Avoidant/Restrictive Food Intake Disorder (ARFID)

Instead, the disorder is characterized by a restricted range or amount of food intake driven by sensory sensitivities, fear of negative consequences like choking, or little to no interest in eating. ARFID often leads to nutritional, medical, or social challenges, alongside significant distress. ^[2]

Key Takeaways

• ARFID is an eating disorder characterized by avoiding or limiting certain foods to the point of inadequate nutritional intake. This restriction is not driven by concerns about body weight or image, but rather by sensory sensitivities, fear of negative physical reactions (such as vomiting), or little to no appetite and a lack of interest in eating.
• Individuals with ARFID may experience significant weight loss (although not in all cases), nutritional deficiencies, and, in severe progressions, may become dependent on tube feeding temporarily. The disorder also causes extreme emotional turmoil surrounding eating, and impaired social functioning related to food and mealtimes.
• Treatment for ARFID is still being investigated, but recent research suggests a multidisciplinary approach, including nutritional rehabilitation and psychotherapy. While recovery can be a lengthy process, early intervention and a comprehensive treatment plan can improve nutritional intake and overall well-being.

Understanding Avoidant Restrictive Food Intake Disorder (ARFID)

Avoidant restrictive food intake disorder (ARFID) is a relatively new diagnosis, previously referred to as "selective eating disorder." In 2013, this was revised and ARFID was classified in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) as a broader and more defined set of criteria. ^[1]

This revision sparked the beginning of a growing area of research, with the refinement of more accurate diagnostic criteria for the disorder. However, while research into ARFID is still in the early stages, the condition is classified as an eating disorder marked by a consistently inadequate intake of nutrition and calories. ^{[1] [3]}

The DSM-5 classifies three different subtypes of the disorder as follows: ^{[1] [3]}

• Lack of interest in food or eating
• Limited food intake based on sensory characteristics
• Concern about negative physical reactions related to eating

Although the disorder is not driven by a desire to lose weight, it is often mistaken for “picky eating” or defiant behavior in children or adolescents. In reality, individuals with ARFID find it incredibly difficult to eat certain foods and may feel distressed when attempting to do so, typically requiring extra support and encouragement to try new or avoided foods. ^{[1] [4]}

It is important to note that avoidant restrictive food intake disorder can be diagnosed at any stage of life and affect individuals of any weight or size. Despite this, it is considered an eating disorder as the associated food-related behavior strays from social norms, leading to distress, difficulty functioning, nutritional deficiencies, and disruption in daily life. ^{[1] [2] [4]}

How Common Is It?

Estimates of how common avoidant restrictive food intake disorder is vary widely depending on how studies were conducted and which population groups were included. However, a 2024 meta-analysis and another recent large-scale review show that the disorder is just as prevalent (if not more prevalent) as other well-known eating disorders. ^[5]

The review found that ARFID affects between 0.3% and 15.5% of children and 0.3% to 4.1% of adults. Overall, the meta-analysis (which investigated 122,861 participants) found that the total prevalence of ARFID was just over 11%. However, when the analysis focused on studies of a higher quality, the estimated prevalence was lower, at 4.5%. ^{[5] [6]}

Even with this more conservative estimate, the findings show that ARFID is still a common eating disorder. Additionally (despite widespread myths), avoidant restrictive food intake disorder can affect people of any age or gender, and often occurs alongside other medical or mental health issues. ^{[5] [6]}

Who Does It Affect?

Avoidant restrictive food intake disorder is a relatively new diagnosis, and research into who it affects is still emerging. While the exact cause of the disorder remains unclear, several risk factors have been linked to its onset. Current research points toward the fact that while the disorder can affect anyone, certain groups are more likely to experience it: ^{[1] [4]}

• Children and young people between the ages of 4 and 14: This age group often shows early signs of food avoidance or restriction.

• Individuals with other psychiatric conditions, such as anxiety or ADHD: These conditions can heighten sensitivities to food, or fears of negative reactions to eating.

• People who do not have body image concerns or a desire to lose weight: Unlike other eating disorders, ARFID is not driven by a desire to change one’s appearance.

