All About Avoidant/Restrictive Food Intake Disorder (ARFID)

What is ARFID?

ARFID stands for avoidant/restrictive food intake disorder. This serious eating disorder often shows up as an extreme avoidance of foods or types of foods. Often considered an eating disorder of childhood, ARFID affects people of all ages. Unlike other eating disorders like anorexia nervosa and bulimia nervosa, ARFID is not driven by concerns about body image or weight.

Instead, people with ARFID may:

Avoid certain foods due to sensory sensitivities (food texture, taste, smell or color)
Have little interest in food or eating
Restrict food because of a fear of choking, vomiting or having an allergic reaction

If left untreated, ARFID can lead to malnutrition and multiple medical complications.

ARFID commonly occurs with

Obsessive-compulsive disorder (OCD)

Anxiety disorders

Autism spectrum disorders

Attention-deficit hyperactivity disorder (ADHD)

Source: Sanchez-Cerezo, J., Nagularaj, L., Gledhill, J., & Nicholls, D. (2023). What do we know about the epidemiology of avoidant/restrictive food intake disorder in children and adolescents? A systematic review of the literature. European Eating Disorders Review, 31(2), 226-246. doi: 10.1002/erv.2964.

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ARFID SYMPTOMS

ARFID symptoms look different for each person.

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Common ARFID symptoms include:

Being a “picky” eater

Lacking 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

Inflexible eating habits

Selecting limited foods each day based on preferred tastes, textures, colors or temperatures

What are the different types of ARFID?

Types of ARFID include aversive, avoidant, restrictive, ARFID “plus" and adult ARFID. The type of ARFID depends on the symptoms and behaviors the individual is experiencing.

Aversive

One type of ARFID is aversive. Individuals with the aversive type of ARFID refuse to eat foods because of strong fears. These fears may include a fear of choking, nausea, vomiting, pain and/or swallowing. In extreme cases, these fears my cause someone to avoid food completely.

Examples

Avoiding eating tortilla chips due to a fear of choking or being cut by the sharp edges; A child with high anxiety avoids dairy products (drinking milk or eating yogurt) due to fear of vomiting

ARFID health complications

Serious complications 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. Experts are still researching the causes of ARFID, including genetic, cultural and psychological factors.

How is ARFID different from anorexia?

The primary difference between ARFID and anorexia is that people with ARFID are not driven by body image concerns.

ARFID vs. anorexia: Medical complications

While the two disorders are different, the medical complications associated with ARFID can be very serious and can 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

85%

85% of children who received CBT showed meaningful improvements in food variety and anxiety

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Source: Thomas, J.J., Becker, K.R., Kuhnle, M.C., et al. (2020). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof-of-concept for children and adolescents. International Journal of Eating Disorders, 53(10), 1636-1646. doi: 10.1002/eat.23355.

ARFID Treatment

Dealing with ARFID can feel overwhelming, especially when it’s your child or loved one struggling. Once an individual is diagnosed with ARFID, the most effective treatment plan will be a multi-disciplinary approach that includes the following:

Medical monitoring, if needed
Individual, group and family therapy
Nutrition counseling and education

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ARFID FAQs

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ARFID 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.

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.

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

Does your child have ARFID? Take the ARFID quiz here.

ARFID treatment involves 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

If you are interested in learning more about ARFID treatment, send us a message or call us at (866) 621-8445.

ARFID is a diagnosable mental health condition included in the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition (DSM-5) as a feeding and eating disorder. ARFID can be a major health concern and 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.