ARFID: Signs, Symptoms, & Treatments

What Is ARFID?

ARFID (avoidant restrictive food intake disorder) is a type of eating disorder in which people do not consume enough food to meet their daily nutritional needs. Some people with ARFID experience anxiety or phobias over certain foods. Others lack interest in eating or report having low appetites.²

ARFID tends to be more common in childhood and adolescence, but the onset can occur at any age. Many people with ARFID eat only certain types of food and in minimal amounts. This pattern may result in health problems and may require treatments ranging from needing nutritional supplements to feeding via tubes.

ARFID Vs. Anorexia

ARFID and anorexia nervosa both include severe food restriction; however, the underlying motives are different. Someone with anorexia limits food because they want to lose weight or achieve a certain body type. They fear weight gain and often punish themselves with extreme dieting techniques to consume as few calories as possible. Someone with ARFID is not motivated by weight loss. Instead, they often restrict calories unintentionally, and it’s because they fear or lack interest in eating.

ARFID Vs. Picky Eating

Research shows that 8%-50% of children between 2 and 11 years old are picky eaters.³ However, being particular about food is a relatively normal part of childhood development. Although picky eaters may be frustrating for family members, the person isn’t necessarily disturbed by their habits.

Picky eaters usually have specific food preferences and can maintain appropriate weight goals. People with ARFID may demonstrate substantial weight loss, and they may show no interest in eating whatsoever. They may also be disturbed by certain food textures or be wary of certain food-related consequences like fear of vomiting, choking, or getting sick.

Picky eaters may turn down most foods and only choose to eat their favorites, but someone with ARFID may report they don’t feel hungry, never think about food, and often forget to eat because food just isn’t a priority.

ARFID Vs. Food Aversion

Some people with food aversion may or may not qualify for an ARFID diagnosis. Food aversion is a general term for the avoidance of eating specific foods due to taste, texture, or smell.⁴ These sensory issues can occur in combination with, or independently of, an ARFID diagnosis.⁴

For example, someone may have a food aversion toward the texture or smell of eggs, but this would not qualify for an ARFID diagnosis because they would be able to supplement their diet with other forms of nutrition. Someone with ARFID may present with a food aversion, meaning they avoid so many foods due to sensory issues that they lose a significant amount of weight and have impaired functioning.

What Are the Warning Signs of ARFID?

Some of the key warning signs that someone is struggling with ARFID include avoiding specific foods, losing significant amounts of weight, difficulty eating with others, or loss of interest in food entirely.⁵ Certain warning signs may or may not be visible to others, especially if the person is an adolescent or adult and tends to eat meals alone.

ARFID in Children

Many parents mistake ARFID for picky eating. After all, the two conditions can look similar. A child with ARFID, however, may seemingly avoid every type of food. Unlike a picky eater, a child with ARFID can fail to achieve specific weight and growth milestones without treatment for the condition.

Signs of ARFID in children can include:⁵

• Negative reactions to smells, textures, tastes, or colors of foods
• Being highly fearful of new foods
• Denying feeling hungry
• Showing an overall disinterest in eating
• Verbally communicating fears of choking or vomiting if they eat a certain food
• Crying or tantrums during meal times
• Complaining of stomach aches or constipation
• Only agreeing to eat very specific preferred foods

ARFID in Teens

ARFID in teens can be more difficult to spot, as teens developmentally start to spend more time alone or with friends. Warning signs are similar to childhood signs of ARFID, and may continue to progress as someone ages. Some warning signs of ARFID in teens might include refusing to sit in on family meals, isolating themselves during meal times, or denying feeling hungry when food is offered.

Signs of ARFID in teens can include:

• Denying feeling hungry when food is offered
• Not eating specific foods or food groups due to sensory issues
• History of only eating preferred foods as a child and now continuing into adolescence
• Not joining in on eating during social events, like birthday parties
• Losing weight
• Vitamin and nutrition deficiencies during yearly physicals
• Lack of general interest in eating at all
• Trouble eating that develops after a stressful life event, like transitioning into highschool

ARFID in Adults

Adults with ARFID may avoid social settings where food is involved due to fear of eating or fear of feeling embarrassed about how they eat. In long-term cases, adults with ARFID may struggle with serious health consequences due to inadequate nutrition.

