ARFID is a serious eating disorder characterised by extreme food avoidance or restriction based on sensory issues, lack of appetite, or fear of negative consequences (e.g. choking, vomiting).
Unlike other eating disorders, ARFID is not driven by body image distress or a desire to lose weight.
Diagnostic criteria for ARFID based on DSM5
The diagnostic criteria for ARFID are broken down into four main sections.
1.The Eating Disturbance
A persistent failure to meet nutritional or energy needs, resulting in significant weight loss, nutritional deficiency, malnutrition, reliance on supplements/tubes, or impaired psychosocial functioning.
2.Exclusion of External Factors
The behaviour is not due to a lack of available food or a culturally accepted practice.
3.Not Associated with Other Eating Disorders
The disturbance does not occur strictly during anorexia or bulimia, and there is no evidence of body image disturbance.
4.Exclusion of Medical/Psychiatric Conditions
The eating disturbance is not caused by other medical or mental conditions, or if present, is severe enough to warrant independent attention.
ARFID is not driven by concerns about body weight or shape.
Global prevalence of ARFID
Estimating the prevalence of ARFID remains challenging due to its relatively recent inclusion in the DSM-5 (2013) and heterogeneity in diagnostic methodologies.
Reported prevalence ranges from 0.35%–3.2% among children and adolescents and 0.3%–3.1% among adults. Although evidence regarding sex differences remains inconsistent, ARFID appears to be more prevalent among males, particularly in paediatric populations, underscoring the importance of gender-sensitive assessment and treatment.
What are the causes of ARFID?
The exact cause of ARFID is not fully understood.
It is thought to result though from a combination of biological, psychological, and environmental factors. Unlike other eating disorders, it is not driven by concerns about body weight or shape.
Major contributing factors are:
- Sensory sensitivities: Heightened sensitivity to taste, texture, smell, temperature, or appearance may lead to avoidance of certain foods
- Fear of aversive consequences: Previous experiences such as choking, vomiting, nausea, pain, or allergic reactions may cause fear and subsequent food avoidance
- Lack of interest in eating or food: Low appetite, early satiety, or limited interest in food can result in inadequate nutritional intake
- Neurodevelopmental factors: ARFID commonly co-occurs with conditions such as Autism Spectrum Disorder and ADHD, where sensory sensitivities and rigid eating patterns may contribute to food restriction
- Anxiety and mental health factors: Anxiety and specific fears can reinforce food avoidance and make dietary expansion more difficult
- Medical and gastrointestinal conditions: Chronic pain, swallowing difficulties, reflux, food allergies, and gastrointestinal discomfort may contribute to restrictive eating
- Genetic and biological influences: Differences in appetite regulation, sensory processing, and vulnerability to anxiety may increase susceptibility, although specific genetic mechanisms remain unclear
ARFID is more common among individuals with ASD & ADHD.
What are the signs of ARFID?
ARFID is characterised by a limited range of accepted foods and avoidance based on sensory characteristics such as taste, texture, smell, or appearance.
Some individuals have little interest in eating, while others avoid food due to fears of choking, vomiting, or gastrointestinal discomfort. Consequences may include weight loss, impaired growth, nutritional deficiencies, fatigue, and gastrointestinal symptoms.
ARFID may also impair social and emotional functioning by limiting participation in meals, social activities, and everyday life.
What is the difference between ARFID and picky eating?
People with ARFID may have very little interest in eating food.
They can be extremely sensitive to certain textures, smells, temperatures, or appearances of food. Food avoidance is due to fear of choking, vomiting, allergic reactions, or other negative experiences. The result is that they will eat only a limited range of “safe” foods.
While ARFID might look like extreme picky eating, the defining difference is the impact it has on the individual’s life.
Picky eaters generally grow out of it and do not suffer from severe medical or social consequences. ARFID can lead to malnutrition, poor growth in children, reliance on nutritional supplements, and social isolation (e.g., avoiding school meals or social events).
Is ARFID dangerous?
Yes, ARFID can be serious. In some cases, it can be potentially life-threatening if it leads to severe malnutrition or significant medical complications.
Eating disorders do not discriminate based on gender, age or socioeconomic status.
Consequences of ARFID
ARFID may result in inadequate nutritional intake and micronutrient deficiencies, potentially compromising overall health, energy levels, and immune function.
In children and adolescents, prolonged nutritional inadequacy may contribute to weight loss, impaired growth, delayed pubertal development, and reduced bone health.
Physical consequences may include weight loss or failure to achieve expected growth and development, particularly in children and adolescents, fatigue, dizziness, weakness, impaired concentration, and gastrointestinal symptoms.
Severe malnutrition can compromise cardiovascular and other physiological functions. ARFID may also contribute to anxiety, psychological distress, and reduced quality of life.
Social functioning can be significantly impaired, as individuals may avoid meals, restaurants, social gatherings, or situations involving unfamiliar foods.
In severe cases, oral nutritional supplementation, enteral feeding, or hospitalisation may be required to restore nutritional status and prevent medical complications.
Treatment of ARFID
ARFID’s treatment usually involves a multidisciplinary approach aimed at improving nutritional intake, increasing food variety, and addressing the underlying reasons for food avoidance.
Treatment is personalised because ARFID can develop through different pathways, including sensory sensitivity, fear of aversive consequences, or a lack of interest in eating.
How can a nutritionist help?
A nutritionist with experience in ARFID can play an important role in treatment.
Their main role is to make sure the person is receiving enough energy and nutrients while gradually helping them develop a more varied and sustainable diet.
They can begin by carrying out a detailed nutritional assessment. This may include reviewing the person’s usual food intake, eating patterns, weight and growth history, food preferences, nutritional deficiencies, and any symptoms such as nausea, constipation, abdominal pain, or early fullness.
A personalised meal plan is needed and is based on the person’s current “safe foods.”
Rather than suddenly removing familiar foods or forcing new foods, the aim is usually to maintain adequate nutrition, help with nutritional deficiencies while gradually expanding the range of foods that can be tolerated.
Someone with ARFID may eat enough calories but still lack nutrients. Where appropriate, a nutritionist can recommend fortified foods or nutritional supplements and monitor whether nutritional needs are being met.
For children and adolescents, the nutritionist can work closely with parents or caregivers. They can provide guidance on meal structure, appropriate portions, nutritional supplementation, and ways to support eating without creating excessive pressure or conflict around food.
Additional support?
Psychological therapy is considered a key component of treatment. Cognitive behavioural therapy for ARFID (CBT-AR) is one of the best-studied approaches.
It helps individuals understand and reduce food-related anxiety, gradually increase food variety, and develop more regular eating patterns. Treatment may involve gradual exposure to avoided foods and situations.
For individuals whose ARFID is primarily related to sensory sensitivity, treatment may involve gradual exposure to different tastes, textures, smells, and appearances of food. The goal is to progressively increase tolerance and acceptance rather than forcing the person to eat unfamiliar foods.
Medical monitoring is also important when ARFID has resulted in significant malnutrition or physical complications. A healthcare professional may monitor weight, growth, vital signs, blood tests, electrolyte levels, and nutritional deficiencies. Severe cases may require intensive nutritional support or hospitalisation.
Family-based interventions can be particularly important for children and adolescents. Parents or caregivers may be involved in establishing regular meals, supporting food exposure, reducing conflict around eating, and encouraging appropriate nutritional intake.
Recovery is possible. Treatment is available.
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