This article takes a deep dive into ARFID – avoidant/restrictive food intake disorder. You’ll learn about the signs of ARFID, how to diagnose ARFID, how to get help for ARFID, and how ARFID is different from extreme picky eating.
ARFID, or avoidant/restrictive food intake disorder, is technically an eating disorder. It is characterized by persistent failure to meet appropriate nutritional needs.
This article answers the following questions about ARFID:
- What is ARFID?
- What are signs of ARFID?
- What causes ARFID?
- How is ARFID different from picky eating?
- What age is ARFID most commonly diagnosed?
- How is ARFID diagnosed?
- What are the health risks of ARFID?
- What kind of help is available for children with ARFID?
- How can I help my child with ARFID or similar feeding challenges?
What is ARFID?
ARFID was previously known as “selective eating disorder.” It is a diagnosis that involves limitations to the amount and/or type of food that one consumes without medical necessity. ARFID is often associated with anxiety.
While ARFID is usually associated with growth delays and nutritional deficiencies (1), weight loss and distress about body image are not the goal of intake restriction.
What are the signs of ARFID?
Signs of ARFID can include:
- Lack of interest in food
- Limiting food intake
- Fear-based food restriction
- Severely limited diet
- Inflexible eating behaviors and/or preferences
What Causes ARFID?
While there is no specific cause of ARFID, research suggests ARFID can be linked to particular genetic, sociocultural, and psychological factors.
ARFID is often associated with (1, 5):
- Obsessive-compulsive disorder
- A traumatic food-related experience, such as choking, vomiting or anaphylaxis
- Early pain or discomfort with eating potentially related to medical conditions such as reflux or food allergies
How is ARFID different from extreme picky eating?
Picky eating can be a normal phase of child development. Picky eating can run on a spectrum of “typical” cases to more extreme or severe picking eating.
While ARFID and more extreme cases of picky eating can share some characteristics, ARFID is very different from typical picky eating in several significant ways.
Picky eating and ARFID are different in the following ways (7):
- Nutritional needs – Most typical and extreme picky eaters do not usually fail to meet their nutritional and/or energy needs, whereas those with ARFID are more likely to experience undernourishment or weight loss.
- Duration of struggles – Over half of “typical” picky eaters overcome their eating challenges after 2 years (8) and most children who experience picky eating become more willing to try new foods as they grow up (6). Extreme picky eaters may not naturally outgrow their eating struggles. Those with ARFID do not outgrow their eating challenges, which can actually get worse over time without the right support.
- Weight status – Picky eaters usually maintain weight even if they are eating a limited diet. Children with ARFID, however, often do experience weight loss as a result of their restrictive eating. Weight, however, is not a reliable marker for either condition as some picky eaters and children with ARFID may be of healthy weight or overweight.
- Social situations – Picky eaters can usually comfortably navigate social situations that involve food, while children with ARFID may experience anxiety prior to and during social events involving food. Extreme picky eaters can also struggle in social situations that involve food.
- Food preferences – Picky eaters of all varieties can have particular food preferences, enjoying some foods more than others. Most typical picky eaters will eat from all food groups. This is less common for extreme picky eaters.
Children with ARFID can be generally uninterested in eating. This might look like not reporting hunger or not thinking much about food and eating (5).
What age is ARFID most commonly diagnosed?
ARFID is most often diagnosed in children and young adolescents. The prevalence of the condition is still being studied, but it is currently estimated to affect as many as 5% of children (6).
Adults and older adolescents can also be diagnosed with ARFID (9).
How is ARFID diagnosed? What are the criteria for ARFID to be diagnosed?
ARFID can be diagnosed by a mental health professional (3).
A health professional will specifically look for:
- Weight loss or failure to achieve expected weight gain
- Nutritional deficiency
- Dependence on supplemental nutrition
- Interference with psychosocial functioning
There are a several factors that rule out an ARFID diagnosis:
- A coexisting medical condition (4)
- A lack of available food (3)
- An established diagnosis of anorexia nervosa or bulimia nervosa (3)
These questions can help distinguish ARFID from other eating challenges:
- What is the range and variety of current food intake?
- How is the quantity of current food intake?
- How long has the avoidance of certain foods or the restriction in intake been occurring?
- Has there been a recent drop in weight and growth percentiles?
