What is avoidant/restrictive food intake disorder (ARFID)?

Reviewed by Brooks Baer, LCPC, CMHP

Written by

therapist.com team

Last updated: 07/29/2024

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ARFID stands for “avoidant/restrictive food intake disorder.” It’s a feeding and eating disorder in which a person avoids certain foods or has extreme limits on what they eat. Typically, this avoidance is not part of an effort to lose weight or change their body shape, but because they lack interest in food or are very sensitive to its taste, texture, or smell.

There are four ARFID types, which include:¹

1. Fearful: Characterized by a fear of negative food-related consequences such as choking, vomiting, or allergic reactions, leading to food avoidance.
2. Sensory: Avoiding foods based on texture, taste, or smell, often leading to a very limited diet.
3. Lack of interest: Showing little to no interest in eating or food.
4. Combination: The most common subtype, featuring some mixture of fearful, sensory, or lack-of-interest motivations.

ARFID in children vs. adults

ARFID is much more commonly diagnosed in children. Studies have shown that the prevalence of ARFID in children and adolescents can be as high as 18%, compared to the 0.3% to 2% occurrence rate of ARFID in adults.²

ARFID vs. picky eating

While “picky eating” might be considered a normal phase that most children pass through, ARFID is much more severe and persistent. Picky eaters might gradually expand their diet over time, but individuals with ARFID often have a very limited range of accepted foods, severely impacting their nutritional intake.

Additionally, “picky eaters” may choose to avoid certain foods because they don’t enjoy them. But people with ARFID avoid food to an extreme degree and may do so out of fear, sensory issues, a complete disinterest in food, or any combination of these reasons.

How is ARFID different from other eating disorders?

When it comes to ARFID, the motivations behind food avoidance are distinctly different from those of other eating disorders. While anorexia and bulimia are typically driven by body image concerns, ARFID is not. Instead, ARFID patients often fear either the physical act of eating or food itself.

Some people who struggle with eating disorders or disordered eating habits also engage in compensatory behaviors such as excessive exercising or laxative use. Those with ARFID, however, typically don’t. They often experience anxiety or stress around food in a different way.

ARFID symptoms

ARFID can be tricky to identify because its symptoms often overlap with those of other conditions and can be mistaken for simple picky eating.

Common symptoms of ARFID include:³

• Dramatic weight loss, or a lack of normal weight gain in children
• Notable levels of malnutrition
• Needing nutritional supplements or even tube feeding to meet dietary requirements
• Digestive issues, such as stomach pain or constipation
• Distorted or absent hunger cues
• Avoidance of social situations involving food, like family meals or birthday parties
• Significant interference with normal daily functioning and development
• Extreme sensitivity to food textures, tastes, or smells

ARFID causes

Researchers don’t know exactly what causes ARFID, but it’s believed that biology plays a big role. Some suggest that ARFID has three main causes:⁴

1. Heightened sensitivity to the taste, texture, smell, or appearance of certain foods.
2. Issues with natural appetite.
3. Increased fear responsiveness, in which the idea of choking or vomiting leads to a fear of eating certain foods.

Mental health conditions like anxiety, obsessive-compulsive disorder (OCD), attention/deficit hyperactivity disorder (ADHD), and autism spectrum disorder (ASD) often cooccur with ARFID.⁵ Likewise, certain physical health conditions or allergies could contribute to the development of ARFID.⁶

A health care professional can provide a thorough assessment to determine if a person has an underlying condition that may be contributing to ARFID symptoms. A mental health professional can help determine is other mental health conditions are playing a role or worsening symptoms.

The impact of ARFID on well-being

ARFID can cause significant weight loss, nutritional deficiencies, and impaired growth and development, including delays in puberty and stunted growth.⁷ People with ARFID often suffer from weaker bones and conditions like iron deficiency anemia, leading to fatigue. Many are dependent on tube feeding or nutritional supplement drinks.

The health impacts of ARFID can be as severe as other eating disorders, sometimes requiring hospitalization. In fact, a study found that nearly one-third of ARFID patients needed hospitalization for medical reasons.⁸

In addition to the severe physical health consequences, ARFID can also have profound effects on a person’s mental health. Individuals with ARFID often experience intense anxiety around food and eating situations, which can lead to social isolation and negatively impact their quality of life. The stress associated with managing the disorder can also result in emotional distress and depression.

ARFID diagnosis and treatment options

ARFID is a relatively new diagnosis that was introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Many people, including some healthcare providers, might not be fully familiar with it. There are four main ARFID diagnostic criteria that must be met:⁹

1. There’s a noticeable problem with eating or feeding, which leads to at least one of the following:

• Significant weight loss
• Major nutritional deficiencies
• Dependence on tube feeding or nutritional supplements
• Significant impact on social functioning

2. The eating issues are not due to religious or cultural practices or a lack of available food.

3. The eating problem is not a result of another eating disorder, indicated by there being no concerns about body image or weight.

4. The eating problem is not better explained by another medical or psychiatric condition.

Children and teens with ARFID can show one or more of these features. They might be of normal weight, overweight, or underweight.

Treatment for ARFID may include a combination of medications and therapies to address the various aspects of the disorder.

Medication for ARFID

There isn’t much research on using medication for ARFID treatment. However, one small study suggests that low doses of an antipsychotic drug could help when combined with other treatments.¹⁰ Medications may be an effective part of a treatment plan for ARFID, but more time and research is needed.

Therapy for ARFID

Therapy has been used as a form of treatment for eating disorders for decades. In particular, cognitive behavioral therapy (CBT) and family-based therapy are known to help children and teens with eating disorders improve.^11,12

A new type of CBT specifically for ARFID (CBT-AR) is currently being studied, which lasts six to 12 months and includes family or individual sessions.¹³ It focuses on improving nutrition and slowly exposing patients to different foods.

Visit our directory to connect with a licensed mental health professional in your area who can help you develop a treatment plan. If you suspect that you or someone you know could have a feeding or eating disorder, immediate help is available. Call the National Alliance for Eating Disorders helpline at 866-662-1235 to speak with a licensed therapist (available Monday through Friday, 9 a.m. to 7 p.m. EST).