Avoidant Restrictive Food Intake Disorder (ARFID)

Some children and adults, despite not being worried about their physical appearance or weight, eat extremely little. They're selective and picky. Unsurprisingly, it has a detrimental effect on their physical health. We're going to explore this disorder.
Avoidant Restrictive Food Intake Disorder (ARFID)
Valeria Sabater

Written and verified by the psychologist Valeria Sabater.

Last update: 07 June, 2023

Do you have a child who eats very little or only eats a specific type of food? Avoidant restrictive food intake disorder (ARFID) is a recently diagnosed clinical condition. To date, we don’t know everything there is to know about the disorder. It describes extremely selective children and adults who, due to their way of eating, don’t meet all their nutritional needs.

These are behaviors that can turn families upside down. Moreover, they put the sufferer’s health at risk. From a psychological point of view, it’s also quite a challenge. These patients restrict their eating due to factors such as aversion to the appearance of the food due to its taste, color, or texture. They might also be afraid of choking.

Indeed, this disorder is a complex and delicate reality and deserves to be analyzed. It’s a new category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

ARFID is only diagnosed if there are serious physical consequences in the patient’s health.

Avoidant restrictive food intake disorder

Avoidant restrictive food intake disorder was formerly known as selective eating disorder. In the updated version of the DSM-V, this condition, which appears to a greater extent among the child and adolescent population, was described in more detail. This is highlighted in research published in the Journal of Eating Disorders.

In a sample of 173 children aged between seven and 17, 22.5 percent of the patients met the ARFID criteria. This is a clinical condition that’s far from being an ordinary eating problem. In fact, sufferers aren’t obsessed with physical appearance or losing weight. Nor do they suffer from body dysmorphia.

Instead, sufferers of this condition restrict their intake for arbitrary reasons, to the point that they don’t meet their nutritional and energy needs. A study conducted by the Johns Hopkins School of Medicine (USA)  claims that there’s not adequate awareness or knowledge of ARFID on the part of healthcare providers.

This puts a part of the population at risk. Therefore, the condition needs to be made far more visible.

The symptoms of ARFID

It’s possible that many parents are worried right now about their child who’s eating very little or is really picky. In reality, sometimes, we often know when an eating behavior changes from fussiness to a problem. This explains why it was decided in 2013 to specify and accurately describe the condition in the DSM-V.

The following list reveals the pattern of behaviors that build avoidant restrictive food intake disorder.

  • Anemia.
  • Gastric reflux.
  • Weakened immune system.
  • Cramps, dizziness, and fainting.
  • Being cold most of the time.
  • Upset stomach.
  • Intestinal disturbances such as constipation.
  • Dry skin, muscle weakness, hair loss.
  • Eating dislikes due to the fear of choking.
  • Striking weight loss due to poor nutrition.
  • Rejection of many foods because of their texture, color, or flavor.
  • Cessation of menstruation in teenage girls and adult women.
  • Psychosocial deterioration and a great risk to the life of the individual.
  • Lower-than-expected growth percentiles in children.
  • Anxiety disorders.
  • Food selectivity that worsens over time.
  • In adults, pronounced thinness of which they’re unaware.
  • Consumption of only a small number of foods.
  • Patients often end up being tube fed.

ARFID is frequently associated with anxiety disorders.

Types of sufferers

Most of the research on ARFID focuses on the child and adolescent population. We know that it’s more frequent in children, but it can also appear in the adult population. Research conducted by the University of Pennsylvania (USA) states that adults with ‘picky’ eating patterns are more likely to develop this condition.

Furthermore, it’s also common that individuals on the autism spectrum (ASD) are more likely to develop ARFID.

Diagnosis of ARFID

For a correct diagnosis of ARFID, a multidisciplinary intervention is required. Medical professionals and psychologists specialized in eating behavior are needed. Next, we’re going to explore each relevant area.

Medical diagnostic

It’s important to note that ARFID can only be diagnosed if the behavior has serious physical consequences. Doctors assess whether nutritional deficiency or having to resort to supplemental or enteral feeding is due to a psychological problem.

Psychological diagnosis

Research published in Pediatrics in Review alludes to the importance of the DSM-V in guiding diagnostic criteria. The criteria are as follows:

  • The patient’s medical history is required.
  • A clear disinterest in food must appear.
  • Fear of choking or secondary physiological effects must be present.
  • The behavior isn’t associated with other eating disorders such as anorexia.
  • Food restriction isn’t due to cultural reasons or a lack of food.
  • There must be avoidance or selection of food based on smell, taste, texture, etc.

You might be interested to read Myths About Eating Disorders


It’s common for sufferers of ARFID to see many different specialists, such as those in the field of nutrition, gastroenterology, or psychiatry, and receive ineffective treatments and misdiagnoses. This is because addressing an eating behavior problem always requires a multidimensional approach by units specialized in eating disorders.

The causes

Avoidant restrictive food intake disorder usually presents striking comorbidity with other clinical conditions. It often appears alongside the following disorders:

  • Learning disorders.
  • Autism spectrum disorder (ASD).
  • Obsessive Compulsive Disorder (OCD).
  • Attention deficit hyperactivity disorder (ADHD).
  • Anxiety problems.
  • Pervasive developmental disorder. (This is suggested in the earlier mentioned research in the Journal of Eating Disorders)

At present, experimental programs are conducted to ascertain which therapeutic approach is the most appropriate for sufferers of avoidant restrictive food intake disorder.

Therapeutic approaches

Therapeutic approaches are always personalized for each patient, starting from their diagnosis. Units specialized in eating disorders employ the strategies listed below:

  • Regular medical care.
  • Psychosocial intervention to improve eating habits.
  • Approach with psychotropic drugs according to the needs of the patient.
  • Treatment of the physical complications derived from a deficient diet.
  • Cognitive-behavioral therapy with the involvement of the patient’s family. This is confirmed in a pilot study conducted by the Massachusetts General Hospital (USA). To date, its effectiveness is unknown, but this therapy is successful in the treatment of most eating disorders.

Progress is well underway for addressing ARFID

Finally, as we mentioned earlier, we still don’t know everything about this type of eating disorder. Undoubtedly, as more scientific literature becomes available, we’ll be able to better understand its etiology and the most suitable therapies for its treatment.

For now, progress is positive. However, a general awareness of this mental health issue is the most important issue.

    All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.

    • Brigham, K. S., Manzo, L. D., Eddy, K. T., & Thomas, J. J. (2018). Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents. Current pediatrics reports6(2), 107–113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534269/
    • Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. The Journal of adolescent health: official publication of the Society for Adolescent Medicine55(1), 49–52. https://pubmed.ncbi.nlm.nih.gov/24506978/
    • Kauer, J., Pelchat, M. L., Rozin, P., & Zickgraf, H. F. (2015). Adult picky eating. Phenomenology, taste sensitivity, and psychological correlates. Appetite90, 219–228. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477986/
    • Nicely, T. A., Lane-Loney, S., Masciulli, E., Hollenbeak, C. S., & Ornstein, R. M. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. Journal of Eating Disorders2(1), 21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145233/
    • Seetharaman, S. y Fields, EL (2020). Trastorno por evitación/restricción de la ingesta de alimentos. Pediatrics in review41 (12), 613–622. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185640/
    • Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current psychiatry reports19(8), 54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281436/
    • Thomas, J. J., Wons, O. B., & Eddy, K. T. (2018). Cognitive-behavioral treatment of avoidant/restrictive food intake disorder. Current opinion in psychiatry31(6), 425–430. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235623/

    This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.