Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder that involves someone limiting the amounts and types of food they eat, due to reasons that are unrelated to one’s body image.

It can involve sensory sensitivities to certain foods, fear and anxiety about food, and/or distress around potential adverse consequences of eating, like choking or vomiting. ARFID results in nutritional deficiencies and impacts physical development and growth. 

No – picky eating is different from ARFID. Picky or fussy eating can be a common behaviour that children display at certain times throughout their development, such as preferring sandwiches to be cut a certain way, or only eating a certain food for a specific period of time. This behaviour can also be a way for children to develop their preferences and establish a sense of control or independence. 

However, picky eating improves over time, and doesn’t have as significant of a health impact on a child as ARFID. ARFID symptoms do not usually improve without treatment and can result in serious health and medical consequences. 

ARFID is more commonly present during childhood and adolescence, and also co-occurs more commonly with autism, ADHD and anxiety. However, it can occur in people of any age, gender, socioeconomic status and background.  

While more research is needed to better understand ARFID, there is a link between autism and ARFID in particular, with an estimated 21% of autistic people experiencing ARFID in their lifetime. 

It is also estimated that up to 26% of people diagnosed with ARFID will also have ADHD. 

Having awareness around ARFID symptoms and warning signs can make a difference to the duration and severity of the illness through early intervention and access to professional support. If you or someone you know is exhibiting warning signs it is vital to seek help as soon as possible. 

The warning signs of ARFID can be physical, psychological and behavioural, and it is possible for someone with ARFID to display some or all of these signs. 

Physical Signs

• Abdominal pain, stomach cramps, upset stomach or constipation
• Any symptoms suggesting micronutrient deficiencies
• Brittle nails, dry hair and hair loss
• Delayed growth
• Fainting or dizziness
• Fatigue or tiredness
• Fine hair on face or body
• Loss or disturbance of menstruation
• Low body temperature
• Minimal appetite
• Muscle weakness
• Pale appearance
• Weight loss or failure to gain weight in children

Psychological Signs

• Difficulty concentrating or learning
• Feeling anxious or distressed around mealtimes and food

Behavioural Signs

• Denying ‘safe’ foods previously eaten 
• Distress when trying new foods 
• Eating food slowly 
• Eating only a small number of foods, which may be similar in taste, texture, smell or sight 
• Expressing fear of vomiting or choking while eating 
• Having no appetite or feeling full before meals 
• Lack of interest in food and/or eating 
• Struggling to eat meals with others 

The risks associated with ARFID can be severe, and include: 

• Amenorrhea 
• Anaemia 
• Anxiety or depression 
• Cardiac arrest 
• Delayed puberty 
• Dependence on tube feeding to meet nutritional needs 
• Depression 
• Electrolyte imbalance 
• Failure to grow, thrive, or achieve developmental milestones 
• Fainting 
• Gastrointestinal problems 
• Heart problems 
• Impaired psychosocial functioning 
• Kidney and liver failure 
• Low blood sugar 
• Low self-esteem 
• Nutritional deficiency 
• Osteoporosis 
• Phobia of adverse eating outcomes, like vomiting or choking 
• Significant weight loss, or in children, a failure to achieve expected weight gain  
• Social anxiety or withdrawal  

Treatment for ARFID focuses on addressing the underlying causes for avoiding food or eating, such as sensory aversions and fears regarding food, with the ultimate goals of preventing complications to an individual’s overall health, enhancing daily life and supporting physical health and development. 

It is important to note that ARFID is a relatively new diagnosis and research within this space is still evolving, including best treatment approaches. 

Therapies that are currently considered for the treatment of ARFID include: 

• Cognitive Behavioural Therapy, including exposure therapy 
• Responsive Feeding Therapy 
• Nutrition counselling 
• Speech-language pathologist, if choking is a concern 

Any treatment approach should be culturally safe, person centred and neurodiversity affirming – this is particularly relevant to ARFID given its common co-occurrence with neurodivergence including autism and ADHD.