What is ARFID?

Eating disorders affect both the mind and body, often creating complex challenges for individuals. They can disrupt daily life, impair relationships, and have serious impacts on physical health, such as malnutrition or organ damage, while also contributing to mental health struggles like anxiety and depression. These disorders come in many forms, from more well-known conditions like anorexia and bulimia to lesser-known but equally important ones, such as Avoidant/Restrictive Food Intake Disorder (ARFID).  

This article breaks down what ARFID is, including why it occurs, how to recognise its symptoms, and what treatment options are available. Whether you’re experiencing this condition yourself or supporting someone who is, understanding ARFID is a step toward finding the right help and recovery path.

What is Avoidant/Restrictive Food Intake Disorder?

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder in which a person avoids or restricts certain foods. Unlike other eating disorders, it’s not driven by concerns about body image or the need to lose weight. Instead, people with ARFID may avoid food because of sensory sensitivities (like the texture, smell, or taste), a fear of choking or vomiting, or a general lack of interest in eating.  

Who is Most Affected? 

ARFID affects both children and adults, with 0.35% to 3.2% of children and 0.3% to 3.1% of adults experiencing the condition. Research shows that boys are more likely to have ARFID than girls, especially in children. This differs from other eating disorders like anorexia and bulimia, which affect more females.¹

Children with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) are at a higher risk of experiencing ARFID. It’s also common for people with ARFID to have anxiety, obsessive-compulsive disorder (OCD), or learning disabilities, suggesting the disorder may be linked to broader neurodevelopmental challenges.¹  

Globally, ARFID’s true prevalence is hard to pinpoint due to differences in how it’s diagnosed. However, its wide range of symptoms makes it a complex condition that requires early detection and personalised treatment to manage effectively.  

Signs and Symptoms of ARFID

ARFID can manifest in different ways and affect a person’s physical health, emotional well-being, and social life. Recognising the signs early is essential to getting the right support.  

Physical Symptoms  

• Weight loss or difficulty gaining weight: Especially in children and adolescents, growth may be slower than expected.  
• Nutritional deficiencies or malnourishment: Limited food intake can lead to a lack of essential vitamins and minerals.  
• Stomach problems or gastrointestinal issues: Poor nutrition can cause symptoms like stomach aches, constipation, or acid reflux.  

Psychological and Behavioural Symptoms  

• Avoiding Certain Foods Based on Sensory Factors: People with ARFID may restrict food intake due to specific sensory characteristics, such as texture, colour, or smell, making mealtimes challenging.  
• Fear of Eating Due to Negative Past Experiences: Past traumatic experiences, like choking, gagging, or vomiting, can instil a deep-seated fear of eating, leading to food avoidance.  
• Anxiety Around Food and Mealtimes: For many, eating becomes a source of stress, causing emotional distress during mealtimes and making it difficult to enjoy food.  
• Limiting Food Intake: Some people with ARFID may restrict their food intake to just a few accepted foods, which can have a significant impact on their nutritional health and overall well-being.

Social Symptoms  

• Avoiding events that involve food: This might include skipping birthday parties, family gatherings, or eating out with friends.  
• Increased isolation: Over time, the fear or stress associated with food can lead to withdrawal from social activities and relationships.  

What Causes ARFID?

ARFID is influenced by a combination of psychological, biological, and social factors. 

Psychological Factors  

Many children and adults with this disorder struggle with anxiety, which makes trying new foods feel overwhelming. Negative past experiences - like choking or food poisoning - can create lasting fears about eating, preventing them from exploring new foods. Some individuals also have heightened sensitivities to textures, tastes, smells, or appearances of food, making it hard for them to tolerate certain items. Together, these factors create a complex picture of ARFID and greatly affect eating habits.

Biological Factors  

Genetics and family history play a role in ARFID, as the disorder may run in families, indicating a possible genetic link that makes some individuals more susceptible.¹ ARFID is often seen alongside co-occurring conditions, such as autism spectrum disorder (ASD) and ADHD, which can heighten sensory sensitivities and contribute to the challenges of eating.

Social and Environmental Factors  

Early childhood experiences can impact the development of ARFID, as extreme picky eating habits or food aversions that begin in childhood may evolve into the disorder over time. Cultural attitudes toward food also contribute - norms and expectations within families or communities about what is considered ‘normal’ or ‘acceptable’ can shape eating behaviours. Peer influence is another factor that can make food-related anxiety worse, especially during adolescence, as social pressures or bullying about eating habits may trigger or worsen existing challenges.

ARFID in Children vs. Adults

ARFID looks different depending on a person’s age. Understanding these differences helps ensure that treatment is tailored to the individual’s needs.  

