Evidence-Based Treatment for ARFID
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What is ARFID?
Avoidant/restrictive food intake disorder (ARFID) is a serious eating disorder where an individual may avoid eating specific foods, restrict the amount of food they eat, or avoid eating altogether. The reduced food intake associated with this eating disorder can lead to a persistent failure to meet one’s nutritional needs. ARFID affects all genders and people of all ages.
ARFID and co-occurring conditions
This eating disorder is often associated with certain health conditions, including:
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73% of patients no longer reported significant eating disorder symptoms
What causes ARFID?
The causes of ARFID include genetic, psychological and sociocultural factors, as well as biological. There is no one single cause. To learn how to help someone with an eating disorder, speak to a trained eating disorder professional. They can make any treatment recommendations, based on your or your loved one's symptoms.
Genetic causes of ARFID
Genetic factors can strongly influence your risk of developing an eating disorder. Eating disorders can be familial illnesses, and there are certain temperamental traits that can predispose someone to develop an eating disorder. These traits can be passed from generation to generation.
Molecular hereditary
Like many mental health conditions, hereditary can be a cause for some eating disorder behaviors. Every human is born with a genetic code, which may exhibit patterns in certain health conditions [1], such as ARFID.
Environmental influence
Another genetic factor that might cause an individual to experience symptoms of an eating disorder is an environmental influence from family members. This can come from meal preparation, observing family members’ behaviors with food and exposure to diets and/or restrictive eating in the home [2].
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378634/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534269/
Social & cultural causes of ARFID
Social and cultural causes of ARFID and other eating disorders also exist. Cultural pressures to eat clean, pure or healthy, as well as increased interests in food processing, sourcing, packing and environmental impacts of food can influence food beliefs and intake.
Healthy appearance expectations
In many cultures in society today, there is often a misconnection that looking thin is the equivalent of being healthy [3]. This is a common cause of eating disorders like anorexia nervosa, which can co-occur with ARFID.
Rigid food beliefs
Another sociocultural factor that can be seen in those struggling with ARFID symptoms is food beliefs. This can include moral beliefs about eating meat and dairy, or how these food items are prepared.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172455/pdf/IJPsy-29-107.pdf
Psychological causes of ARFID
People who have mental health symptoms related to OCD, anxiety, ADHD and autism may also experience ARFID symptoms.
OCD
Symptoms of ARFID can co-occur with OCD. In some extreme cases, obsessions with food intake or preparation can lead to ritualistic compulsions. [4] If you are concerned that you or a loved one may be struggling with an eating disorder and OCD, know that there are many treatments that can help, including exposure and response prevention therapy.
Anxiety
Anxiety can be linked with ARFID, specifically in patients who experience anxieties and fears around eating. They may avoid eating out of fear that they will choke, vomit or even die if they eat certain foods. [5]
ADHD
ADHD can affect ones eating habits. Some people with ADHD don’t have strong hunger cues. They go long periods without eating, they may eat smaller meals and snack less. They may simply forget to eat. Preparing food can take a lot of organization and coordination. Eating can be easily forgotten or procrastinated on.
Autism
There is a clear connection between autism and ARFID. Many people with autism have strong sensory sensitivity. Due to sensory issues, these individuals may not eat enough to maintain their body weight and nutritional needs. You may see increased anxiety around food and mealtime.
4. https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/
5. https://www.nationaleatingdisorders.org/more-picky-eating-7-things-know-about-arfid/
Listen to our ARFID podcast
To learn more about how ARFID interacts with anxiety, OCD, ADHD and autism, listen to our Mental Note podcast episode, "What Is ARFID Anyway?" The podcast features licensed clinical psychologist Michelle Jones, PhD of Eating Recovery Center. Dr. Jones has a great passion for helping individuals with ARFID. She has spent years researching ARFID, since it first became a diagnosis.
ARFID symptoms
Common ARFID symptoms include:
- Being a “picky” eater
- Having a lack of interest in food
- Avoiding foods due to texture or consistency
- Refusing to try new foods
- Requiring food to be prepared a specific way
- Feeling afraid to eat due to fear of a possible allergic reactions, choking or vomiting
Symptoms will look different for each individual. Due to their restrictive eating habits, people with ARFID may be at very low body weights or suffer from malnutrition.
