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Understanding Avoidant/Restrictive Food Intake Disorder (ARFID)

With avoidant/restrictive food intake disorder, or ARFID, recently added to the DSM, care teams are better able to take a targeted treatment approach. Through the new definitions, they can bolster their understanding of how this condition differs from anorexia nervosa and other eating disorders. Then, they can provide their patients with the ideal level of care and assist in resolving the barriers to recovery.  

Similarly, loved ones can greatly benefit from learning all about ARFID and its differences from other eating disorders. Their understanding will help patients move through the treatment process with purpose and hope. They can continue to use that knowledge to assist with the transition back home and beyond.

To get started, all they have to do is browse through this guide. By the end, they will better understand this disorder and what the eating disorder recovery process might entail.

What is ARFID?

People with avoidant/restrictive food intake disorder, also known as selective eating disorder, are not able to eat enough to meet their body’s energy and nutritional needs. Unlike anorexia nervosa, this inability does not link back to a fear of gaining weight or dissatisfaction about body image.

Instead, ARFID often links back to anxiety disorders or other conditions that make it difficult to eat certain things or in adequate amounts. In some people, this condition stems from severe picky eating in childhood that does not resolve with time.

Affected individuals may shy away from certain foods or stop eating early due to the food’s color, smell, texture, or flavors. They may also have a fear of choking on the food or vomiting it back up, keeping them from enjoying their meals.

As selective eating continues, the lack of calories causes a delay in growth and weight loss. Children with this condition may not grow as tall as expected and may not be able to keep weight on. Teens and adults tend to lose weight as a result of food restrictions. Across all ages, vitamin and mineral deficiencies are common, especially when ARFID results in eating only a few different types of food in minimal quantities.

Risk Factors

Although treatment experts do not know exactly what causes ARFID, some risk factors increase the likelihood of it developing. Genetics, for example, can play a role since eating disorders tend to run in families. Environmental and social factors can then trigger the development of this eating disorder.

Individuals with a sensitive disposition, for example, might be triggered into refusing to eat by food with an unpleasant texture. If they grow anxious about eating that food or encountering that texture again, their difficulties may increase. Traumatic experiences, such as choking or vomiting, can also contribute to fears about eating that food again.  

People with anxiety or obsessive-compulsive disorder are at an increased risk of developing ARFID for similar reasons. Feeling anxious about having to eat a problematic food item can leave them pushing their plates away more often than not. As the eating disturbances take hold, their mental and physical health often begins to decline, leading to even more problems eating.

Social issues surrounding the health and cleanliness of food can contribute to ARFID development as well. Individuals who are worried about contaminants during food processing, for example, might have trouble eating enough each day as their meals are disrupted by intrusive thoughts.

Since many underlying problems tend to cause this disorder to develop, it is important to receive help in sorting it all out. Eating disorder specialists can assist in determining what is causing the disordered eating patterns and assist in compassionately resolving them.

Signs and Symptoms

By looking for the signs and symptoms of ARFID, loved ones can help tell if difficulties eating require help from a professional. Behavioral signs are often discovered well before any physical symptoms appear. Mental symptoms arise as well, but they can be harder to spot, especially in the beginning stages.


The first behavioral sign of ARFID is a refusal to eat foods that were previously enjoyed. The outright refusal may appear as picky eating at first, causing minimal alarm amongst family members. The avoidance of the food tends to escalate, however, extending to foods with a similar appearance, taste, or texture.

Instead of refusing to eat the food outright, some individuals just claim to not feel hungry. If they work with a doctor to try to figure out the cause of their low appetite, they tend to come up empty-handed. Alternatively, individuals may eat extremely slowly and often fail to finish their entire meal. For this reason, they may have trouble eating in a certain amount of time, such as during lunch periods.

As these issues occur, many people stop trying to eat out with family and friends. They may turn down lunch invitations or find a spot somewhere quiet to eat on their own. The social isolation tends to worsen the issue as time goes on and negatively impacts their relationships.


In kids, ARFID causes them to stop growing properly, leaving them behind their peers in both height and weight. Instead of climbing upward as they should, the lines on their growth charts may flatten out or even take a downturn. Beyond these charts, children stop growing out of their clothing and shoes, clearly showing their lack of growth.

In teens and adults, the signs are a bit more subtle, as they mostly revolve around weight loss. Depending on their overall caloric intake, they may lose several pounds a month or more. With the weight, they also lose inches, going down in clothing sizes over time. As this occurs, individuals may start to wear layers of clothing to cover up the weight loss. The extra layers also help with the cold intolerance that arises due to malnutrition.

Other physical signs of ARFID across all ages include:

  • Brittle nails
  • Dry skin
  • Thinning hair
  • Swollen feet

With dramatic weight loss, it is also common for people to develop a fine layer of hair all over their body, called lanugo. The hair develops as a way for the body to keep itself warm as fat stores are depleted.


