What is ARFID?
Avoidant/Restrictive Food Intake Disorder (ARFID) is a serious eating disorder characterized by persistent avoidance or restriction of food. This can deprive the body of essential nutrients, slow down normal bodily functions, and lead to significant health complications.
ARFID, previously known as selective eating disorder, is officially recognized by the American Psychiatric Association and is listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Unlike other eating disorders, such as anorexia, bulimia, and binge eating, ARFID does not involve a desire to improve body image or lose weight. Instead, individuals with ARFID avoid or restrict specific foods, or all foods, due to reasons unrelated to body image.
Table of Contents
- What Causes ARFID?
- Key Symptoms and Warning Signs of ARFID
- Types of ARFID
- ARFID Statistics
- What Happens If You Don’t Get Treatment for ARFID?
- How to Help Someone With ARFID
- Co-Occurring Disorders in Clinical Practice
- Different Types of Therapy for ARFID
- Who We Treat
- ARFID Treatment Programs at Eating Disorder Solutions
- Start Your ARFID Recovery Today
- Frequently Asked Questions About ARFID
- Helpful Resources
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What Causes ARFID?
ARFID doesn’t have a single cause. It typically develops through a combination of sensory, psychological, and environmental factors. Many adults trace their eating challenges back to childhood, when early patterns of food avoidance or aversion first began. In other cases, ARFID develops later in life, often triggered by a traumatic event or an allergic reaction.
ARFID is also associated with mental health conditions, which can intensify restrictive eating behaviors. Some adults experience ARFID as a lack of appetite or a general disinterest in food, suggesting a possible neurological component. Environmental influences, such as growing up with pressure to eat, mealtime battles, or having limited exposure to a variety of foods, can reinforce avoidance patterns by creating negative associations with eating and reducing a person’s willingness to try new or previously rejected foods.
Recognizing the varied roots of ARFID is essential for effective support and treatment. With compassionate, individualized care, recovery is possible at any age.
Key Symptoms and Warning Signs of ARFID
Most of the time, it’s up to family members to notice the signs and help loved ones get ARFID treatment. In general, the condition is characterized by disordered eating and a failure to meet the appropriate nutritional requirements and weight. Usual ARFID symptoms include:
- ARFID often begins as picky eating or sticking to a small list of safe foods.
- People may have strong reactions to textures, tastes, smells, or appearances.
- Many avoid certain foods after choking, vomiting, or allergic reactions.
- People can experience weight loss over time as a result of limited eating.
- Many people have little appetite and often forget to eat.
- Eating a narrow range of foods can result in missing essential nutrients.
- Dependence on meal replacement shakes or supplements.
- Regularly skipping meals or avoiding eating in social situations.
- Anxiety, distress, or discomfort during mealtimes.
Types of ARFID
ARFID manifests in different ways, and clinicians generally recognize three main subtypes based on the underlying reasons for food avoidance.
Avoidant ARFID (Sensory-Based)
This type is driven by strong sensory sensitivities. The person avoids certain foods because of their texture, taste, smell, or appearance. For example, they might refuse anything creamy or slimy, like yogurt or mashed potatoes, and stick to dry, crunchy, or bland foods. Their aversions are not a choice but a genuine sensory reaction, and this type often overlaps with sensory processing issues.
Restrictive ARFID (Low Appetite/Limited Intake)
This subtype involves very low interest in eating. Individuals may rarely feel hungry, get full quickly, or view eating as a chore. For instance, an adult with this type might eat only small amounts of a few bland foods, saying things like “I’m just not hungry.” Over time, this can lead to weight loss and nutritional deficiencies, even without any body image concerns.
Aversive ARFID (Fear-Based)
In this type, the person avoids food due to a fear of negative consequences like choking, vomiting, or pain. This often develops after a traumatic experience with food, but fears can also arise without a clear cause. For example, someone might only eat soft foods because they are terrified of choking, even if they know the food is safe.