Types of ARFID
Like other eating disorder conditions, there are several different types of ARFID, depending on the symptoms the individual is experiencing. The types of ARFID include: avoidant, aversive, restrictive, ARFID “plus" and adult ARFID.
Avoidant
One common type of ARFID is avoidant. In this condition, individuals simply avoid certain types of foods in relation to sensory features, causing a sensitivity or over stimulation reaction. These patients may feel sensitive to the smell of foods; textures, including soft foods or fruit and vegetables that have prickly or defined textures; or general appearance, including color.
Aversive
Another type of this eating disorder is aversive. Individuals whose food refusal is related to the aversive type may experience on fear-based reactions. Aversive ARFID evokes a fear of choking, nausea, vomiting, pain and/or swallowing, forcing the individual to avoid the food altogether.
Restrictive
Individuals who experience restrictive ARFID may show signs of little-to-no interest in food. This type can make one forget to eat altogether, show signs of a low appetite or get extremely distracted during mealtime. Another symptom of restrictive ARFID includes extreme pickiness of foods, resulting in limited intake.
ARFID "plus"
Individuals who are experiencing more than one type of ARFID can begin to develop features of anorexia nervosa, including concerns about body weight and size, fear of weight gain, negativity about fatness, negative body image without body image distortion and preference for less calorie-dense foods. This combination of symptoms is categorized as ARFID “plus,” a co-occurring eating disorder.
Adult ARFID
Individuals with ARFID in their adult years may still have symptoms that were experienced in their adolescent years and can be categorized as avoidant, aversive or restrictive type. ARFID symptoms in adults can include selective or extremely picky eating, food peculiarities, texture, color or taste aversions related to food.
ARFID symptoms in children and teens
Lack of interest in food
Although ARFID can affect individuals of any age, this eating disorder can be more common in children and adolescents. One warning sign is a strong lack of interest in food.
Fear-based food restriction
Children with ARFID might avoid certain foods out of fear of texture, smell or appearance, [1] or construct feelings of fear that a certain food may cause them to vomit/feel sick or choke.
Limiting food intake
Children who experience this eating disorder can generally limit their food intake for an array of reasons. As explained above, this can be due to a certain fear of food, but it can also come in the form of fasting behaviors.[2]
Read: Learn more about ARFID in children.
Read: Learn more about ARFID in teens.
1. https://www.nationaleatingdisorders.org/more-picky-eating-7-things-know-about-arfid/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281436/
ARFID symptoms in adults
Inflexible eating behaviors
When it comes to identifying symptoms in adults, one common warning sign is inflexible eating behaviors. There is a clear distinction between food preferences in healthy adults versus inflexible eating behaviors found in ARFID-diagnosed individuals, including:
- Refusing to try different or new types of food
- Extremely specific preparation of food choices
- Sensitivity to sensory qualities perceives from a food, whether physical or emotional
These eating disorder symptoms evoke inflexible eating behaviors similar to anorexia nervosa or bulimia. [3]
Fear-based food restriction
Another common symptom in adults is fear-based food restriction. Individuals who experience distress about certain foods can have an emotional or physical reaction due to thoughts of an allergic reaction, choking or vomiting [3]. This can cause individuals to avoid certain foods and/or textures, depleting the individual of nutritional value. Fear-based food restriction can also result in low body weight due to anorexia nervosa behaviors and increased anxiety around food. [4]
Read: Learn more about ARFID in adults.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5086050/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151474/
Health risks of ARFID
The health risks associated with ARFID include:
- Weight loss or being severely underweight
- Nutritional deficiencies (e.g., anemia or iron deficiency) and malnutrition
- Growth failure, stunted growth or falling off growth curves for weight and height
- Fatigue or weakness
- Dry nails and hair
- Hair loss
- Trouble concentrating
- Reduction in bone density
These symptoms are similar to those found in people with anorexia nervosa and other eating disorders.
How is ARFID different from anorexia?
ARFID may be confused with restrictive eating disorders like anorexia because weight loss and nutritional deficiency are common shared symptoms between the two disorders. However, the primary difference between ARFID and anorexia is that ARFID lacks the drive for thinness that is so common for individuals with anorexia.
ARFID vs. anorexia: health complications
Complications associated with ARFID may mirror the health risks of anorexia nervosa for low-weight patients. These risks include:
- Cardiac complications
- Heart problems
- Kidney and liver failure
- Bone density loss/osteoporosis
- Anemia
- Electrolyte imbalances
- Low blood sugar
- Constipation
- Bloating and other gastrointestinal issues.