- Are there signs and symptoms of nutritional deficiency or malnutrition?
- Is intake supplemented to ensure adequacy?
- Is food or eating causing any distress or interference with day to day functioning?
Note that if your child does not meet these specific diagnostic criteria, it does not mean they are not facing a valid struggle or that you cannot get help.
Health risks of ARFID
There are a number of potential health risks associated with ARFID. These can include:
- Weight loss or underweight
- Nutritional deficiencies
- Failure to thrive
- Stunted growth
More serious complications related to inadequate nutrition can occur. These include:
- Cardiac complications
- Kidney failure
- Liver failure
- Constipation and other gastrointestinal issues
- Low blood sugar
- Electrolyte imbalance
It is possible to avoid these complications with treatment.
How can I help my child with ARFID or similar feeding challenges?
If you suspect your child has ARFID, if they have received an ARFID diagnosis, or if your child is struggling with extreme picky eating challenges that sound similar to ARFID, you can seek the support of a professional.
Professionals who work with children with ARFID can include: a doctor, psychologist, registered dietitian, occupational therapist, or speech therapist.
There are also actions you can begin taking immediately at home to support your child with their feeding challenges or ARFID diagnosis:
- Avoid pressuring your child to eat foods they are not yet comfortable with
- Do your best to make mealtimes and eating comfortable for your child
- Expose your child to new foods
I work with parents to help their children with eating challenges learn to comfortably and confidently try new foods and add variety. You can book a call with me here.
What kind of help is available for children with ARFID?
Since there are various causes and potential risks of ARFID, individualized treatment is important. The right treatment will meet your child’s medical, nutritional, mental health and feeding-specific needs while reducing stress and mealtime anxiety (3).
ARFID treatment options can include (10):
- Behavioral therapy
- Desensitization therapy, such as food play
- Exposure therapy
- Parent coaching
- Nutritional support
ARFID is a diagnosis involving limitations to the amount and/or type of food that one consumes without a medical cause. ARFID is sometimes considered to be “extreme picky eating.” While extreme picky eating and similar eating challenges may have some overlap with ARFID traits, ARFID has specific diagnostic criteria.
Regardless of a diagnosis, it is possible to help your child comfortably try new foods and eat more variety.
I am a registered dietitian and extreme picky eating expert who uses a child-led approach to help parents create positive mealtimes and find solutions that allow their child to become more flexible and empowered in their food choices.
- How Food Allergies Can Trigger a Serious Picky Eating Disorder. https://www.allergicliving.com/2021/09/17/how-food-allergies-can-trigger-a-serious-picky-eating-disorder/. Accessed October 22, 2021.
- Sharp WG, Stubbs KH. Avoidant/restrictive food intake disorder: A diagnosis at the intersection of feeding and eating disorders necessitating subtype differentiation. Int J Eat Disord. 2019;52(4):398-401. doi:10.1002/EAT.22987
- Katzman DK, Norris ML, Zucker N. Avoidant Restrictive Food Intake Disorder. Psychiatr Clin North Am. 2019;42(1):45-57. doi:10.1016/J.PSC.2018.10.003
- Diagnostic and Statistical Manual of Mental Disorders (DSM–5). 5th edition. Washington DC: American Psychiatric Association; 2013.
- Avoidant Restrictive Food Intake Disorder (ARFID) | National Eating Disorders Association. https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid. Accessed October 22, 2021.
- Norris ML, Spettigue WJ, Katzman DK. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. 2016. doi:10.2147/NDT.S82538
- Strum J. ARFID vs. Picky Eating. The Recovery Village. https://www.therecoveryvillage.com/mental-health/avoidant-restrictive-food-intake-disorder/related/arfid-vs-picky-eating/. Published 2020. Accessed October 25, 2021.
- Mascola AJ, Bryson SW, Agras WS. Picky eating during childhood: A longitudinal study to age 11-years. Eat Behav. 2010;11(4):253. doi:10.1016/J.EATBEH.2010.05.006
- Lesser J. More than picky eating—7 things to know about ARFID. National Eating Disorders Association. https://www.nationaleatingdisorders.org/blog/more-picky-eating—7-things-know-about-arfid. Accessed October 27, 2021.
- TREATING | ARFID Awareness UK. https://www.arfidawarenessuk.org/treatment. Accessed November 3, 2021.