• Those who exhibit fewer compensatory behaviors than other eating disorders: Behaviors like purging or excessive exercise are not common in people with ARFID.

• Autistic individuals are more likely to be affected by ARFID: People with autism often have sensory sensitivities, but not all people with autism have ARFID.

• People with medical conditions: Digestive issues, nerve-related disorders, or experiences like vomiting or food allergies can lead to fear and avoidance of eating.

• Individuals with heightened anxiety or trauma history: Experiencing distressing events like choking, vomiting, or traumatic life events may manifest as a fear of eating.

• Growing up with restrictive feeding patterns: Caregivers who unintentionally reinforce food avoidance by only offering "safe" foods or not introducing variety may unknowingly contribute to the onset of ARFID.

Symptoms and Signs

People with ARFID can be differentiated by three main motives for avoiding certain foods or eating less overall, which have been classified into subtypes. These factors affect how much a person with the disorder eats or the types of foods they are willing to eat, and are not related to a desire for weight loss. ^[1]

As a result, avoidant restrictive food intake disorder manifests differently in each person with the condition. The three subtypes of ARFID are: ^{[1] [4] [7]}

• Sensory intolerance: Some individuals are highly sensitive to the way food feels, looks, smells, or tastes. In ARFID, this sensitivity goes beyond typical food dislikes and can cause strong emotional reactions and refusal to eat certain foods.

• Lack of interest in food: Some people with ARFID may have a persistently low appetite and do not experience hunger in the same way as healthy individuals. In these cases, eating may seem more like a task rather than a pleasure, making it difficult to maintain nutritional needs.

• Fear of negative consequences from eating: Past experiences (like stomach pain, abnormal bowel movements, difficulty swallowing, choking, or vomiting) can create fear or anxiety around certain foods, leading people with this form of ARFID to stick only to foods they believe are ‘safe’.

Signs of ARFID

Over and above the criteria listed in the DSM-5, there are a number of signs and symptoms to look out for if you are concerned that you or a loved one may be struggling with avoidant restrictive food intake disorder. In all cases of ARFID, individuals tend to limit types of foods or amounts eaten, which can broaden over time and lead to: ^{[4] [7]}

• Weight loss
• Severe nutritional deficiencies requiring supplementation
• May only consume food through a tube
• Physical health problems (such as persistent stomach issues or bowel problems, etc)
• Mild physical symptoms (like fatigue or high energy, cold intolerance, etc)
• Feelings of satiety even without eating (particularly at mealtimes)
• Little to no interest in food, low appetite, and may avoid drinking or eating

Causes

While the DSM-5 outlines common clinical features of ARFID, there is still limited evidence explaining the underlying causes of these patterns. That being said, research has shown that avoidant restrictive food intake disorder is linked to a combination of factors, including physical, psychological, and environmental triggers as well as brain abnormalities. ^[1]

Physical Triggers

Some individuals develop ARFID due to pre-existing medical problems such as digestive issues or nerve-related conditions. In addition to pain, Physical triggers can include beginning a new medication, vomiting after food has been eaten, or concerns about having an allergic reaction to food. ^[1]

Psychological Factors

Some forms of avoidant restrictive food intake disorder are similar to anxiety disorders and may stem from both physical and mental health issues. If a person has had a distressing experience with vomiting or choking (even as a witness), or has had other traumatic experiences (such as losing a loved one or being bullied), it can lead to chronic fear of eating certain foods. ^[1]

Environmental Influences

Family dynamics and early feeding experiences can unintentionally reinforce restrictive eating into adulthood. This includes only offering a child their preferred foods or not introducing food variety. Additionally, the emotional tone around meals (especially from caregivers) can shape a child's comfort levels and willingness to try new foods. ^[1]

Brain Abnormalities

Research suggests that ARFID is linked to abnormalities in how the brain processes sensory information, hunger and fullness cues, as well as emotional responses to food. These differences in brain responses can make eating feel stressful or overwhelming. ^[1]

Additionally, neurodevelopmental conditions such as autism and attention deficit hyperactivity disorder (ADHD) that commonly co-occur in individuals with ARFID can influence eating behaviors (e.g, being highly sensitive to food textures or losing interest in eating). ^[1]

Are Children More Likely to Develop ARFID than Adults?