Many individuals experience a mix of these types, but identifying the primary cause is crucial for tailoring effective ARFID treatment. Sensory-based ARFID may respond best to exposure therapy targeting textures and flavors, while fear-based ARFID often requires anxiety-focused interventions. The goal in every case is to help the person achieve nutritional adequacy safely and comfortably.
ARFID Statistics
Though only recently recognized, ARFID may be more common than many realize. A 2023 study of over 50,000 U.S. adults found that about 4.7% screened positive for ARFID, compared to 0.6% for anorexia, suggesting ARFID could affect 1 in 20 adults. Unlike anorexia and bulimia, ARFID affects men and women at similar rates, with some studies indicating slightly higher rates in males and non-white individuals, highlighting the risk of underdiagnosis.
Most adults with ARFID trace symptoms back to childhood picky eating, but about 21% develop it in adulthood, often after traumatic food-related events. ARFID tends to be chronic without treatment and frequently overlaps with other conditions; for example, about 13.8% of adults with ARFID have a history of autism, and obsessive-compulsive traits are also common. These patterns underscore the need for comprehensive, personalized treatment for ARFID that addresses the eating disorder and related mental health concerns.
Sources:
https://equip.health/articles/understanding-eds/arfid-in-adults-causes-risk-factors
https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/
https://www.psychiatryadvisor.com/news/arfid-prevalence-demographics-and-correlates/
https://kahmcenter.com/supporting-eating-disorder-recovery/arfid/
https://jeatdisord.biomedcentral.com/articles/10.1186/s40855-808-42131-z
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What Happens If You Don’t Get Treatment for ARFID?
Because ARFID directly impacts a person’s nutritional intake, the consequences of leaving it untreated can be quite serious. The body cannot function optimally without sufficient nutrients, and over time, significant health problems can arise.
Chronic Nutritional Deficiencies
A limited diet often causes deficiencies in key vitamins, minerals, and calories. For example, avoiding fruits and vegetables can lead to vitamin C and A deficiencies, while skipping meats or dairy can cause anemia or bone loss. These deficiencies may develop slowly but can seriously impair organ function, immunity, and energy levels.
Malnutrition and Low Body Weight
Many adults with ARFID become underweight or malnourished, though malnutrition can also occur at a normal weight. Signs include muscle loss, extreme fatigue, feeling cold, hormonal disruptions, and weakened immunity. This can make everyday tasks difficult, lower work performance, and diminish the overall quality of life.
Medical Complications
ARFID can affect nearly every organ system. Risks include heart issues (irregular heartbeat, heart failure), electrolyte imbalances, gastrointestinal problems like constipation or gastroparesis, kidney dysfunction, and osteoporosis, increasing the risk of fractures even in younger adults.
Mental Health Decline and Isolation
Prolonged ARFID often worsens anxiety and avoidance behaviors, making treatment harder over time. Social isolation typically increases, which can lead to depression, loneliness, and shame around eating difficulties. Malnutrition itself may amplify anxiety and obsessive thinking, further entrenching the disorder.
Severe cases can require hospitalization for malnutrition or critical care. The good news is that ARFID is treatable, and early intervention can restore health and improve quality of life. If you or someone you know is struggling, seek help as soon as possible.
How to Help Someone With ARFID
Supporting someone with ARFID or seeking help yourself starts with understanding that this is a real and complex eating disorder, not simply “picky eating” or a matter of willpower. Whether you are concerned about a loved one or navigating your own recovery, educating yourself is a key first step. If you are approaching someone you care about, keep the conversation gentle and avoid framing their eating habits as something they can easily overcome. For those personally struggling, it is important to know that your experience is valid and that ARFID treatment and recovery are within reach.
Friends and family can be most helpful by listening without judgment and avoiding quick-fix advice. Comments like “just try it” or “you’ll be fine” can minimize their experience and cause frustration. Instead, offer steady encouragement and suggest professional help when the person feels ready. If you are working through ARFID yourself, even small steps toward recovery, such as contacting a therapist or exploring ARFID treatment options, are meaningful. Recovery takes time and patience, and every bit of progress matters. A supportive environment that promotes understanding and celebrates small victories can make all the difference in the journey toward healing.
