What is ARFID?
- eatingdisordertherapy
- Oct 13
- 2 min read
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating or feeding disturbance marked by an ongoing pattern of restricted food intake or limited variety that leads to one or more clinically significant consequences (weight or nutritional deficiency, dependence on enteral feeding or supplements, or marked psychosocial interference). The restriction is not driven by body image concerns or fears of weight gain.
How does ARFID present?
People with ARFID typically fall into overlapping presentation profiles driven by:
• Sensory aversions (strong dislike of textures, smells, or tastes)
• Lack of interest in eating (low appetite or low interoceptive awareness)
• Fear of aversive consequences (such as choking, vomiting, or gagging after a traumatic experience)
Presentations range from very selective “picky eating” with stable weight but major social impairment to severe restriction with weight loss and medical complications.
How common is it?
Prevalence estimates vary by sample and method, but research suggests ARFID affects a small yet significant portion of the population. Rates are generally higher in clinical than community samples, and awareness of the disorder has increased substantially in recent years.
Common comorbidities and risk factors
ARFID often co-occurs with anxiety disorders, obsessive compulsive traits, gastrointestinal problems (for example, reflux or functional gut symptoms), and neurodevelopmental conditions such as autism spectrum disorder or ADHD. When autism is present, sensory and routine-based features are often more pronounced.
Assessment: what to screen for
A thorough assessment should include medical and weight history, nutritional status, feeding history (onset, drivers, sensory factors, traumatic experiences), gastrointestinal symptoms, and screening for anxiety, autism, or trauma. It is important to assess functional impact (social eating, school or work participation, family mealtimes) and rule out other medical explanations or body image concerns. Multidisciplinary input from a dietitian, pediatrician or gastroenterologist, psychologist or psychiatrist, and occupational therapist is often essential.
Evidence-based approaches to treatment
Evidence supports a multidisciplinary, individualized approach:
• Medical stabilization and nutrition support are priorities when weight or nutrition is compromised.
• Psychological treatment: Cognitive-behavioral therapy uses gradual exposure to new or feared foods, anxiety reduction strategies, and increased variety. Family-based approaches are useful for young
er individuals, and trauma-focused therapy may be indicated when a feeding trauma has occurred.
• Occupational or feeding therapy can address sensory-based avoidance or oral-motor difficulties, often integrated with CBT techniques.
Research is still developing, but studies show encouraging outcomes with structured, exposure-based, and family-supported interventions.
Clinical takeaways
• Persistent selective eating can be serious if it affects nutrition, growth, or daily functioning.
• Screening for comorbidities is important, as these factors influence both presentation and treatment.
• Collaborative care among medical, nutritional, and psychological professionals improves outcomes.
• A trauma-informed approach is essential when fear-based avoidance follows a distressing event such as choking or vomiting.