Avoidant/restrictive food intake disorder has the potential to cause serious mental health issues as the fears about eating increase. Anxiety about certain foods tends to arise first, only revolving around certain flavors, textures, and appearance in the beginning. They may also focus on the temperature of the food, refusing to eat things that are outside of the desirable range.

Many people also develop a fear of choking on the food if they force themselves to eat it. Pressure to eat undesirable foods can worsen this fear and cause additional distress. Some may even feel concerned about vomiting up the food, especially if they gag upon trying to eat it or even at the thought of doing so.

Unlike many other eating disorders, like anorexia nervosa, ARFID does not revolve around the fear of gaining weight. Instead, the food is at the crux of the issue, making it even more challenging to resolve.  

For that reason, eating disorder recovery must revolve around relieving food anxieties and the underlying thoughts causing the discomfort. Without working toward recovery, people with this disorder can experience several health complications as weight decreases and malnutrition sets in.

Health Complications

Without eating enough food each day, people with ARFID are not getting their nutritional needs met. As a result of the malnutrition, health problems set in rather quickly. These health problems grow worse as their body tries to operate without the right balance of vitamins and minerals. Weight loss compounds the issue, as their system does not even have fat stores to rely on during this time of need.

Health problems that occur as a result of the malnutrition include:

  • Slow heart rate
  • Improper hormone levels
  • Low blood pressure
  • Dizziness
  • Fainting
  • Trouble sleeping
  • Weak muscles

Also, their immune system cannot fight against germs, leaving them at risk of developing infections and other issues. Their wounds are slow to heal as a result, increasing the risk of infection even more.

Without receiving the right amount of food and nutrients, the digestive system also fails to work properly. Constipation is common as the system does not receive enough food to process and create waste. As this occurs, people may start to have stomach cramps that leave them curled up in a ball. Gastric juices in the stomach start to wreak havoc as well, causing acid reflux and even resulting in ulcers.

Lab results can show the effects of ARFID, though not usually until later stages. In the beginning, the body tends to compensate for the change in food intake, leaving little sign of a problem in the lab results. Even without clear indicators, electrolyte imbalances can damage the heart and other organs, resulting in lasting health complications or even death.

ARFID Treatment Options

Beyond being potentially life-threatening, ARFID can decrease the quality of life, making it difficult to cope through each day. Thankfully, treatment (Virtual ARFID IOP Program | Walden (waldeneatingdisorders.com) can help people move toward eating disorder recovery and avoid relapse. Treatment teams focus on resolving the underlying causes of selective eating disorder to restore normal eating habits.

Before treatment can start, however, eating disorder specialists have to make an accurate diagnosis. Through a look at the symptoms and concerns, they can tell if it is ARFID and not anorexia nervosa or another eating disorder. The main difference is the reason for restricting eating. Anorexia nervosa arises due to worries about body size and weight, while ARFID revolves around anxiety about the appearance, texture, or flavor of food.

Since restrictive eating disorder does not resolve on its own, treatment is necessary to make a full recovery. The severity of the condition will influence what type of treatment is best. People can either go into a residential treatment facility or day treatment. If health complications are particularly severe, hospitalization may be needed to restore the balance of nutrients before treatment begins.

Individual and Group Therapy

Once people start working toward eating disorder recovery in day or residential treatment, the care process will revolve around several therapy models, including:

  • Cognitive-behavioral therapy
  • Dialectical behavior therapy
  • Art therapy
  • Interpersonal therapy

While using therapy to process feelings and learn how to cope, individuals will learn how to become more mindful about their inner workings. The mindfulness practice will give them a chance to assess how they are feeling in the moment and see why that is. Then, they can use that information to resolve their fears and work through barriers to recovery.

Mindfulness is often paired with meditation to help open up the mind and connect with the body. The meditation sessions also help bring peace to anxious individuals as they work on becoming fully recovered from a selective eating disorder.

Nutritional Programming

Another important facet of eating disorder recovery is nutritional programming. The care team helps everyone challenge their long standing beliefs about food to get through the anxiety. They understand that this process can take a long time and provide compassionate support every step of the way.

With that support, people can focus on slowly unwinding their fears through every meal and afterward during the therapy sessions. As they do so, they move through the level system, slowly gaining more control over their food choices and portions. At the higher levels, they may take on planning meals, going shopping, and even cooking.

A variety of eating settings also helps resolve fears and restore the relationship with food. In addition to eating meals as a group and during family events, they may go on outings. These outings help everyone learn how to enjoy their meals once again while regaining control of their lives.

As individuals level out of treatment, they will receive help transitioning back home. The eating disorder recovery center will continue to remain a source of support as they return home and move forward in their lives. They can reach out anytime for assistance from their care team, helping them avoid relapse and remain recovered for life.

When signs and symptoms of ARFID arise, it is easy to get help from an effective eating disorder treatment center by calling 888-228-1253. The admission specialists are there to help everyone take the first steps toward becoming recovered from selective eating disorders and similar conditions.


Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.