Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID is characterised by food avoidance or restriction due to low appetite/food apathy, sensory sensitivity or fear of undesired consequences such as choking.
People with ARFID usually do not have weight and body image concerns that are often associated with other eating disorders like Anorexia Nervosa, but it is also possible for people to have several eating disorder diagnoses and, therefore, complex, differing symptoms and concerns.
Given that ARFID was only listed as a diagnosable eating disorder in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) in 2013, there is a lack of awareness and understanding about this illness.
ARFID is more than just ‘picky eating’ – it is a serious eating disorder with potentially damaging health consequences, such as a lack of growth, weight loss, malnutrition and psychosocial impairment. ARFID can also impact anyone of any age.
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Limited accepted foods. Accepted foods often share similar sensory properties. May be underweight or malnourished as a result.
• Limited variety in accepted foods. One or more food groups are often missing from diet. Nutritional deficiency(s) as a result.
• Sensory sensitivities identified with some foods. Avoidance/distress of foods associated with similar feared sensory properties.
• Avoidance of food following a negative feeding experience. Fear of vomiting. Fear of choking. Fear of gagging.
• Unwilling or refusing or distress with trying new foods.
• Extreme fear or disgust of the smell, sight, taste, texture of some foods.
• Lack of appetite and difficulty identifying hunger and satiety cues.
• Periods of only eating one food or food group for extended periods of time, followed by refusal to eat the food again.
• Avoidance/ distress of social activities involving food and eating.
• History of medical conditions impacting feeding experience, appetite, growth and enjoyment of food/eating.
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At present, there is no one standardised evidence-based treatment for ARFID.
Emerging ARFID treatment research indicates preliminary findings for a positive outcome for applying CBT-AR and FBT- Unified Protocols or modified FBT.
Treatment components of these emerging treatments include;
• parental supervision to ensure weight
restoration utilising preferred high-calorie foods;
• correction of nutritional deficiencies;
• reducing mealtime stress and anxiety;
• anxiety management and techniques aimed at gradually expanding the variety and range of accepted food.
Treatment should target the factors that maintain
ARFID and a treating team, including a
A combination of medical, dietetics, speech pathology, and psychology/social work may help address and manage both the physical health and psychosocial aspects of the condition.
ARFID can co-occur with other health conditions and mental ill health
All four people with lived experience shared that their experiences with ARFID coincided with other co-occurring conditions.
They discussed how ARFID often co-existed with other eating disorder diagnoses and three people shared that they had received a co-occurring diagnosis of Anorexia Nervosa.
One person shared that living with ARFID led to Binge Eating behaviours, and others described how ARFID co-occurred with anxiety, depression, trauma, and neurodivergence, such as autism and ADHD.
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