Co-Occurring Disorders in Clinical Practice
Many adults with ARFID experience other mental health conditions alongside their eating challenges, which can complicate recovery and require a comprehensive approach. These co-occurring disorders can both contribute to the development of ARFID and arise as a result of prolonged disordered eating.
- Anxiety Disorders: Anxiety is one of the most common co-occurring conditions. This can range from generalized anxiety and social anxiety, particularly around eating in public, to specific phobias related to food or swallowing.
- Obsessive-Compulsive Disorder: Many clients exhibit obsessive thoughts or rigid routines around food. While some have formal OCD diagnoses, others simply show obsessional behaviors tied to food preparation, appearance, or eating rituals.
- Trauma and PTSD: For some adults, ARFID is directly linked to a past traumatic experience, such as choking or severe illness, while others may have broader trauma histories that heighten anxiety and avoidance around eating.
- Depression: Longstanding eating challenges often take a toll on mental health, with many clients experiencing persistent low mood, hopelessness, or withdrawal. Malnutrition itself can also worsen depressive symptoms.
- ADHD and Neurodevelopmental Factors: Research shows that ARFID occurs more often in individuals with ADHD compared to the general population, as traits like impulsivity, sensory sensitivities, and inattentiveness can disrupt regular eating habits and complicate recovery.
Different Types of Therapy for ARFID
ARFID treatment requires a comprehensive approach that blends medical, nutritional, and psychological care. At Eating Disorder Solutions, we tailor each client’s recovery plan with evidence-based therapies designed to address the unique challenges of ARFID.
Nutritional Counseling and Meal Support
A registered dietitian plays a key role in guiding clients to rebuild a balanced diet safely. Nutritional counseling goes beyond meal plans. It involves educating clients about how food supports physical and mental health, and gradually reintroducing essential nutrients in manageable ways. We meet clients where they are, starting with safe foods and expanding step by step. Structured meal support sessions allow clients to practice eating challenging foods with coaching, helping to reduce anxiety and build confidence over time.
Cognitive Behavioral Therapy (CBT)
CBT is a cornerstone of ARFID treatment, focusing on identifying and challenging unhelpful beliefs about food. Clients learn to reframe anxious thoughts and gradually test new foods through behavioral experiments. For example, someone might start by tasting a small amount of a feared food and reflecting on their experience. Over time, these exposures help break the cycle of avoidance, reduce fear, and build tolerance. CBT also targets rigid eating routines and teaches coping strategies to manage anxiety during meals, fostering more flexible and confident eating habits.
Exposure Therapy
Exposure Therapy helps clients face food-related fears step by step. We work collaboratively to create a hierarchy of feared foods or eating situations, starting with manageable exposures and gradually increasing difficulty. Whether it is handling, smelling, or tasting a feared food, each exposure helps retrain the brain’s anxiety response. We also practice situational exposures, like eating in social settings, to build real-world confidence. This method is proven to reduce fear and avoidance, allowing clients to reclaim normal eating experiences.
Family Therapy and Supportive Counseling
Even for adults, involving family or close support systems can enhance recovery. We offer family education and therapy to improve understanding, reduce tension, and strengthen communication. Sessions help families learn how to provide support without pressure, set healthy expectations, and celebrate progress. For partners or spouses, we also address relationship dynamics impacted by ARFID, ensuring a supportive environment at home.
Psychiatric Care (Medication Management)
While no medication cures ARFID itself, treating co-occurring conditions like anxiety or depression can make recovery smoother. Our psychiatric providers offer personalized evaluations and, when appropriate, prescribe medications to reduce anxiety or improve mood, supporting clients’ engagement in therapy. Medication use is always collaborative and closely monitored to ensure the best outcomes.