ARFID in Children  

• Development vs. Picky Eating: While picky eating is a normal phase for many children, ARFID takes it to another level. Children with ARFID experience intense fears or aversions to certain foods, which can severely limit their intake and negatively affect their growth and overall health.
• Behavioural Signs: Kids with ARFID may refuse entire food groups, show distress at mealtimes, or completely avoid trying anything new. These behaviours can make mealtimes challenging for everyone involved.
• Impact on Development: If left unaddressed, ARFID can significantly hinder a child's growth, learning, and social life. It can lead to avoiding situations like school lunches or birthday parties, which are prime times for social development.
• Treatment for Children: Treatment typically involves family-based therapy and creating supportive eating environments at home. Engaging kids in fun, interactive ways to explore new foods and involving them in meal preparation can make a big difference. In more severe cases, children may require interventions like tube feeding to ensure they receive the nutrition they need to thrive.

ARFID in Adults  

• Persistence from childhood: For some, ARFID continues into adulthood, especially if the disorder wasn’t addressed earlier.  
• Daily life challenges: Adults with ARFID may struggle with grocery shopping, dining out, or participating in meals with family or friends. This can lead to isolation and strain in relationships.  
• Emotional and physical impact: Persistent ARFID can affect overall well-being, contributing to malnutrition, low energy, and mental health challenges like anxiety and depression.  
• Treatment for adults: They may benefit more from cognitive-behavioural therapy (CBT) to address underlying anxieties and fears about food. Support may also focus on building social confidence and creating meal routines that fit their lifestyle.  

Diagnosis of ARFID

Diagnosing ARFID requires a thorough assessment by both medical and mental health professionals to understand how the disorder impacts physical health, nutrition, and daily life. Since ARFID shares similarities with other conditions, it’s important to rule out medical issues (like gastrointestinal disorders) or psychological disorders (such as anxiety or phobias) that could also affect eating habits. A comprehensive evaluation of ARFID dives into a person's food history, avoidance patterns, sensory sensitivities, and any triggers like trauma or anxiety. 

Impact of ARFID on health and well-being

ARFID symptoms can have a significant impact on both physical and mental health, affecting an individual’s daily life, relationships, and overall well-being. Without proper treatment, the impact can worsen over time, leading to serious health and emotional challenges.  

Physical Health Consequences  

Limited food intake may result in malnutrition, causing vitamin and mineral deficiencies that can negatively impact energy levels and organ function. This poor nutrition can also weaken the immune system, making it harder for the body to fight off infections and illnesses. For children, insufficient nutrient intake may stunt growth and hinder healthy development. Over the long term, chronic undernourishment can lead to issues like bone density loss, fatigue, digestive problems, and developmental delays.

Mental Health Implications  

ARFID can have a profound impact on mental health, leading to increased anxiety and depression. The ongoing struggles with food can heighten these symptoms, creating a distressing cycle that’s hard to break. Individuals often develop intense food-related fears, resulting in more restrictive eating patterns that further deteriorate their mental well-being. Plus, many people with ARFID tend to avoid social situations involving food, such as parties or family dinners. This avoidance not only intensifies feelings of loneliness but also leads to emotional withdrawal from vital social connections.

Social and Emotional Impact  

ARFID can significantly strain relationships, making it challenging to connect with others, as shared meals are often a key part of social bonding. Friends and family members may struggle to understand the disorder, which can lead to tension and frustration. Navigating food-related situations - like school lunches, workplace events, or holiday gatherings - can be exhausting and stressful, further contributing to feelings of isolation and avoidance. The emotional toll of living with ARFID is substantial, often involving persistent worry, guilt, or shame about eating habits, which can weigh heavily on an individual's mental well-being over time.

Early diagnosis and appropriate treatment can significantly ease the impacts of ARFID, enhancing not only physical health but also mental well-being and social connections. With the right support, people with ARFID can cultivate healthier relationships with food, leading to a more balanced and fulfilling daily life.

Treatments for ARFID

Treating ARFID requires a holistic, individualised approach that addresses the cognitive, emotional, and behavioural aspects of the disorder. Evidence-based therapies help individuals build healthier eating patterns, manage anxiety, and reduce avoidance behaviours.  

Enhanced Cognitive-Behavioral Therapy (CBT-E) targets unhelpful thoughts and behaviours, encouraging gradual food expansion and tracking progress. Dialectical Behavior Therapy (DBT) focuses on emotional regulation, mindfulness, and coping strategies for social situations involving food. Acceptance and Commitment Therapy (ACT) promotes acceptance of difficult emotions, helping individuals align eating habits with personal values and long-term goals.  

Nutritional counselling complements these therapies by offering personalised meal plans and support to ensure balanced nutrition. Together, these interventions help individuals overcome food-related anxiety and develop sustainable, healthy relationships with food.

When to Seek Professional Help

Signs that you or someone you know may need professional support include consistently avoiding certain foods, significant weight loss, nutritional deficiencies, and anxiety about eating. Early intervention is key, as it can help avoid physical health issues and improve mental well-being and social interactions. 

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ARFID is a serious eating disorder that can significantly impact both physical and mental health. If you or someone you know is living with ARFID, it’s important to seek professional help.

Contact Joanne Fitzgerald Therapy to learn more about how she can support you on your journey to recovery. Joanne specialises in helping individuals with eating disorders like ARFID and offers compassionate and personalised therapy.

Sources

1. Source: StatPearls. (2023). Avoidant/restrictive food intake disorder. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK570571/