ARFID in Adults: What Are the Symptoms and How Is It Treated?

Have you ever wondered if your highly specific eating habits were more than just “picky eating”? Often mislabeled as such, avoidant restrictive food intake disorder (ARFID) is a condition where an individual avoids eating specific foods, or restricts the amount of food they eat.

ARFID diagnosis in adults

In 2013, ARFID was officially added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a manual that helps providers make mental health diagnoses. Still, many adults who struggle with ARFID are not properly diagnosed.

“The majority of patients with ARFID seeking care are still children and teens, likely because their parents are concerned and bring them to the attention of medical providers,” shares Jamie Manwaring, PhD, research team member at Eating Recovery Center (ERC) and lead author of a new study on ARFID in adults alongside ERC’s director of research, Renee Rienecke, PhD, FAED.

Since ARFID is still a relatively recently recognized condition, there are also providers who may not be as familiar with the diagnosis. “For example, an adult with ARFID might seek treatment with a medical provider, but if the provider isn’t as aware of ARFID, they may be more apt to send them to gastrointestinal specialists or other non-eating disorder providers,” explains Dr. Manwaring.

ARFID symptoms in adults

Adults with ARFID often have inflexible eating patterns, which can leave them labeled as extremely “picky” with regard to food selection. There is a clear distinction between food preferences, which everyone has, and the inflexible eating behaviors found in people diagnosed with ARFID. These inflexible behaviors include the following:

• Refusal to try different foods or new types of food
• Requiring extremely specific preparation of food choices
• Sensitivity to the sensory experience of a food, such as smell or texture

Another common symptom of ARFID in adults is fear-based food restriction. Individuals who experience distress about certain foods can have an emotional or physical reaction due to fear of having an allergic reaction, choking or vomiting. Because of this fear, they may avoid certain foods and/or textures that have nutritional value. Fear-based food restriction can also result in low body weight and increased anxiety around food.

Types of ARFID in adults

Not all ARFID experiences are alike. While the types listed here all fall under the same clinical diagnosis of ARFID, it’s important to note this condition can present in the following ways:

• Avoidant: Individuals avoid certain types of foods because of their sensory features, causing a sensitivity or overstimulation reaction. It may be related to smell, texture or general appearance, including color. 
• Aversive: This type is based on fear, such as fear of choking, nausea, vomiting, pain and/or swallowing. This forces the individual to avoid the food altogether.
• Lack of Interest: Individuals may show little to no interest in food. This can make one forget to eat, show signs of a low appetite or get extremely distracted during mealtimes. Another symptom of this type includes extreme pickiness around foods, resulting in limited intake.

Causes of ARFID in adults

There is no single cause of ARFID, and the research is still quite limited. However, new research from our team at ERC Pathlight shows that, for most adults with ARFID, onset of illness occurred during childhood.

The various causes of ARFID include the following factors:

• Biological
• Genetic
• Psychological
• Sociocultural

As an example, every human being is born with a genetic code, which may exhibit patterns of certain mental and physical health conditions, such as ARFID.

Adults with symptoms of anxiety and obsessive compulsive disorder (OCD) may also experience ARFID symptoms. Our research also found that about one-third of study participants (adults with ARFID at ERC) had moderate to severe OCD symptoms, and one-third of the sample had a probable post-traumatic stress disorder diagnosis.

Treatment for ARFID in adults

The most important step toward getting treatment as an adult for ARFID is having an accurate diagnosis. Within an ARFID diagnosis there are different presentations as listed above, and there is not a “one size fits all” treatment approach for each.

To ensure an accurate diagnosis, you will want to find providers who are experienced and trained in eating disorder treatment. “If your doctor suspects a case of ARFID, they should make a referral to a therapist and dietitian with the clinical expertise to get a consensus,” explains Ovidio Bermudez, MD, FAAP, CEDS, senior medical director of child and adolescent services and chief clinical education officer at ERC, in this Mental Note podcast episode. Only then should treatment begin.

Depending on the diagnosis and following a comprehensive assessment, treatment may include some or all of the following interventions:

• Medical and psychiatric stabilization
• Nutritional rehabilitation and weight restoration
• Family/caregiver involvement
• A multidisciplinary treatment team approach (medical, psychosocial, nutritional)
• Collaboration with referring providers

Our approach: Working with adults with ARFID

The treatment approach at ERC is unique for each individual. ARFID treatment addresses and includes the following:

• The patient's developmental history and stage of development
• Internal and external motivators as well as goals and values
• Family dynamics and family involvement
• Multidisciplinary treatment team alignment
• Seamless treatment team communication
• Collaboration with referring providers

A unique component of ARFID treatment at ERC -- as well as all our treatments for eating disorders -- is continuous education of patients and caregivers alike about the diagnosis, interventions, treatment expectations and treatment goals. We support you from assessment to discharge -- and beyond.

If you or a loved one has recently been diagnosed with ARFID as an adult, know that you’re not alone! It might feel like no one understands what you’re going through. If you feel this way, know that your feelings are valid and that there are others out there who “get it.” If you’re looking for additional support, you can always give us a call at 877-825-8584 to share your story and discuss options. We are here for you. 

Clinically reviewed by Jamie Manwaring, PhD, research team member at ERC, and Renee Rienecke, PhD, FAED, director of research at ERC.