Holistic and Experiential Therapies
We also integrate complimentary therapies like art therapy, ecotherapy, mindfulness, and group therapy. These approaches help clients process emotions, manage stress, and build confidence outside of the eating disorder. Group therapy offers valuable peer support, helping clients feel less isolated and more motivated by sharing experiences and successes.
Who We Treat
We understand that ARFID can affect anyone, regardless of gender, background, or life stage. Our adult-focused programs at Eating Disorder Solutions are designed to meet each person’s unique needs in an inclusive, supportive environment. We work with adults from diverse backgrounds, including:
- Adults of All Ages: We support adults across the lifespan, from young professionals to those in midlife or retirement. Some have struggled with eating issues since childhood, while others develop ARFID later in life due to health events or trauma. Whether facing long-standing challenges or newly emerging symptoms, we provide age-appropriate care that fits real-life responsibilities, offering flexible scheduling and virtual options to make treatment accessible.
- College Students: Navigating college life with ARFID can be especially tough, with dining halls, irregular schedules, and social pressures. We help students build practical coping strategies and balanced routines while accommodating academic demands. Our outpatient and virtual programs are designed to fit class schedules, offering flexible session times to support both health and academic success.
- LGBTQ+ Individuals: We provide affirming, culturally sensitive care for LGBTQ+ adults, recognizing unique challenges such as anxiety, trauma, or past struggles with body image. Our team ensures that therapy is respectful of each person’s gender identity and lived experience, creating a safe, inclusive space for healing.
- Athletes: Athletes may develop rigid or avoidant eating patterns linked to performance routines or fears of physical discomfort during competition, such as bloating, nausea, or gastrointestinal distress. Our team, experienced in sports nutrition and athlete psychology, helps clients maintain proper fueling while gradually expanding their diet to support both recovery and peak performance.
- Working Professionals: Busy professionals may mask ARFID under the guise of convenience, relying on limited foods or skipping meals due to stress. We offer flexible in-person and virtual treatment options that fit around demanding work schedules. Our programs address workplace-related stress, teach practical self-care strategies, and provide tools for managing challenges like work travel or high-pressure events.
ARFID Treatment Programs at Eating Disorder Solutions
At Eating Disorder Solutions, we provide a full continuum of care tailored to adults with ARFID, offering everything from 24/7 supervised treatment to flexible outpatient options. Our ARFID treatment programs are designed to meet each client’s unique needs and schedules, ensuring the right level of support at every stage of recovery.
Flexible ARFID Treatment - Intensive Outpatient Program
Intensive Outpatient Program (IOP) offers flexible treatment and allows clients to resume more of their regular activities. Sessions are typically held 3 to 5 days a week for a few hours per session, including group therapy, supported meals, and individual check-ins. IOP focuses on reinforcing coping skills, addressing challenges that arise in everyday life, and preventing relapse. This level of care is ideal for adults transitioning from PHP or for those who need ongoing support while balancing work or college commitments.
ARFID Treatment from Home - Virtual Intensive Outpatient Program
Our Virtual Intensive Outpatient Program (Virtual IOP) provides the same high-quality care as in-person IOP but through secure video sessions. This option is perfect for adults who live outside the Dallas area or have responsibilities that make in-person attendance difficult. Clients participate in live group therapy, nutrition sessions, and meal support from home, with full engagement and therapist guidance. Virtual IOP allows clients to practice recovery in their real-life environments, which helps them build sustainable habits and confidence.
24/7 Care for ARFID at Our Facility in Dallas - Residential Program
Our Residential Program offers intensive, round-the-clock care in a homelike setting in Dallas, Texas. Our residential ARFID treatment program is ideal for adults who are medically unstable, severely malnourished, or unable to function in daily life. Clients live on-site, receiving medical supervision, individual and group therapy, structured meal support, and exposure practice in a highly supportive environment. The residential setting fosters a sense of community, allowing clients to share progress and encourage one another. Most clients stay for several weeks to a few months, focusing fully on recovery and building a strong foundation for ongoing progress.
