What is ARFID?
Avoidant/restrictive food intake disorder (ARFID) is an eating disorder where a person regularly avoids certain foods or limits how much they eat. This is not due to body image concerns but rather to:
- Low appetite or lack of interest in food/eating
- Strong reactions to how food feels, tastes or smells
- Fear of choking, vomiting , allergic reaction or other aversive consequence
Left untreated, ARFID can lead to serious problems with nutrition, development and emotional well-being.
As a clinician who works closely with children, teens and adults with ARFID, I’ve seen how harmful certain misconceptions can be and how the right care can help. In this article, I’ll share key ARFID statistics and facts, clear up common myths and offer guidance on how to support a loved one.
Who does ARFID affect — and why?
ARFID can look different from person to person, but these facts offer a clearer picture of how it presents and who it affects.
- In a study of over 50,000 adults, researchers found those who screened positive for ARFID tended to be younger, male, had lower household income, were less likely to be white and more likely to be Hispanic/Latino.[1]
- Multiple studies show that the most common ARFID symptom profile includes sensory sensitivity/avoidance and lack of interest in eating.[1]
- Other studies have found that ARFID is more common in boys than another eating disorder: anorexia nervosa.[2]
While weight and body image are not part of the ARFID diagnosis or presentation, I’ve seen patients with ARFID later develop symptoms of other eating disorders, including fear of weight gain and body image concerns. See how another eating disorder, anorexia, affects boys here.
How common is ARFID?
ARFID prevalence rates vary widely depending on the population and setting being studied. Overall, findings indicate that ARFID is common in clinical settings and probably common in the general population as well.[3]
The numbers show that ARFID is more prevalent than many realize.
- Research is limited but suggests ARFID affects between 0.3% and 15.5% of the general population.[1]
- In specialized eating disorder treatment programs, the rate is higher, with ARFID affecting up to 55.5% of people[1]
- Other studies have found that specialized feeding clinics report the highest rates of ARFID -- between 32% and 64%.[4]
ARFID and co-occurring conditions
Many people with ARFID also experience other mental health conditions, which can affect how symptoms appear.
- Conditions that commonly co-occur with ARFID include autism spectrum disorder (ASD), anxiety disorder, attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD).[4]
- There is a higher risk of ARFID in individuals with ASD and ADHD.[5]
- A meta-analysis found that 16.27% of individuals with ARFID had ASD -- and 11.41% of those diagnosed with ASD also had ARFID.[6]
- Other research found ASD to be present in 8.2-54.8% of children diagnosed with ARFID.[7]
Adult ARFID statistics
While thought of as a childhood disorder, ARFID affects many adults too, often with long-standing symptoms and unique challenges.
- In a study of 1,029 adult patients with feeding and eating disorders, 9.2% were diagnosed with ARFID. The researchers also found that adults with ARFID had a shorter duration of illness, had less severe symptoms and were less likely to be admitted to a hospital for their illness compared to other eating disorders.[8]
- In a study of 81 adults, one-third identified with the statement, “I am a very picky eater.” But only 3% reportedly had ARFID symptoms.[9]
- New research (including work from ERC clinicians) found that many adults with ARFID started developing symptoms during childhood; about one-third had moderate to severe OCD symptoms and one-third had a probable post-traumatic stress disorder (PTSD) diagnosis.[10]
Childhood ARFID statistics
ARFID often begins in early childhood and can significantly impact nutrition, development and emotional well-being if left untreated.
- ARFID goes beyond picky eating. Children with ARFID don’t simply outgrow it, and the limited variety of foods they eat can lead to malnutrition and serious health concerns over time.[11]
- ARFID is found in 5-14% of patients in pediatric inpatient eating disorder programs and up to 22.5% of patients in day treatment programs[11]
- ARFID often goes unrecognized because not everyone “looks” underweight. In one study, only 11% of teens with “possible ARFID” were found to be clinically underweight.[12]
- In a recent study, 85% of children who received cognitive behavioral therapy for ARFID (CBT-AR) showed meaningful improvements in food variety and anxiety after just 12 weeks.[13]
Clearing up common ARFID myths
Even though ARFID has been a recognized diagnosis for over a decade, I continue to hear many myths about ARFID in practice. Let’s address the four most common myths here.
Myth 1: ARFID only affects children.
ARFID affects people of all ages and genders. While it is more common in children and young teens, adults with ARFID often avoid certain foods, limit the variety and volume of foods, and may struggle with health or emotional challenges.