More signs of ARFID in adults include:

• History of avoiding specific food groups or being “a picky eater”
• Only eating preferred foods and fearing any new foods
• Avoiding eating around others
• Low weight
• Gastrointestinal issues
• Nutritional imbalances
• Vitamin deficiencies
• Fears of choking or vomiting
• Relying on supplements for dietary needs

ARFID Types

There are three main types of ARFID: avoidant, aversive, and restrictive types. These three classes are named after the behaviors people tend to present with. It is also possible to have a mix of the ARFID types.

The types of ARFID are:

• Avoidant: Individuals with avoidant type of ARFID avoid specific foods or whole food groups due to sensory issues. For example, they may avoid certain fruits, vegetables, or meats because of taste, texture, color, or smell.
• Aversive: Individuals with aversive type of ARFID fear the negative consequences of consuming food. These consequences may include expected abdominal pain, vomiting, choking, gastrointestinal issues, or allergic reactions.
• Restrictive: Individuals with restrictive type of ARFID have a general disinterest in food. They may forget to eat meals, skip meals, or look disconnected during meal times with others.

ARFID Symptoms

The main symptom of ARFID is failing to eat enough food to meet nutritional needs. Understanding why someone does not eat enough food will help determine if ARFID is the appropriate diagnosis, or if it’s another condition. ARFID consists of both psychological and physical symptoms that cause significant distress to an individual’s well-being.

Psychological Symptoms of ARFID

Common psychological symptoms of ARFID include:¹

• Sudden refusal to eat certain foods
• Reported fears of choking or vomiting
• Having no appetite (or a very low appetite)
• Eating very slowly and barely consuming whatever is served
• Problems with eating in social situations
• Limiting food intake to avoid feared or disliked textures
• Difficulty chewing and digesting

Physical Symptoms of ARFID

Common physical symptoms of ARFID include:¹

• Rapid weight loss (or failing to gain expected weight in childhood)
• Gastrointestinal distress
• Difficulty concentrating
• Fatigue
• Dizziness or fainting
• Insomnia or other sleep-related problems
• Loss of menstruation (or menstrual irregularities)
• Feeling cold all the time

ARFID Symptoms in Adults

ARFID symptoms in adults tend to be similar to symptoms in children and teens, with the added embarrassment and shame of knowing what is socially expected. Adults with ARFID also tend to have a history of experiencing food aversions or being “a picky eater” as a child, which was never resolved and resulted in long-term ARFID symptoms.

ARFID symptoms in adults include:

• Avoiding social gatherings with food
• Avoiding grocery store shopping
• Using high-calorie supplements to cover inadequate nutrition
• Denying feeling hungry
• Only eating preferred foods
• Having a history of “being a picky eater”
• Looking distracted during family meals
• Significant weight loss
• Nutritional deficiencies

What Health Complications Can Happen With ARFID?

Over time, ARFID can have severe consequences. Lack of proper nutrition and inability to socially function around food can damage someone’s body, mind, and relationships. People can develop low self-esteem from embarrassment or shame about their eating habits. They may also develop vitamin, mineral, and nutritional deficiencies as a result of long-term ARFID. Studies show that people with untreated ARFID are at risk for heart issues, electrolyte imbalance, slow heart rate, and loss of period.⁴

Causes & Risk Factors of ARFID

Like any eating disorder, there isn’t one specific cause of ARFID. Instead, ARFID likely results from a combination of genetic, psychological, environmental factors, and triggering events (i.e., choking). Certain risk factors may exacerbate someone’s predisposition to develop this condition.

Genetic Factors

History of gastrointestinal issues, such as GERD or vomiting, are a risk factor for developing ARFID.⁷ Children of mothers with eating disorders and family history of high anxiety are also connected to the development of ARFID.⁷ This may indicate a biological risk factor for developing ARFID, mixed with the environment of raising a child in a high-anxiety home and modeling disordered eating to cope. Some ARFID theories also suggest that certain people are more sensitive to taste perceptions than others, leading to symptoms of ARFID.⁴

Triggering Events & Social Factors

Individuals who had past traumatic reactions during eating, such as choking, vomiting, or an allergic reaction, can go on to develop ARFID in response to the trauma.⁴ It is equally common in both sexes in infancy and childhood, but ARFID with comorbid autism is more common in males.⁷

ARFID should not be diagnosed when the avoidance of food is related to specific cultural or religious practices. Presentations similar to ARFID happen in many geographic locations, including the United States, Canada, Australia, and Europe.⁷