Daytime ARFID Treatment - Partial Hospitalization Program
Partial Hospitalization Program (PHP) provides intensive, daylong treatment for adults who are medically stable but still need significant support. Clients typically attend treatment 5 to 7 days a week for full-day sessions and return home at night. PHP includes supervised meals, individual and group therapy, nutrition education, and exposure exercises. This program helps clients maintain recovery momentum while practicing new skills in real-world settings between sessions. PHP strikes a balance between structure and independence, often serving as a step-down from residential care or a direct entry point for those needing daily support without 24-hour supervision.
Start Your ARFID Recovery Today
Seeking help for ARFID takes courage. You might feel uncertain about asking for help, especially if you have been struggling for a long time. But ARFID is a complex disorder that often requires professional treatment, and reaching out is a powerful step toward healing. At Eating Disorder Solutions, we’re here to guide you from your first call through every stage of recovery.
From the moment you begin treatment, you’ll be welcomed with warmth and expertise. Your dedicated therapist will work closely with you to set meaningful goals, and we’ll celebrate each milestone together. On difficult days, we offer creative solutions and unwavering support to keep you moving forward.
ARFID recovery is about more than expanding your diet. It’s about reclaiming your freedom to live fully and confidently. Imagine traveling, socializing, and nourishing your body without fear. Many of our clients tell us, “I wish I had started sooner,” and we hope you’ll feel the same.
Contact us today for a free, confidential consultation. Together, we can take the first step toward lasting recovery.
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Frequently Asked Questions About ARFID
Do I have ARFID?
If you avoid many foods due to sensory issues or fear (not weight concerns), and it’s causing health or life problems, ARFID is possible. A professional evaluation is the best way to confirm and begin treatment.
How is ARFID diagnosed?
ARFID is diagnosed by a healthcare professional based on DSM-5 criteria, focusing on persistent eating restrictions that lead to weight loss, nutritional deficiencies, or interference in daily life, without body image concerns.
How common is ARFID?
ARFID affects an estimated 0.5% to 5% of people, with studies suggesting about 1 in 20 adults may meet criteria. It’s likely more common than previously thought, especially now that awareness is increasing.
How does ARFID develop?
ARFID can develop from childhood picky eating, after traumatic food-related events, or during periods of illness. Anxiety, sensory sensitivities, and certain personality traits often contribute to its onset and persistence.
Can you develop ARFID as an adult?
Yes, ARFID can develop at any age, often after traumatic events like choking or illness. Even adults with no prior eating issues can develop avoidant patterns that meet ARFID criteria and benefit from treatment.
Is ARFID genetic?
There’s no single ARFID gene, but genetic traits like sensory sensitivity and anxiety may increase risk. Often, ARFID runs in families, influenced by both genetics and environment, though recovery is possible regardless.
Can ARFID be cured?
Yes, ARFID is treatable. With therapy and support, many people fully recover and regain normal eating habits. Recovery is gradual, but most see lasting improvements and no longer feel controlled by food avoidance.
What is the best treatment for ARFID?
The best treatment combines nutritional counseling with therapy, especially CBT and exposure therapy. A personalized approach that addresses the root cause, whether fear, sensory issues, or low appetite, is key to success.
What are the three types of ARFID?
The main types are: Sensory-Based Avoidance (triggered by texture or taste), Lack of Interest (low appetite), and Fear of Aversive Consequences (fear of choking, vomiting, etc.). Many people have a mix of these.
What is the difference between ARFID and picky eating?
Picky eating is common and usually doesn’t impact health. ARFID involves extreme avoidance that leads to weight loss, nutritional issues, or social impairment, and it often causes significant distress or anxiety.
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External Resources
2024 Fonseca NKO, Curtarelli VD, Bertoletti J, Azevedo K, Cardinal TM, Moreira JD, Antunes LC.
2024 Kambanis PE, Mancuso CJ, Becker KR, Eddy KT, Thomas JJ, De Young KP.
2022 Kennedy HL, Dinkler L, Kennedy MA, Bulik CM, Jordan J.
2019 Katzman DK, Norris ML, Zucker N.