Understanding Avoidant Restrictive Food Intake Disorder (ARFID)

What is ARFID?

By Hannah Steinberg, PsyD, CHOC post-doctoral fellow

Avoidant Restrictive Food Intake Disorder, also known as ARFID, is a relatively new mental health condition that was introduced in 2013 and is characterized as an eating disorder.

In a nutshell, ARFID is a condition that causes someone to limit the amount and type of food that they are willing to eat based off different features of the food. Some examples might be that your child will only eat a certain brand of cheese, certain colors of food (e.g., only willing to eat foods that are beige or yellow), or only eating foods that are a certain consistency (e.g., your child will not eat foods that are too chewy or crunchy). Importantly, while ARFID is under the category of eating disorders, individuals with ARFID are not limiting the types or amounts of food that they eat because they do not like their personal appearance or in an attempt to lose body weight. Learn more about the signs of other eating disorders, like anorexia nervosa here.

ARFID can develop in a few different ways. Sometimes, individuals with ARFID eat a limited diet because they do not like the way certain foods taste or feel or smell (as described above). Other times, ARFID can develop after a scary experience, like choking. For example, if a child recently ate a carrot and choked, they could then become more nervous about eating food in general, or maybe they start avoiding foods with similar textures to carrots to avoid choking again.

Similarly, some people develop ARFID because they are afraid of becoming sick. For example, if a child recently ate a hamburger and threw up afterward, they might become anxious that the next time they eat a hamburger (or other meat), they will get sick again. 

And in other cases, ARFID can be diagnosed because someone has a disinterest in eating food. Again, it is not that this person is not eating because they want to lose weight or look a certain way, but rather, that they are genuinely uninterested in food and eating.

What is the difference between ARFID and picky eating?

Some of the symptoms above may sound similar to the characteristics of a person who is a picky eater. So, what is the difference between ARFID and picky eating? Generally, picky eaters only avoid a few foods, and the avoidance does not get in the way of their day-to-day lives. So, for example, someone may not like eating hamburgers, but when they go to a birthday party, they are still able to find something else to eat at a party, like a hot dog or piece of pizza. For someone with ARFID, however, their restrictions may limit their food choices so much that even at the same birthday party, they are unable to find anything to eat.

Who does ARFID affect?

Because ARFID is a relatively new diagnosis, there is limited research on how common ARFID is. Overall, studies have found that ARFID affects between 0.5% to 5% of children and adults in the general population. ARFID develops most commonly during early childhood and can last through adulthood, though it can also develop at any age. Research has also found several risk factors for the development of ARFID including very severe forms of picky eating and co-existing conditions including autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), anxiety disorders and depression.

How to get help for ARFID

Given that ARFID is a mental health condition that can lead to medical complications, it is important to seek out care from both a physician and a mental health provider, such as psychologist or therapist. If you suspect your child has ARFID and has lost weight, you could start seeking out help from your child’s pediatrician.

If your pediatrician suspects that your child could have symptoms of ARFID or malnutrition, they may recommend and send a referral to a doctor who specializes in eating disorders. These doctors are experts in treating eating disorders and can make tailored recommendations by working with a team of dieticians, social workers and mental health providers. CHOC’s bulimia and anorexia nervosa clinic accepts referrals and treats all types of eating disorders, including ARFID.

How is ARFID diagnosed?

To receive an ARFID diagnosis, a person’s current eating habits must lead to significant nutritional or health problems like weight loss, failure to grow, nutritional deficiency, dependence on supplements, or psychological difficulties. Most pediatricians can evaluate your child for general symptoms of malnutrition, by checking your child’s vital signs (such as changes in their heartrate or blood pressure), weight and other physical symptoms (e.g., dizziness, fainting, dry skin, thinning of hair on head).

How is ARFID treated?

There are several forms of treatment for ARFID that are effective for treating and reaching recovery. The leading treatment for eating disorders is called family-based therapy, which is a treatment that empowers caregivers and family members to help a person with ARFID establish healthy eating habits and reduce symptoms of the disorder.

Sometimes, though, an individual’s diet can be so limiting that they begin to lose a significant amount of weight and become medically unstable, meaning that their heart is placed under too much stress. Often times, in this case, they may be admitted to the hospital for medical monitoring and to help with weight restoration.

Eating disorders are very serious mental health conditions that respond well to both medical and mental health interventions. The earlier you can seek out support and intervene, the more likely you are to have successful outcomes.

Resources about ARFID and eating disorders

Podcast: Warning Signs of Eating Disorders

National Eating Disorder Association (NEDA)

National Association of Anorexia Nervosa and Associated Disorders (ANAD)