What is ARFID? Understanding Avoidant Restrictive Food Intake Disorder

Key Points

• ARFID is an eating disorder characterized by an intense fear of eating certain foods
• ARFID stands for Avoidant Restrictive Food Intake Disorder.
• It's not just "picky eating"; it's a medical condition that leads to severe health consequences if left untreated.
• Eating disorder specialists, including a Registered Dietitian, can help with ARFID treatment.

Imagine being unable to eat because your mind and body won’t let you, even if you're literally starving. That’s the terror-filled reality for people with ARFID or Avoidant Restrictive Food Intake Disorder. It's a newly recognized eating disorder that often begins in childhood and can persist into adulthood.

While there's a lot more to learn about this little-known eating disorder, here's an overview of what ARFID is, what signs to watch out for, the difference between ARFID and picky eating, and what eating disorder treatment looks like.

You’ll also discover how registered dietitians specializing in eating disorders play a vital role in ARFID treatment and recovery.

What is ARFID?

ARFID is an eating disorder where a person avoids eating specific foods because of their texture, taste, or fear of choking or falling ill. Some healthcare providers may refer to the condition as 'ARFID selective eating disorder.’

People with ARFID often have a small list of acceptable or "safe" foods such as mac and cheese, chicken nuggets, plain white bread, pizza, or other comfort foods.

ARFID can lead to severe nutritional deficiencies, significant weight loss, and poor muscle growth, especially in children.

Who is most at risk of developing ARFID?

ARFID often starts early, beginning as early as infancy or childhood, and can continue into adulthood. It’s more common in young children and equally common in females and males. However, ARFID can be present even in teens and adults.

What are the symptoms of ARFID?

ARFID may look a little different in each person, but there are some common patterns.

ARFID symptoms are:

• Rapid and significant weight loss
• Digestive issues like constipation
• Abdominal cramps
• Fatigue
• Irregular periods or delayed puberty
• Dizziness
• Fine hair on the body (lanugo)
• Weak or under-developed muscles.

ARFID vs Anorexia and other eating disorders

Unlike other eating disorders like anorexia nervosa or bulimia nervosa, ARFID is not rooted in body image issues. While some individuals with ARFID may also experience body image concerns, these are not the primary cause of their food avoidance and low appetite.

What are the early signs of ARFID?

One of the early signs of ARFID is extreme picky eating. A child may refuse different types of foods and stick to a few "safe" foods. Often, they lack an appetite and may be completely uninterested in eating.

Some kids may complain about feeling full around mealtimes. Over time, these habits can lead to nutritional deficiencies, slow growth, and other health issues.

How is ARFID diagnosed?

According to DSM-5, the most recent diagnostic manual, the criteria for ARFID are:

• Low weight, severe weight loss, or the inability to meet age-related weight requirements.
• Nutritional deficiencies that are caused by restricted eating.
• Dependence on supplements or a feeding tube to meet nutritional needs.
• Eating habits disrupt activities of daily life, including the intense fear of social situations that involve food.

It’s important to first rule out other causes, such as medical conditions, cultural practices, or other eating disorders. A healthcare provider or a licensed mental health professional will evaluate medical history, physical health, eating habits, and emotional well-being before diagnosing eating disorders like ARFID.

Is it ARFID or picky eating?

Normal picky eating is a casual dislike of certain foods, and many kids outgrow it. On the other hand, ARFID can feel like an ever-present invisible force field that keeps someone from getting the nutrition they need.

Picky eaters may avoid a few foods but generally get enough calories to stay healthy and grow in a healthy manner. With ARFID, someone may have only five to ten preferred foods, leading to serious health concerns like significant weight loss, poor growth, or a need for nutritional supplements.

Anxiety is another key difference between eating disorders and general food preferences. ARFID often involves intense fear and severe distress when it comes to eating certain foods. People with ARFID may worry about choking or vomiting when it comes to certain foods. Picky eaters might not like certain textures or sensory experiences but typically do not experience the same level of stress.

Experienced Registered Dietitian Rita Faycurry, RD, says," While picky eating and ARFID may seem similar on the surface, a significant difference is what lies beneath. Eating disorders are mental health conditions that relate to how a person feels about food or social situations involving food—even when it impacts their health."

If you’re concerned about your own or a loved one’s eating habits, reach out to a mental health professional or eating disorder specialist. A dietitian who specializes in eating disorders often works hand in hand with doctors and counselors to address nutritional deficiencies and encourage healthy eating practices.

The first step is to learn more. A Fay ARFID nutritionist can get you started.

What causes ARFID?

The exact cause of ARFID is not known. Research suggests that genetics play a significant role, accounting for 79% of the risk of developing it. Some studies have found a close link between ARFID and autism spectrum disorder.

ARFID can be triggered by events like choking or health issues such as acid reflux, vomiting, nausea, or allergies. These experiences can create negative associations with certain foods or mealtimes as a whole.

Children and adults with ARFID may also have anxiety disorders, depression, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD).

Faycurry, RD, notes, "If you have ARFID or are supporting someone who does, it’s important to understand that ARFID is not a choice. No one chooses the intense anxiety, malnutrition, social isolation, and trauma it brings. If you’re a parent or caregiver of someone with ARFID, remember that you’re not to blame for this condition. ARFID, like other eating disorders, is a complex mental health condition influenced by genetic, biological, and other factors."

What's the best ARFID treatment?

ARFID can be treated, and long-term recovery is possible.

ARFID treatment prioritizes improving nutrition, addressing weight challenges, and tackling the psychological factors behind eating behaviors that lead to avoiding food. Therapy is essential to help process food-related trauma and explore the underlying anxiety and discomfort that prevent healthy eating. When required, therapy may also include autism spectrum disorder experts.

Expert eating disorder dietitian nutritionists gradually introduce new foods, develop personalized meal plans, treat nutritional deficiencies, and support long-term ARFID recovery.

Get help now. Use Fay to find ARFID treatment near you provided by board-certified eating disorder experts.

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.