Because it’s seen as a childhood issue, many cases of ARFID in adults go undiagnosed. However, symptoms can be just as severe and treatment equally effective.
Myth 2: ARFID is “picky eating.”
ARFID may resemble picky eating, but it’s more severe and persistent. ARFID is a serious eating disorder. It often involves avoiding entire food groups and not eating even when hungry. It’s not a phase, and it can significantly impact growth, health and/or development.
The extreme nature and consequences help distinguish the two. Many children grow out of picky eating, while ARFID requires specialized eating disorder treatment.
Myth 3: ARFID is not as serious as other eating disorders.
The symptoms linked to ARFID can cause serious physical and emotional challenges due to changes in weight, social anxiety, emotional distress, compromised growth and malnutrition.
For instance, restrictive eating may lead to weight loss and nutritional deficiencies. These can cause:
- Low mood
- Irritability
- Difficulty concentrating
- Rigid thinking
- Social isolation
The good news is many of these changes improve with treatment and an improved nutritional state.
Myth 4: All individuals with ARFID are underweight.
While some people with ARFID may experience weight loss, that’s not true for everyone. ARFID occurs in all body types and often goes undiagnosed in people at higher weights.
Weight loss is not part of the diagnostic criteria for ARFID. A diagnosis is based on eating behaviors, nutritional status and how symptoms affect daily functioning. Recognizing this helps reduce bias and the risk of underdiagnosis.
Is it “picky eating” or ARFID?
Added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013, ARFID is often mistaken for picky eating and still widely misunderstood -- even among providers.
Both picky eaters and individuals with ARFID have a limited range of preferred foods. The differences outlined below can help you tell when it may be something more serious.
| Picky eating | ARFID |
|---|---|
| Limited variety of foods, but still meets basic needs | Severely limited variety. Some may cut out entire food groups (e.g., fruits and vegetables) or avoid solid foods completely. Their list of preferred or accepted foods is very short. |
| Often gets better over time | Does not improve without treatment |
| Typically based on characteristics of the food such as taste or texture preferences | Often caused by fear of negative consequences (e.g., choking, vomiting, allergic reactions), sensory distress, or very low interest in food/eating |
| Eats enough to support health, growth and development | May not eat enough -- growth and health may be affected |
| Usually causes little distress | Eating can cause fear, anxiety or high distress |
| Rarely affects daily functioning | Can lead to social isolation, stress and emotional challenges and can impact all areas of functioning in life |
Still not sure if it’s ARFID? Take this short quiz.
If you’re wondering if it’s picky eating or something more serious, this quiz can help you identify key signs and when to seek support.
Tips for supporting picky or avoidant eaters
When someone with ARFID is afraid of, overwhelmed by or disinterested in trying new foods, progress often comes slowly. I often share these tips with caregivers of young patients to help offer support and promote gradual, lasting change.
- Work in small steps. Introduce new or avoided foods slowly and systematically. Progress may be slow at first but try to stay patient. Even tiny steps add up over time.
- Stick to a consistent routine. Keep regular meal and snack times each day. Meals should take priority over other activities so that eating becomes expected and predictable.
- Focus on the positive and include rewards. We all respond well to incentives and praise for doing hard work. Sticker charts, screen time, verbal praise or other small rewards right after new foods are tasted can help motivate your loved one.
- Create a calm environment. Outside of exposures, try to make mealtimes relaxed and pleasant. Serve familiar foods and focus on positive conversation.
- Offer steady encouragement. If your loved one is overwhelmed, it can be helpful to remind them that their reaction is expected, they are capable, and this is the way to overcome their eating disorder. Supportive comments like “You’re doing great, let’s keep going” or “You haven’t tried this food enough yet to know if you like it” can go a long way.
If you or a loved one is struggling with ARFID, you are not alone -- and help is available. Treatment for ARFID often includes exposure-based interventions, cognitive behavioral strategies and family support.
Find help for ARFID today
While ARFID-specific treatments are fairly new, the results are promising. By focusing on the reasons behind avoidant or restrictive eating, I’ve seen many patients make real progress: eating more, feeling less anxious around food and returning to daily life with more confidence.
Eating Recovery Center offers ARFID care for all ages across the U.S. and a specialized ARFID treatment program for kids and teens in Baltimore. To learn more about our ARFID treatment programs, call us at 866-622-5914 or reach out for a free assessment. It just takes one call to get started.