ARFID Treatment
Treatment for ARFID begins with an assessment to understand the type of ARFID an individual is experiencing. This may include features like:
- Sensory issues related to textures or flavors
- Low appetite or general disinterest in food
- Fears tied to past experiences such as choking or nausea
It is also important to identify conditions that can co-occur with ARFID, such as anxiety, OCD, ADHD or autism. Understanding these co-occurring issues helps our clinical teams create personalized treatment plans with targeted therapies, nutrition interventions, and medication management to best support recovery.
Specialized therapy for ARFID
ARFID therapy involves a combination of individual, family and group sessions grounded in evidence-based approaches. At ERC, we draw from a variety of treatment approaches, including family-based treatment and emotion-focused family therapy. We also -
- Gain a deeper understanding of ARFID through psychoeducation
- Build coping strategies to reduce anxiety and increase flexibility around eating
- Develop self-esteem and social skills with peers facing similar challenges
- Empower caregivers with effective skills that support their loved ones through treatment and beyond
- Track progress and celebrate milestones
ARFID medical care
A comprehensive medical evaluation is conducted at the start of treatment to assess potential complications associated with ARFID, including:
- Delays in growth and development
- Inadequate nutrition
- Gastrointestinal symptoms
In some cases, hospitalization may be required to stabilize medical conditions. During this time, patients are closely monitored to ensure both medical and nutritional needs are fully addressed. At ERC, inpatient and residential treatment centers provide 24/7 medical care, nursing supervision and psychiatric support to promote stabilization, healing and recovery.
Our approach to ARFID eating disorder treatment
At ERC, treatment is designed to meet the unique needs of individuals with ARFID. Our approach includes:
- Personalized treatment plans that address your specific challenges
- Targeted therapy groups to help patients explore new foods, build social skills and manage anxiety in a safe community of peers
- Active family involvement, from meal support to weekly check-ins, to maintain progress at home
- Specialty tracks for co-occurring conditions, such as trauma or OCD, offer additional support to address the full picture
- Clinical teams trained in neurodiversity to support all individuals and provide necessary accommodations to help individuals progress through treatment
- Onsite education support weekdays during the school year to help kids continue progressing in school
- Nearby housing for families to stay close to loved ones in treatment
Find ARFID treatment near you
Dealing with ARFID can feel overwhelming, especially when it’s your child or loved one struggling. At ERC, we offer a specialized ARFID treatment program for kids and teens in Baltimore, and nationwide support for all eating disorders at every level of care.
Explore our comprehensive approach to treating eating disorders like ARFID:
- Inpatient treatment
- Residential treatment
- Partial hospitalization treatment (PHP)
- Intensive outpatient treatment (IOP)
- Virtual intensive outpatient treatment (virtual IOP)
- Intensive treatment unit (ITU)
Whether you prefer ARFID treatment at home or in-person at our specialized ARFID treatment center, we’ll listen to what you’re going through and guide you to the exact support you need to heal.
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Nutrition support for ARFID
Most eating disorder treatment programs include regular sessions with a registered dietitian. At ERC, our ARFID nutrition therapy goes beyond the standard approach. Our dietitians work closely with you and your family to:
- Identify your or your loved one’s food and meal preferences
- Develop individualized ARFID-specific meal plans that build upon these preferences
- Offer nutritional guidance for adequate intake
- Establish consistent and balanced eating routines
- Gradually increase food variety and improve nutrient intake through ARFID exposure therapy
- Implement food hierarchies with hands-on caregiver support
- Support other nutrition-related goals, such as weight restoration, if necessary
Get matched with the exact support you need.
With one conversation, our will help you better understand what you’re going through and what you need.
We will meet you where you are, listen to your story in a therapeutic setting, and match you with the level of support that meets your struggle.
For Providers: Partner with the nation’s leading eating disorder experts
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ARFID facts & statistics
After reviewing the symptoms, causes, health risks, and treatment options above, explore the latest ARFID facts and statistics below.