Before the DSM was revised in 2013, some children had struggles with eating that did not meet the criteria for an official eating disorder diagnosis. As a result, they were often classified under vague categories like “Eating Disorder Unspecified”. However, this was problematic, as many of these individuals showed no preoccupations with weight or body shape. ^[1]

Due to the fairly recent reclassification of the disorder in the DSM-5, comparisons of prevalence between children and adults are limited, and estimates vary widely depending on the study setting and methodology. That said, research indicates that ARFID is more commonly identified in children than other eating disorders, though it can affect individuals of any age. ^{[1] [4]}

This is because food avoidance based on taste, texture, or smell often begins in early childhood and can continue into adulthood. However, “picky eating” in children is typically a temporary part of normal healthy development, but if these patterns persist and begin to affect a child's physical health, social life, or emotional well-being, it may indicate the presence of ARFID. ^{[1] [4]}

Can it be Prevented?

As scientists are not yet clear on the exact causes of ARFID, preventative measures are currently speculative based on potential risk factors. That said, psychoeducation and seeking early intervention for evolving mental health symptoms often result in better treatment outcomes for other psychiatric conditions.

• Early identification of food avoidance: Children between the ages of 4 and 14 often show early signs of food avoidance or restriction, which can be addressed with therapy in order to prevent symptoms from worsening.

• Addressing traumatic experiences: Helping children cope with traumas (including incidents of choking or vomiting) with therapy, reassurance, and a calm home environment may prevent these experiences from evolving into ARFID.

• Positive mealtime environment: Creating a relaxed mealtime atmosphere can encourage children to be more open to new foods. It is beneficial to address any personal frustrations regarding a loved one’s eating habits so as to maintain composure.

• Educate individuals with psychological or medical conditions: People with anxiety, autism, ADHD, or digestive disorders are more likely to develop ARFID and may benefit from nutritional education that inspires a healthy relationship with food.

• Encourage food variety: Offering (and encouraging the consumption of) a wide variety of foods while avoiding the urge to provide only "safe" foods to children may help prevent the development of avoidant restrictive food intake disorder.

Risks and Complications

Avoidant restrictive food intake disorder can have serious effects on a person’s physical and mental well-being and subsequent quality of life. As the condition often involves eating only a narrow range of foods, individuals typically struggle with the following key areas of concern: ^[1]

Nutritional Deficiencies and Malnutrition

Individuals with ARFID are at a higher risk of nutritional deficiencies due to eating a limited variety of foods, which can affect overall health and may lead to a dependence on supplements. In severe cases, this may result in the need to be fed through a tube, or even hospitalization to stabilize an individual’s nutritional status. ^[1]

Significant Weight Loss and Hospitalization

While weight loss can occur in both avoidant restrictive intake disorder and anorexia nervosa, it is often less pronounced in ARFID. However, in comparison to individuals with anorexia, people with ARFID usually require longer hospital stays. Furthermore, those with ARFID are more likely to need tube feeding for nutrition during treatment. ^[1]

Other Medical Complications

In severe cases of ARFID, the body doesn't get enough of the nutrients it needs, which can lead to medical complications. These include tiredness, trouble thinking clearly, feeling faint, persistent constipation, and being very sensitive to the cold. Additional symptoms may include dry skin, absent menstruation, decreased bone strength, hair thinning, and a slow heart rate. ^[1]

Co-Occurring Psychiatric Disorders and Neurodevelopmental Conditions

ARFID commonly coexists with other mental health conditions, including obsessive-compulsive disorder (OCD), anxiety, and trauma-related disorders. Additionally, the disorder commonly occurs alongside neurodevelopmental conditions, including ADHD and autism. This overlap can complicate recovery, requiring longer treatment durations and more intensive interventions. ^[1]