Psychological Factors

Temperaments found in people who have anxiety disorders, autism spectrum disorder, obsessive-compulsive disorder, and attention deficit and hyperactivity disorder increase the risk of developing ARFID.⁷ Studies have also indicated that some individuals with ARFID may have underlying dysfunction in appetite-controlling parts of the brain.⁴

Co-Occurring Disorders

The most commonly co-occurring disorders with ARFID include anxiety disorders, obsessive-compulsive disorder, and neurodevelopmental disorders such as ADHD, autism spectrum disorder, and intellectual developmental disorder.⁷

Common co-occurring disorders with ARFID include:⁷

• Autism: When ARFID and autism co-occur, there may be rigid eating behaviors and heightened sensory issues to food.
• ADHD: When ARFID and ADHD co-occur, there may be distractedness from eating that leads to missing meals, sensory issues with food, or stimulant medications leading to a lack of appetite.
• OCD: When ARFID and OCD oc-occur, there may be avoidance or restriction of food intake related to food obsessions. Some people may also develop food rituals related to obsessions and compulsions mixed with ARFID aversions.
• Anxiety: When anxiety and ARFID co-occur, there may be a lack of appetite from experiencing high panic and anxiety.
• Depression: When depression and ARFID co-occur, both may cause a general disinterest in food. Sometimes, when mood issues are treated with antidepressants, this symptom will resolve.

How to Help Your Child With ARFID

Helping your child with ARFID involves being a role model, providing structure, rewarding positive behaviors, and practicing emotion regulation skills together. Although it can be frustrating when your child is not eating what you offer, it is important to develop patience and understanding around their symptoms. Becoming impatient will only frustrate your child and maintain their symptoms. Seeking a professional to help with your and your child’s emotions related to ARFID can offer much needed support during recovery.

Here are several tips for helping your child recover from ARFID:

• Be a role model: Children can be visual learners, so modeling healthy eating habits can help encourage them that it is safe and normal to consume their feared foods.
• Schedule regular meals and snacks: Children often thrive with routines, so scheduling meals and snacks can help encourage them to find safety in structured times for eating.
• Have regular family meals: Regular family meals can offer structure and routine, while providing time for socializing and spending quality time as a family. These regular family meals also serve as a time for your child to practice skills learned in therapy so that they develop the skills needed to transition into adolescence.
• Encourage, but don’t force: Forcing your child to eat will only reinforce negative emotions around meal time. Encouraging them, in contrast, can help them develop their own internal motivations for finishing a meal.
• Reward positive eating behaviors: Children respond well to positive reinforcement. When you see your child exhibiting good eating behaviors, be sure to offer praise in whatever form they respond best to.
• Help your child relax before eating: High anxiety situations can make it even less likely that your child will be able to push through feared meals. Encouraging breathing and relaxation techniques can encourage your child to learn how to calm their own anxieties for better preparation before eating.
• Stay calm even when they don’t eat: It is important to remind yourself that your child is not behaving this way on purpose and they are lacking the skills required to properly eat. Practice your own emotion regulation strategies, or see a professional if you feel you cannot stay calm when your child is unable to eat.

Belcher notes, “Understanding that ARFID is not ‘picky eating,’ and that it is a complex eating disorder, shifts the focus from judgment to support. Avoid all comments about what they choose to eat or not eat. Restaurants or events with unknown food sources can cause stress, thus, serve or request foods your loved one enjoys and offer emotional support throughout the event. For younger children, ensure foods they enjoy are available and seek the guidance from their care team to increase accepted foods.”

How to Cope With ARFID as an Adult

There are various strategies for coping with ARFID as an adult. Seeking the guidance and assessment of professionals, following through with treatment, and setting up the conditions for recovery can help ensure you have the tools needed for the best treatment outcomes. As you recover, knowing your triggers and support system will help you plan for obstacles during treatment.

Here are several tips for coping with ARFID:

• Seek an appointment with your primary care provider for a physical to rule out any underlying issues or complications that have happened as a result of ARFID symptoms.
• Follow through with any medical suggestions, including lab tests to check for vitamin deficiencies or nutritional imbalances.
• Seek the care of a therapist to help with any underlying emotional issues or comorbid mood conditions.
• Seek help from a registered dietician to structure, plan, and prepare nourishing meals.
• Identify a support system while you recover from symptoms, including friends, family, spiritual communities, and online resources that can offer support during recovery.
• Remember to take medications to support nutritional recovery, such as suggested vitamins and supplements.
• Identify people, places, and situations that trigger ARFID symptoms. Utilize your therapist to either develop exposures to challenge these triggers, or employ lifestyle changes to minimize triggers.
• Use relaxation techniques prior to meals, or whenever anxiety symptoms arise.

