ARFID Causes and Treatments

A closer look at avoidant/restrictive food intake disorder

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Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by eating very little food or avoiding eating certain foods. It's a relatively new term that first appeared in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013.

It was previously known as selective eating disorder and is often characterized as "severe picky eating" but can cause serious health problems if left untreated.

Young boy applies hand over mouth technique to avoid lunch

MarkoNOVKOV / Getty Images

What Is ARFID?

Individuals with ARFID develop a type of problem with feeding or eating that causes them to:

  • Avoid particular foods
  • Avoid consuming foods altogether

As a result, they aren’t able to take in enough calories or nutrients through their diet. This can lead to:

  • Nutritional deficiencies
  • Delayed growth (in children)
  • Problems with weight gain

ARFID usually presents in infancy or during childhood and may persist into adulthood. It may initially resemble picky eating that’s common during childhood, however, these picky eating patterns usually resolve within a few months without causing problems with growth or development. With ARFID, the eating problems are persistent and can have serious health implications.

Types of Foods Avoided

A person may restrict the amount or type of a particular food or avoid a particular food based on factors such as:

  • The appearance: This could be based on color, size, and shape.
  • The texture: They may avoid all soft foods, for example.
  • The odor of food: Some odors may make the individual feel sick.

Behaviors

There are many behavioral signs that an individual may demonstrate which suggests they could have ARFID. These include:

  • Eating very slowly on a regular basis
  • Being unable to finish what has been served
  • Having no appetite without an apparent reason
  • Refusing to eat some foods because they're afraid of vomiting or choking
  • Suddenly refusing to eat foods that they used to eat

Reasons for Food Avoidance

The DSM-5 gives some examples of types of avoidance or restriction that may be present in ARFID. These include:

Lack of Interest in Food

In some cases, the individual may not recognize that they are hungry in the way that others would, or they may generally have a poor appetite. For them, eating might seem a chore and not something that is enjoyed, resulting in them struggling to eat enough. Such people may have restricted intake because of low interest in eating. 

Sensory Avoidance

People in this category struggle primarily with food variety; they are often extremely selective regarding the food that they consume. They often have sensory hypersensitivity that results in setting rigid rules involving food (such as only eating foods of a certain color or texture). They will often only accept the same limited number of foods prepared in the exact same manner and served in exactly the same way.

Fear of Consequences of Eating

In some cases, the person may have had a distressing experience with food, such as choking or vomiting, or experiencing significant abdominal pain. This can cause the person to develop feelings of fear and anxiety around food or eating and lead them to avoid certain foods or textures. Significant levels of fear or worry can lead to avoidance based on concern about the consequences of eating.

ARFID vs. Other Eating Disorders

ARFID is different from anorexia nervosa, bulimia nervosa, and related conditions; in ARFID, beliefs about weight and shape do not contribute to the avoidance or restriction of food intake.

A diagnosis of ARFID would also not be given if there is another clear reason for the eating difficulty, such as a medical condition that results in appetite loss or digestive difficulties.

AFIRD Is Not About Weight Control

Unlike individuals with anorexia nervosa, people with ARFID do not worry about their weight or shape and do not restrict their diet for this reason.

Diagnosis

ARFID is often challenging to diagnose as family members and clinicians may believe the individual is just a “picky eater” and will grow out of it. However, if the individual is losing weight and/or not gaining weight, there should be a concern.

Warning Signs

Some common signs that someone is suffering from ARFID include:

  • Avoidance of foods based on texture, color, taste, smell, food groups, or other factors.
  • Frequent gagging or vomiting after exposure to certain foods.
  • Difficulty chewing or swallowing food.
  • Lack of appetite or consumption of only very small portions.
  • Social isolation or avoidance of places that are connected with food, like a cafeteria.

Diagnostic Criteria

To meet the criteria for ARFID, the food restriction cannot be explained by:

  • Lack of food
  • Culturally sanctioned practice (such as a religious reason for dietary restriction)
  • Another medical problem that if treated would solve the eating problem

Furthermore, it must lead to one of the following:

  • Dependence on tube feeding or oral nutritional supplements
  • Difficulty engaging in daily life due to shame, anxiety, or inconvenience
  • Significant nutritional deficiency
  • Significant weight loss (or failure to make expected weight gain in children)

How Common Is ARFID?

Given its status as a recently defined disorder, it's difficult to know just how prevalent ARFID is in children and adolescents. In some studies, the rates of ARFID have ranged from 5 to 14% among pediatric inpatient eating disorder programs.

Studies have consistently demonstrated that—compared to those with anorexia nervosa or bulimia nervosa—ARFID patients are younger, have a higher proportion of males, and are commonly diagnosed with comorbid psychiatric and/or medical symptoms.

Complications

ARFID can have a negative impact on the individual’s physical health and as well as on their psychological wellbeing.

When a person does not take in enough calories, they are likely to lose weight. Children and young people may fail to gain weight as expected and their growth may be affected, with a slowing in height increase.

Comorbidity

As with all eating disorders, the risk factors for ARFID involve a range of biological, psychological, and sociocultural issues.

Researchers know much less about what puts someone at risk of developing ARFID, but they do know:

  • People with autism spectrum conditions are much more likely to develop ARFID, with one study finding that 20% of children with ARFID have an autism spectrum disorder.
  • Children who don’t outgrow normal picky eating, or in whom picky eating is severe, appear to be more likely to develop ARFID.
  • Many children with ARFID also have a co-occurring anxiety disorder, with as many as 50% having a generalized anxiety disorder. Obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) are also common among individuals with ARFID.

Risks

In ARFID, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences.

In some people, serious weight loss or malnutrition may develop, which needs treatment. In people whose food intake is very limited, nutritional supplements may be prescribed. In some cases, a period of tube feeding may be recommended if the physical risk is judged to be high.

If ARFID causes malnutrition, this can affect children's growth and development, potentially causing irreversible health issues. Children who are malnourished may have a predisposition to serious health effects that could develop years later, such as:

  • Heart failure
  • Asthma
  • Allergies
  • Chronic respiratory disease
  • GI disease
  • Diabetes
  • Kidney failure

When To See a Doctor

Regardless of how healthy you think your child is, you should call a doctor if you notice that your child:

  • Appears underweight
  • Doesn’t eat as frequently or as much as they should
  • Seems distressed or withdrawn
  • Regularly appears tired and sluggish
  • Vomits frequently

Treatment

Treatment for ARFID is usually tailored to the needs of the individual, based on the specific nature of the difficulties the person is experiencing and what is considered to be maintaining these. Most often, treatment can be delivered in an outpatient setting.

Treatment could involve family-based treatment (for young people) or cognitive behavioral therapy, and sometimes medication may be suggested, most often to help with anxiety.

The individual’s physical health should also be monitored and managed by their primary care physician or pediatrician. Treatment may also involve nutritional management through support from a dietician, and help with sensory problems.

A Word From Verywell 

ARFID is often described as "severe picky eating" but it can become a serious health issue if left untreated. Without professional help, ARFID can lead to dangerous nutritional deficits, growth issues, and a number of health complications like kidney failure and heart issues.

If you are concerned your child may be suffering from ARFID, please seek medical help as soon as possible.

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