Developmental and Social Impact

ARFID is associated with delayed development in learning abilities, physical growth, and facial movements, including chewing. Additionally, the disorder can have profound psychosocial implications, especially for children and adolescents, by increasing family stress and leading to social challenges where food is involved. ^[1]

Diagnosing ARFID

Avoidant restrictive food intake disorder is diagnosed when a person does not meet their nutritional requirements, social and daily functionality is impaired, and resulting weight loss or deficiencies are not driven by concerns about body size or weight. ^[1]

According to the DSM-5, avoidant restrictive food intake disorder is diagnosed based on a persistent failure to meet nutritional and/or caloric needs, resulting in one or more of the following symptoms: ^[1]

• Significant weight loss (failure to grow adequately or gain weight in children)
• Noticeable nutritional deficiencies
• Dependence on tube feeding or oral nutritional supplements
• Serious disruption in emotional well-being that affects daily or social functioning

To meet diagnostic criteria, the dysfunctional eating cannot be due to: ^[1]

• Limited access to food
• Culturally accepted dietary practices
• Episodes of anorexia or bulimia
• A distorted perception of weight or size
• A different psychiatric disorder
• A medical condition (unless ARFID symptoms are of greater severity than typical for a co-occurring illness)

Avoidant Restrictive Food Intake Disorder Subtypes

Three avoidant restrictive food intake disorder subtypes have been identified and categorized according to the differing motives behind food avoidance. When a person is diagnosed with ARFID, the healthcare practitioner will additionally confirm which subtype they fall into, based on the following criteria outlined in the DSM-5: ^[1]

Low Appetite

• Limited food intake due to low appetite or lack of interest in food
• Difficulty with eating, such as taking small bites or needing a long time to finish meals

Sensory-Based Avoidance

• Avoidance linked to sensory abnormalities (eg. strong dislike of certain tastes, textures, smells, or how specific foods look)
• Extreme food selectivity or fear of trying new foods

Aversive-Based Avoidance

• Avoidance or restriction that develops after a distressing event (including physical reactions, but also a wide range of traumatic experiences)
• Ongoing fear of negative physical sensations such as choking, nausea, or pain

Getting Help for Yourself or a Loved One

Avoidance based on the sensory qualities of food often begins in early childhood and may continue into adulthood. Avoidant restrictive food intake disorder can follow a long-term, persistent pattern that greatly affects not only the individual’s social and emotional well-being but also that of their family. ^[1]

As a result, it is important to seek treatment for the condition, whether as an outpatient or in a hospital setting. In the US, the National Alliance for Eating Disorders is the leading national nonprofit dedicated to offering education, referrals, and support to individuals affected by eating disorders and their loved ones. The organization offers the following services: ^{[1] [8]}

• A free helpline staffed by therapists, offering referrals and support across all levels of care (866-662-1235). The hotline is active from 9:00 am – 7:00 pm EST (M-F)
• An interactive referral platform available via website and app at findEDhelp.com
• Free weekly support groups, led by therapists, offered both virtually and in person for individuals with eating disorders and their loved ones
• Educational presentations and full-day training sessions

Treatment Options

Unfortunately, the limited knowledge surrounding avoidant and restrictive eating has posed challenges with the effective management of ARFID. This is because more research is required in order to determine the best treatment for the disorder. ^{[1] [4]}

That said, recent research (including a 2022 study from The Royal College of Psychiatrists and a large-scale 2024 review) has stated that a combination of medical interventions and behavioral treatments can be used to treat individuals with the disorder. ^{[1] [4]}

Individuals with avoidant restrictive food intake disorder require a multidisciplinary treatment plan involving professionals such as doctors, dietitians, psychiatrists, psychologists, occupational therapists, and paediatricians for children. ^[1]

Depending on the severity of the condition, the care setting can range from outpatient services with a coordinated team to inpatient care for medical and nutritional stabilization in a hospital or eating disorder treatment center. ^[1]

Specific treatments for avoidant restrictive food intake disorder tend to vary from person to person, depending on the underlying subtype and various symptoms. However, treatment and management typically aim to: ^{[1] [4]}