When to See a Healthcare Provider for ARFID Symptoms

It is best to seek the care of a healthcare provider at the first sign of ARFID symptoms. Everyone is different, and symptoms can progress quickly when untreated in certain individuals. Especially if you are noticing gastrointestinal issues, experiencing faint pulse or blood pressure, or unable to get yourself to eat enough to sustain energy, you should seek a healthcare provider to assess acute medical issues.

Getting an ARFID Diagnosis

To diagnose ARFID, a medical professional will usually engage in a complete assessment of the individual’s medical and mental health history. If diagnosing a child, the medical professional will often speak to both the parents and the child to understand the presenting issue.

To diagnose ARFID properly, a qualified healthcare professional will assess the person’s eating habits and other lifestyle factors, such as if they have an underlying medical condition (like diabetes), mental health conditions, or specific cultural practices surrounding food intake.⁶ It’s essential to fully separate ARFID from picky eating or other eating disorders.

Treatment for ARFID

ARFID eating disorder treatment often requires a comprehensive, multidisciplinary approach. The specific treatment will vary based on the severity of the person’s condition and past history of professional intervention. If the individual has co-occurring mental health issues, treatment should provide adequate interventions for all symptoms.

Belcher encourages, “ARFID, like all eating disorders, is best treated through a team approach. Eating disorder specialists, including registered dietitians, licensed therapists, and medical providers including psychiatrists, should work together to identify strategies to renourish clients and begin to expand foods the client eats. Many clients’ symptoms improve with a specific type of Cognitive Behavioral Therapy for ARFID: CBT-AR. A dietitian and therapist work closely to plan for, execute, and process food exposures. Consistent and continued exposure to new foods and processing the emotional experience is the path to an improved quality of life, and health.”

ARFID Therapy

Therapy can be highly effective for treating ARFID, providing a safe and supportive environment for recovery. Your therapist will work with you to develop reasonable goals and identify realistic steps towards achieving those goals.

Types of therapy for ARFID include:

• CBT-AR: In CBT-AR, cognitive-behavioral strategies are used to implement the volume before variety strategy where someone is encouraged to eat large amounts of preferred foods to maintain weight, before progressing to varying their food intake.⁸
• Family-based therapy for ARFID: Family-based therapy can help address underlying family dysfunctions that maintain ARFID symptoms. Through family-based therapy, parents in particular, can learn to offer structure and support for family meals until their child exhibits better independence around food. 
• Supportive parenting for anxious childhood emotions for ARFID: SPACE-ARFID is a newer form of therapy for ARFID symptoms focused on parents developing healthier reactions to their child’s ARFID symptoms.⁹ Through therapy, parents help encourage food flexibility in their children.⁹

Medication for ARFID

There are currently no FDA-approved psychiatric medications for ARFID; however, research shows that mirtazapine and lorazepam can reduce food-related anxiety. Furthermore, olanzapine may help reduce rigid thoughts about food.⁵

Similarly, physicians may recommend specific supplements or vitamins to ensure nutritional balance. If the individual has co-occurring mental health issues, it is important to evaluate the need for medication.

How to Get Help for ARFID

If you suspect you have an eating disorder, including ARFID, it is important to visit your primary care physician first. They will conduct a full physical and determine the severity of your condition via bloodwork, urine testing, or X-rays. They may also refer you to specialists such as registered dietitians and ARFID specialists.

You should follow similar guidelines for children. Talk to your child’s pediatrician about your concerns. It may be helpful to write down the symptoms you observe and note when they started and how frequently they present. Your pediatrician may also provide referrals for child ARFID specialists.

In severe cases, hospitalization is necessary. Hospitalization allows for continuous monitoring and evaluation of the physical effects associated with ARFID. Discharge occurs after achieving medical stabilization.

How to Find an ARFID Therapist

If you’re interested in finding a therapist to help you deal with symptoms of ARFID, start your search in a free online therapist directory. You can narrow down your search by things like cost, expertise, and location.

Can ARFID Be Prevented?

There is no documented way to prevent the symptoms of ARFID from developing. You can empower yourself through paying attention to and addressing risk factors for development from ARFID. You can also seek help at the first sign of symptoms in yourself, or others, as early intervention gives the best treatment outcome possibilities.