- ARFID is more common in children and young adolescents and less common in late adolescence and adulthood. [1]
- ARFID is often associated with psychiatric co-morbidity, especially with anxious and obsessive compulsive features. [1]
- ARFID is more than just “picky eating;” children do not grow out of it and often become malnourished because of the limited variety of foods they will eat. [2]
- The true prevalence of ARFID is still being studied, but preliminary estimates suggest it may affect as many as 5 percent of children. [2]
- Boys may have a higher risk for ARFID than girls. [2]
- 63 percent of pediatricians and pediatric subspecialists were unfamiliar with the diagnosis of ARFID
- Rates of ARFID are between 5% and 14% in pediatric inpatient ED programs and up to 22.5% in a pediatric eating disorder day treatment program. [4]
- Prevalence in the general population is not known. [4]
- ARFID affects more males than females. [5]
1. ARFID: Some new twists and some old themes. Ovidio Bermudez, MD, FAAP, FSAHM, FAED, F.iaedp, CEDS. (2016)
2. Norris, M. L., Spettigue, W., & Katzman, D. K. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213-218.
3. Canadian Pediatric Surveillance Program
4. Norris, M. L., Spettigue, W., & Katzman, D. K. (2016). Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213-218.
5. Eddy, K. T., Thomas, J. J., Hastings, E. R., Edkins, K., Lamont, E., Nevins, C. M., . . . Becker, A. E. (2015). Prevalence of DSM-5 Avoidant/Restrictive Food Intake Disorder in a pediatric gastroenterology healthcare network. International Journal of Eating Disorders, 48(5), 464-470.
ARFID resources
From books to websites to articles to videos, we’ve gathered the best resources on Avoidant/Restrictive Food Intake Disorder (ARFID) here.
ARFID Books
Food Refusal and Avoidant Eating in Children, including those with Autism Spectrum Conditions by Gillian Harris and Elizabeth Shea
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Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child's Diet by Cheri Fraker, Dr. Mark Fishbein, Sibyl Cox, Laura Walbert
Find Online | Find at a Library
Off the C.U.F.F.: A Parent Skills Book for Management of Disordered Eating by Nancy Zucker, PhD
Find Online | Find at a Library
Helping Your Child with Extreme Picky Eating: A Step-by-Step Guide for Overcoming Selective Eating, Food Aversion, and Feeding Disorders by Katja Rowell MD, Jenny McGlothlin MS CCC-SLP, Dr. Suzanne Evans Morris
Find Online | Find at a Library
Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults by Kamryn Eddy and Jennifer Thomas
Find Online | Find at a Library
Sad Perfect by Stephanie Elliot
Find Online | Find at a Library
ARFID FAQs
Is ARFID an eating disorder?
Avoidant/restrictive food intake disorder is an eating disorder characterized by a persistent failure to meet one’s appropriate nutritional intake or energy needs. This can lead to serious health complications that are similar to those of anorexia nervosa, including fatigue, failure to grow, low bone density, trouble concentrating and more.
When does ARFID develop?
ARFID is more commonly diagnosed in children and young adolescents and may affect up to five percent of children. However, older adolescents and adults can also be diagnosed with ARFID. Typically, children do not outgrow this eating disorder and may become malnourished over time, due to the limited diet they consume.
How do I know if my child has ARFID?
You may consider screening your child for ARFID if they:
- Lack interest in eating
- Avoid eating certain foods due to texture, smell or appearance
- Avoid eating for fear of choking or vomiting
- Are experiencing weight loss or medical issues
Learn more by taking our ARFID self-assessment.
Can ARFID be cured?
ARFID is effectively treated with an evidence-based approach that includes:
- A comprehensive assessment
- Medical and psychiatric stabilization
- Nutritional rehabilitation and weight restoration (if needed)
- Family/caregiver involvement, education and support
- A multidisciplinary treatment team approach (medical, psychosocial, nutritional)
Collaboration with referring providers
Is ARFID serious?
ARFID is associated with multiple serious health risks. People with ARFID may lose weight or fail to grow properly. They may also experience other life-threatening complications affecting the following systems: cardiac, gastrointestinal, pulmonary, endocrine, bone health, neurologic and dermatologic. With prompt treatment, individuals can fully recover from this condition.
Can adults have ARFID?
Adults can experience ARFID later in life. Warning signs of ARFID in adults include highly inflexible eating habits: being extremely “picky,” selecting foods based on preferred tastes, textures, colors, or temperatures, refusing to try new foods or avoiding foods out of fear of choking or vomiting on the food.
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Dr. Elizabeth Easton is a Clinical Psychologist. She serves as the National Director of Psychotherapy at Eating Recovery Center and Pathlight Mood & Anxiety Center. She is also the owner of Easton…
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