• Stabilize medical health issues and restore nutritional health
• Address psychological stressors (by identifying which foods are being avoided, understanding the reasons, and gradually helping the person try these foods)
• Supporting the return of enjoyment in eating and social engagement around food

Nutritional Interventions

If a person with ARFID has developed physical health issues (such as low weight, poor growth, or malnutrition), these need to be treated before underlying psychological challenges can be addressed. The initial treatment goal for individuals with the disorder is to restore body weight using preferred foods and supplements to boost intake without forcing feared foods. ^{[1] [4]}

Nutrient gaps differ based on which foods a person avoids. Regardless of the specificities, treatment options to improve nutrition and support weight restoration may include: ^{[1] [4]}

• Multivitamins or drops to cover general deficiencies
• Specific mineral supplements (e.g, zinc, iron, etc.)
• In severe cases, tube feeding may be temporarily required

Customized Meal Plan and Food Chaining

A meal plan will be designed by a dietitian or nutritionist (starting with caloric needs, then later adjusting nutritional requirements). Food chaining and exposure therapy are often used to gradually introduce foods with similar sensory characteristics to preferred foods. For example, if an individual likes a certain type of chips, they will begin by eating those, then try a different type of chip, and finally roast potatoes. ^{[1] [4]}

Psychological Treatments

Once a person’s physical health issues have been addressed, psychological treatments for ARFID can begin. These therapies aim to shift eating patterns and should be tailored to the individual's ability to reflect on and adapt their eating habits. ^{[1] [4]}

Although there is limited solid evidence, promising results suggest that cognitive-behavioral therapy (CBT) and family-based therapy (FBT) can effectively reduce ARFID symptoms, alongside exposure therapy or graded exposure. ^{[1] [4]}

CBT adapted for ARFID has shown highly positive outcomes, including weight gain, increased food intake, and reduced anxiety. That said, individuals with the disorder may require a combination of each form of psychotherapy. ^[1]

Cognitive Behavioural Therapy (CBT)

CBT is a talk therapy that helps individuals develop healthier ways of thinking and responding to difficult situations. A specific form of CBT has been developed to treat ARFID, and involves setting personalised goals and gradually expanding the range of foods eaten. With the support of a therapist, individuals with ARFID are guided through exposure to feared or disliked foods. ^[4]

Exposure Therapy (Graded Exposure)

Graded exposure is a technique used in exposure therapy (a form of CBT) to gradually shift how a person with avoidant restrictive food intake disorder responds to certain foods. With this form of therapy, foods are ranked based on how much distress they cause, after which the individual works with a psychologist to create a step-by-step plan for trying these avoided foods. ^[4]

The plan is designed to progress toward small, achievable goals while learning anxiety management strategies (such as deep breathing or meditation). This approach can be especially beneficial for those who fear eating due to past negative food reactions, such as choking or vomiting. ^[4]

Family-Based Therapy (FBT)

Family-based therapy was originally designed to assist individuals with anorexia, but has since been developed specifically for treating ARFID. FBT recognizes the essential role that caregivers and family members can play in supporting a person struggling with ARFID. Family-based therapy techniques may be used alongside other therapies and include: ^[4]

• Providing families with practical skills to support their loved ones
• Guidance on creating consistent routines and structure around mealtimes
• Suggestions regarding adjustments to the home environment that support eating goals
• Teaching strategies to manage eating-related anxiety

Medication

At present, there is limited evidence-based research supporting the use of medication in treating ARFID. However, doctors often prescribe pharmaceuticals that help stimulate appetite, as well as short-term anti-anxiety medications if a person’s fear is significantly impacting food intake. ^{[1] [4]}

Additionally, emerging studies are investigating the use of existing psychotropics (medications that influence mood, thoughts, or behavior) as supplementary treatments for ARFID. Preliminary findings suggest that the following medications show promise: ^[1]

• Olanzapine (atypical antipsychotic): Associated with reduced mental rigidity around food and an increased appetite alongside weight gain
• Mirtazapine (antidepressant): Known for treating depression or anxiety and promoting appetite and weight gain
• Buspirone (anxiolytic): Used in ARFID to reduce anxiety (specifically fear of vomiting), improve eating behavior, and promote weight gain
• Other medications: One hospital study used olanzapine, fluoxetine (an antidepressant), and cyproheptadine (an appetite stimulant) as part of a broader treatment program, with all six patients in the series reaching the target body mass index (BMI).

