist into adolescence and adulthood, and research increasingly shows that it also affects young adults, not just children.⁴

In one large study of adults who completed an online eating disorder screening, 4.7% screened positive for probable ARFID, a rate similar to that of anorexia nervosa in the same sample. Adults with probable ARFID also tended to be younger, more often male, and have lower incomes than those with other eating disorders.⁴

In some cases, ARFID can also precede a later diagnosis of anorexia nervosa, particularly if a person begins to develop concerns about weight or body shape that weren't part of their original food avoidance.¹

How ARFID Is Diagnosed

According to the DSM-5, an ARFID diagnosis requires an eating disturbance (such as an apparent lack of interest in food, avoidance based on the sensory properties of food, or a fear of aversive consequences) that leads to one or more of the following:⁵

• Significant weight loss, or in children, a failure to gain expected weight or height.
• A significant nutritional deficiency.
• Dependence on nutritional supplements or tube feeding.
• Marked interference with psychosocial functioning.

The eating disturbance also can't be better explained by a lack of access to food, a cultural practice, another medical condition, or another eating disorder involving body image concerns.⁵

In practice, diagnosis usually involves a comprehensive medical and nutritional history, blood work to check for nutritional deficiencies, and a psychological evaluation to rule out anorexia nervosa, bulimia nervosa, and other conditions with overlapping symptoms.¹

Health Effects of ARFID

Left untreated, ARFID can lead to serious physical and mental health consequences.

Depending on which foods a person avoids and how limited their diet becomes, ARFID can cause malnutrition, weight loss, or, in children, a failure to grow and gain weight as expected.¹

Nutritional deficiencies can also affect specific body systems. For example, someone who avoids meat and dairy may develop deficiencies in vitamin B12, iron, or calcium that can lead to fatigue, weakened immunity, or poor bone health.²

In more severe cases, ARFID can require hospitalization or reliance on tube feeding to restore adequate nutrition.¹

ARFID can also take a toll beyond the physical. In one large study, 34.9% of adults with probable ARFID reported suicidal ideation, showing that the emotional weight of the condition can be as serious as its physical effects.⁴

Treatment Options for ARFID

Treating ARFID works best with a multidisciplinary team, which may include a physician, a mental health professional, a registered dietitian, and, in some cases, a speech-language pathologist to address swallowing or oral-motor concerns.¹

Because ARFID doesn't generally involve fear of weight gain, treatment focuses on nutritional rehabilitation and gradually expanding the foods and amount a person eats, rather than addressing body image beliefs.³

Psychological and behavioral approaches, not medication, are the primary focus of ARFID treatment and may include:¹

• Cognitive behavioral therapy for ARFID (CBT-AR): A structured program, typically 20 to 30 sessions, built around increasing food volume before increasing variety, meaning a person first works on eating more of the foods they already accept before gradually introducing new ones.²
• Family-based treatment for ARFID (FBT-ARFID): This involves caregivers directly in treatment, helping them build the confidence and skills to support their child's eating at home.³
• Supportive parenting for anxious childhood emotions for ARFID (SPACE-ARFID): This approach helps parents address problematic eating behaviors while encouraging their child to become more comfortable and flexible with food. Research suggests it can reduce ARFID symptoms and their impact on daily life.³

These cognitive behavioral therapy (CBT) approaches, adapted specifically for ARFID, also help reduce meal-related anxiety and shift rigid beliefs about food.¹

Medication isn't a primary treatment for ARFID, but it's sometimes used off-label alongside therapy, for example, to help stimulate appetite or ease anxiety around eating.¹

Because ARFID is a comparatively new diagnosis, the evidence base for these treatments is still developing compared to research on anorexia nervosa, bulimia nervosa, and binge eating disorder.¹

Treatment may also need to take into account any co-occurring conditions a person has, such as anxiety, ADHD, or ASD. Health conditions that occur at the same time as one another can interact and affect a person's symptoms and treatment, so care tends to work best when these conditions are addressed together rather than separately.⁶

Depending on how severe a person's malnutrition or psychological symptoms are, ARFID care can range from outpatient therapy to more intensive eating disorder treatment options, including day programs or, in rare cases, hospitalization for medical stabilization.¹

How to Help Someone with ARFID

If your child or another loved one shows signs of ARFID, catching it early gives treatment the best chance to work.¹

Watch for a list of accepted foods that keeps narrowing, weight loss or poor growth, or ongoing distress around meals, and bring these signs to a doctor rather than waiting to see if they resolve on their own.

It's natural to want to fix the problem by pushing someone to eat more or try new foods, but pressure and food battles at mealtimes can increase anxiety and can make avoidance worse rather than better.

Instead, the most helpful thing you can do is support professional treatment: help schedule appointments, learn about the specific factors driving your loved one's ARFID, and follow the guidance of their treatment team rather than trying to manage the condition alone at home.

Find Treatment for ARFID

You don't have to navigate ARFID alone. Effective treatment is available no matter your age or how long you or a loved one have been living with the condition. Many programs offer age-specific care, since ARFID can look different in young children, teens, and adults.

If you're ready to take the next step, you can find eating disorder treatment centers near you, including programs with specialized ARFID care. Reaching out for support is often the hardest part, and it's the first step toward a healthier relationship with food.