What is ARFID?

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder where an individual avoids eating specific foods, restricts the amount of food they eat, or avoids eating altogether. Far more than just “picky eating,” this can lead to a persistent failure to meet one’s nutritional needs. ARFID is more common in children and young adolescents. However, it can occur in late adolescence and adulthood as well. Affecting all genders, ARFID is often associated with psychiatric co-morbidities, including autism, ADHD, anxiety and obsessive-compulsive disorder.  

What are the Causes of ARFID? 

The causes of ARFID include genetic, psychological and sociocultural factors, as well as biological. There is no one single cause of ARFID. Understanding the causes of ARFID can guide treatment. However, a course of action for patients experiencing ARFID will also be based on their individual symptoms and progress in treatment. 

Genetic Factors of ARFID

One major influence on the cause of eating disorders is found is genetic factors. Eating disorders are familial illnesses, and temperamental traits predisposing individuals toward developing an illness are 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.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378634/

Environmental Influence

Another genetic factor that might cause an individual to experience symptoms of ARFID 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].
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534269/

Sociocultural Factors of ARFID

Another cause of ARFID and other eating disorders can be sociocultural factors. Cultural pressures to eat clean/pure/healthy as well as increased interests in food processing, sourcing, packing and the environmental impact can influence food beliefs and intake.

Healthy Appearance Expectations

In many cultures and in society today, there is oftentimes a misconnection that looking thin is the equivalent of being healthy [3]. This is a common cause of anorexia nervosa, which can co-occur with ARFID.
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172455/pdf/IJPsy-29-107.pdf

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.

Psychological Factors of ARFID

Anxiety and obsessive compulsive disorder symptoms tend to accompany eating disturbances, as do co-occurring mood and anxiety disorders.

Obsessive Compulsive Disorder

For many patients, symptoms of the ARFID eating disorder can co-occur with OCD, also known as Obsessive Compulsive Disorder. In some more extreme cases, obsessions with food intake or preparation can lead to ritualistic compulsions. [4]
[4] https://iocdf.org/expert-opinions/expert-opinion-eating-disorders-and-ocd/

Anxiety

Anxiety can be another cause of ARFID, specifically in patients who experience anxiety or fear around eating. They may avoid eating out of fear that they will choke, vomit or even die if they eat certain foods. [5]
[5] https://www.nationaleatingdisorders.org/blog/more-picky-eating%E2%80%947-things-know-about-arfid

refrigerator food

What are the Symptoms of ARFID? 

Common ARFID symptoms include:

  • Lack of interest in food
  • Avoiding foods due to texture or consistency
  • Being a “picky” eater
  • 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

Due to their restrictive eating habits, people with ARFID may be at very low body weights or suffer from malnutrition. Knowing the warning signs and symptoms of ARFID is an important first step in seeking care for this type of eating disorder.

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, Adult ARFID and ARFID “Plus.”

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 the ARFID 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. Restrictive ARFID can make one forget to eat altogether, show signs of a low appetite or get extremely distracted during mealtime. Another symptom of Restrictive includes extreme pickiness of foods, resulting in limited intake.

Adult ARFID

Symptoms of ARFID not only take place in children and adolescents; in fact, many adults can show signs of 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 types of ARFID. ARFID symptoms in adults can include selective or extremely picky eating, food peculiarities, texture, color or taste aversions related to food.

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.

ARFID in Children

Lack of interest in food

Although ARFID can affect individuals of any gender or age, this eating disorder can be more common in children and adolescents. One warning sign of ARFID is the lack of interest in food.

Fear-based food restriction

Children who show symptoms of 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 ARFID 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]

[1] https://www.nationaleatingdisorders.org/blog/more-picky-eating%E2%80%947-things-know-about-arfid
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281436/

ARFID in Adults

Inflexible eating behaviors

When it comes to identifying ARFID symptoms in adults, one common warning sign is inflexible eating behaviors, which can be categorized as one being extremely “picky” with food selection. 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, and sensitivity to the sensory one perceives from a food, whether physical or emotional. These ARFID symptoms evoke inflexible eating behaviors that can cause attitudes of anorexia nervosa or bulimia. [3]

Fear-based food restriction

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 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]

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5086050/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151474/

What are the 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.

ARFID vs. Anorexia

ARFID is often confused with anorexia nervosa 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 Health Risks are Similar to Anorexia Risks

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.

How is ARFID Treated? 

ARFID treatment may include some or all of the following interventions, following a comprehensive assessment:

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

A key component of ARFID treatment at ERC is continuous education of patients and parents alike about the patient's diagnosis, interventions, treatment expectations and treatment goals. We support the patient and family members from assessment to discharge and beyond. The consequences of ARFID can be fatal so prompt treatment is highly recommended.

How is ARFID Treated?

The treatment approach at ERC is unique for each individual. 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 & family involvement
  • Multidisciplinary treatment team alignment
  • Seamless treatment team communication
  • Collaboration with referring providers

A key component of ARFID treatment at ERC is continuous education of patients and parents alike about the patient's diagnosis, interventions, treatment expectations and treatment goals. We support the patient and family members from assessment to discharge and beyond.

Specialized Treatment for ARFID Gives You the Best Chance for Recovery

Dealing with ARFID is scary, especially if it’s your child that’s suffering. Fortunately, there is hope for recovery and a life free of this eating disorder. Please call us at 877-825-8584 so we can discuss the symptoms you are observing and discuss your treatment options.

Eating Recovery Center is the nation's only health care system dedicated to the treatment of ARFID at all levels of care, including inpatient treatment, residential treatment, partial hospitalization treatment and intensive outpatient treatment.

ARFID Statistics & Facts

In addition to understanding the symptoms, causes, health risks and treatment options for avoidant/restrictive food intake disorder (ARFID), it’s also important to understand the facts and statistics.

What are the Facts About ARFID?

  • 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 females5

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
Find Online | Find at a Library

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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