More than picky eating—7 things to know about ARFID

Share this article:

Most parents can attest to the difficulty of getting kids to try new foods. Picky eating is nothing new, but what happens when it involves many foods, never goes away, or gets worse?

Avoidant/Restrictive Food Intake Disorder is an eating disorder involving an extreme avoidance or low intake of food. We spoke with Dr. Julie Lesser, MD, child and adolescent psychiatrist at Rogers–Minneapolis, and put together seven facts that you should know about ARFID.

1. ARFID is different than picky eating

While picky eating and ARFID may have certain similarities, ARFID is differentiated by the level of physical and mental distress that eating causes. Someone with ARFID may have difficulty chewing or swallowing, and can even gag or choke in response to eating something that gives them high levels of anxiety. The anxiety can also cause them to avoid any social eating situation, such as a school lunch or birthday party.

With ARFID, foods may be avoided based on physical characteristics such as texture, smell, and appearance, or based on past negative experiences like choking or vomiting. ARFID is a new addition to DSM-5, the official list of psychiatric diagnoses. It had been known as feeding disorder of infancy or early childhood, or eating disorder, not otherwise specified.

2. ARFID can cause serious health issues

One of the most common results of ARFID is significant weight loss or failure to gain weight and grow for those who should be in a growth spurt. Significant levels of nutritional deficiency may require higher levels of care for medical stabilization. Another common result is high levels of stress, especially around eating in social settings.

3. ARFID patients are not concerned with weight loss or body image

Even though weight loss is a frequent sign of ARFID, it’s important to note that this isn’t the reason for avoiding food. The lack of a preoccupation with body image or a fear of gaining weight is one way that ARFID differentiates itself from other eating disorders, such as anorexia nervosa and bulimia nervosa. Despite this, the consequences of ARFID may be just as severe.

4. ARFID may occur in people of all ages and genders

While ARFID is more often diagnosed in children and adolescents, it may occur in adults. This might include those who went untreated as children and have a long pattern of selective eating based on sensory concerns or feelings of disgust with new foods. While some eating disorders are more often found in females, ARFID is much closer to an even split or possibly even more common in males than females.

5. Many people with ARFID have co-occurring conditions

It is common for people who are diagnosed with ARFID to have a co-existing anxiety, mood disorder, or another condition, such as autism spectrum disorder. If a medical condition that impacts appetite or eating is present, the degree of food avoidance must go beyond what would be expected for the medical condition to be classified as ARFID.

6. Treatment for ARFID is effective

Despite ARFID being a recent addition to DSM-5, there are already effective treatment practices in place. Rogers treats ARFID with cognitive behavioral therapy with a specific focus on exposure and response prevention. We develop a list of anxiety provoking scenarios on an individual basis known as exposure hierarchies. Starting with repeated exposure to the least stressful scenarios, patients reset their anxiety levels and gain confidence. Patients also learn coping skills for long-term recovery.

7. ARFID has psychological and physical warning signs

Psychological signs can include:

• Fears of choking or vomiting
• Lack of interest in food or appetite
• Picky eating that becomes worse
• Limiting food intake to particular textures
• Complaints of upset stomach or feeling full around mealtimes

Physical signs can include:

• Stomach cramps and other gastrointestinal complaints
• Cold intolerance
• Menstrual irregularities
• Difficulty concentrating
• Dizziness or fainting
• Sleep-related issues
• Fatigue

Rogers offers treatment for eating disorders at various levels of care throughout the country, including a residential program in Oconomowoc, WI. If you think that you or someone you know may have ARFID, another eating disorder, or other mental health concerns, call 800-767-4411 for a free, confidential screening, or request a screening online.