ARFID in adults: Signs, causes, treatment, and recovery

Key Points

• ARFID, or Avoidant Restrictive Food Intake Disorder, is an eating disorder that can affect anyone, including adults.
• It is much more than picky eating; it's a serious and complex mental health condition.
• It is possible to heal from ARFID. Treatment involves a team of eating disorder experts, including doctors, dietitians, nutritionists, and psychiatrists or psychologists.

What if you felt sheer panic at the mere thought of eating? Your throat tightens, and anxiety takes over, making even the idea of food unbearable. While many enjoy exploring new recipes or cuisines, for those with ARFID, food brings intense fear, not excitement.

ARFID, or Avoidant Restrictive Food Intake Disorder, is a serious eating disorder with significant health risks. But it’s often misunderstood.

People with ARFID are often dismissed as "picky eaters" or "attention-seeking." In reality, they face a daily battle with their eating disorder. It prevents them from getting the nutrition they need and living the life they want. It can lead to social isolation and a host of medical and mental health issues.

If you're looking to help yourself or a loved one struggling with ARFID, read on to learn what it is, symptoms, diagnosis, and how to find ARFID treatment.

What is ARFID? Can adults have ARFID?

ARFID is a serious eating disorder that affects both children and adults. People with ARFID may restrict, avoid, or fear certain foods and stick to a limited number of comfort foods.

While some adults carry ARFID over from childhood, others may develop it for the first time as adults.

The mental health condition, sometimes called 'selective eating disorder,' was officially recognized in 2013 when it was added to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).

ARFID is estimated to affect between 0.5% and 5% of children and adults. Because it's a newly recognized eating disorder, there is very little data; the actual number could be higher.

What causes ARFID in adults?

A recent study found that almost 80% of a person's likelihood of developing ARFID comes from their genes. So, family history plays a significant role in whether someone develops ARFID or not.

Adults with ARFID usually avoid foods based on past distress or negative experiences related to food or mealtime. For example, dealing with severe allergic reactions, vomiting, nausea, diarrhea, or other gastrointestinal issues after meals can trigger adult ARFID.

Although people with ARFID restrict their food intake and may experience extreme weight loss, it is not similar to anorexia. ARFID is not prompted by a need for thinness or body image issues.

ARFID in adults is often accompanied by anxiety, depression, and obsessive-compulsive disorder (OCD).

There is also a close link between ARFID and neurodivergent conditions like autism spectrum disorder and attention deficit hyperactive disorder (ADHD). Studies show that approximately 21% of individuals with autism will experience ARFID at some point in their lives. Additionally, 26% of those with ARFID also have ADHD. However, more research on ARFID in adults is needed.

What are the symptoms of ARFID in adults?

ARFID symptoms include:

• Significant weight loss (although you do not have to be underweight to have ARFID)
• Nutritional deficiencies
• Digestive issues like cramps and constipation
• Low body temperature
• Irregular or missing periods
• Fatigue
• Lanugo (fine hair on the body)
• Weak muscles.

What are some behavioral changes in adults with ARFID?

Adults with ARFID may experience a lack of appetite, claim to feel full during meals, and usually do not eat entire food groups. Many rely on a small list of "safe" or "beige" foods, like plain noodles, bread, mac and cheese, or chicken nuggets.

Living with ARFID can be incredibly isolating. Most people with ARFID eventually avoid eating around others or skip social gatherings for fear of drawing attention to their eating habits. Because ARFID is not well-known, most people with the disorder struggle to be understood.

Having ARFID may mean developing complex rules around food and food storage. For example, some may not like certain types of foods touching or certain types of packaging around their food.

What foods do people with ARFID eat?

People with ARFID usually stick to a few foods and may prefer highly processed foods that are easy to digest. Foods like mac and cheese, potato chips, French fries, chicken nuggets, cheese, and goldfish crackers. This 'beige diet' is preferred by picky eaters and those with autism and ARFID.

These foods provide comfort because their taste and texture are predictable and consistent. They offer a sense of safety and reliability with every bite. These safe foods also have subtle flavors that do not lead to a sensory overload.

What are the health complications of ARFID?

Left untreated, ARFID may lead to significant weight loss, electrolyte imbalance, and heart issues like cardiac arrhythmias and cardiac arrest. Those who eat a sufficient quantity of their "safe" foods may maintain their weight but face other health consequences like nutritional deficiencies.

ARFID is a serious medical condition that can lead to several long-term effects. People may struggle with constant fatigue, difficulty concentrating, sleep problems, dry skin, brittle nails, and hair loss. They may also have a weaker immune system, making them more prone to infections, and experience slower wound healing.

How is ARFID diagnosed?

The DSM-5 criteria for an ARFID diagnosis are:

• Insufficient food intake due to an intense fear or aversion to certain foods
• Weight loss
• Significant nutrient deficiencies
• A need for nutritional supplements or a feeding tube
• Inability to manage social interactions and day-to-day tasks (psychosocial functioning).

Before arriving at an ARFID diagnosis, healthcare professionals must ensure that the food restriction is not caused by limited access to nutritious foods or motivated by a desire to reach a low body weight.

Also, the individual must be examined and evaluated to ensure that ARFID symptoms are not caused by underlying medical conditions like gastrointestinal disorders, inflammation, or food allergies.

You don't have to struggle alone. Fay can help you find qualified experts providing the best ARFID treatment near you.

How is ARFID different from other eating disorders?

The biggest difference between ARFID and other eating disorders is that the focus is on the act of eating itself, not body weight or appearance. So, even if someone with ARFID has a negative body image, it is not the reason why they restrict their food intake.

To distinguish themselves from those with eating disorders, people with ARFID refer to their condition as a 'feeding disorder' instead.

How is ARFID treated?

Eating disorder treatment is usually a collaboration between a team of specialists, including doctors, registered dietitian nutritionists, psychiatrists, and mental health counselors.

ARFID treatment for adults largely consists of Cognitive Behavioral Therapy (CBT). CBT, or Cognitive Behavioral Therapy, is a type of talk therapy that focuses on changing behaviors and thoughts with practical strategies.

Treating ARFID with CBT involves gradually introducing new foods in a supportive way. It also teaches coping skills for managing anxiety and emotional discomfort. The goal is to make meals less stressful and more manageable.

Registered Dietitians play a central role in eating disorder treatment teams to help address nutritional deficiencies, monitor and promote healthy weight gain, and manage other nutrition-related issues.

There is no medication to treat ARFID. In rare and extreme cases, a temporary feeding tube may be needed.

What does ARFID recovery look like?

It's important to note that eating disorders like ARFID are progressive and do not go away by themselves. You or a loved one with ARFID will need professional help, and remember, recovery is possible.

While recovery is possible at any stage, early intervention can significantly improve your chances of recovery, according to the National Eating Disorders Association (NEDA).

Consider reaching out to an eating disorder specialist to learn your treatment options and get started with ARFID recovery.

Find ARFID treatment near you or online using Fay.

The views expressed by authors and contributors of such content are not endorsed or approved by Fay and are intended for informational purposes only. The content is reviewed by Fay only to confirm educational value and audience interest. You are encouraged to discuss any questions that you may have about your health with a healthcare provider.