Accommodations for ARFID and Autism

Autistic individuals perceive and interact with the world in unique ways, which may require adjustments to their avoidant restrictive food intake disorder treatment. These adjustments are known as accommodations, and may include: ^[4]

• Creating a calm eating environment: Ensure the space is free from noise, distractions, and interruptions, with no other people eating nearby
• Allowing flexibility: This could involve eating small meals throughout the day or having foods at unusual times, such as breakfast foods for dinner
• Encouraging the exploration of food: Inspire the autistic person with ARFID to explore how food smells or feels before attempting to eat it, which may aid in adjustment
• Allowing ‘stimming’ during meals: Some individuals may feel more comfortable engaging in behaviors like standing, moving, or using fidget toys or screens while eating.
• Maintaining consistency: Try to avoid unexpected changes, such as allowing eating in front of the TV one day and then insisting on eating at the table the next.
• Recognizing difficulties with hunger cues: Understand that the individual may struggle to identify when they are hungry or satiated.
• Avoiding hiding foods within other foods: Autistic people are often sensitive to small changes and may lose trust if food is concealed in ways they don’t like.

Living with ARFID

People who live with avoidant restrictive food intake disorder face a range of challenges that can affect multiple aspects of their lives. One of the most concerning impacts of untreated ARFID is on physical health, because if the disorder progresses, individuals may become underweight and malnourished, leading to fatigue, weakness, and impaired functionality. ^[4]

As people with ARFID often struggle to consume enough food, there is a risk of developing nutritional deficiencies in vitamins, minerals, and other essential nutrients. Being nutrient deficient can result in serious medical complications, further impacting overall well-being. In children with untreated ARFID, the disorder can prevent healthy growth and development. ^[4]

Additionally, the psychological effects of ARFID are profound, often causing significant distress in the form of anxiety related to eating certain foods or surrounding mealtimes. This distress can have a negative impact in social settings, where eating habits may become a source of conflict and shame, making it hard to connect with others and leading to isolation. ^[4]

Fortunately, there is hope for individuals living with the disorder, and emerging research suggests that treatments including nutritional interventions, therapy, and potentially medication can help people with ARFID overcome their distress and restore a healthier relationship with food. With the right support and care, it is possible to recover both physically and mentally.

Final Thoughts

Avoidant restrictive food intake disorder (ARFID) is characterized by restricted eating driven by sensory issues, fear of negative consequences, or low interest, rather than body image or weight concerns. This pattern of limited consumption often leads to nutritional deficiencies, medical complications, and difficulties in social situations involving meals or food.

Effective treatment for ARFID involves a multidisciplinary approach that addresses both the physical and psychological aspects of the disorder. Nutritional rehabilitation aims to restore health and ensure adequate intake, while cognitive-behavioral therapy (CBT), exposure therapy, and family-based therapy (FBT) work to address underlying causes and expand dietary variety.

While research on medication is ongoing, certain drugs may be used to manage anxiety or stimulate appetite as part of a broader treatment plan. Ultimately, with early intervention and comprehensive care, individuals with ARFID can experience significant improvement in their nutritional status, reduce their anxieties around food, and enhance their overall quality of life.

Author

Star Gorven

Star Gorven is a wellness and mental health writer with a talent for crafting evocative and evidence-based content across a wide range of topics. Her work blends analytical research with imagination and personality, offering thoughtful insights drawn from her exploration of subjects such as psychology, philosophy, spirituality, and holistic wellbeing.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Jennifer Brown

Dr. Jennifer Brown is dual board-certified in family medicine and obesity medicine. She currently works for Amwell Medical Group, providing virtual primary care services, including mental health treatment.

Activity History - Medically reviewed on April 14, 2026 and last checked on March 19, 2026