What is ARFID?

Most people avoid certain foods; it is not uncommon to turn a nose up at mushy mushrooms, balk at the idea of smelly fish, or pick out unwanted cilantro. But for those with food-related sensory issues, it's not a case of fussiness, but rather intense disgust at certain foods and fear at the prospect of eating them. In some cases, this can develop into an eating disorder called Avoidant/Restrictive Food Intake Disorder, or ARFID, where an individual avoids the vast majority of foods. ARFID can affect nutrient intake, which can then affect overall health. It may lead to life-threatening complications if left untreated.

Individuals with ARFID limit the volume and/or variety of foods they consume, but unlike some other eating disorders such as anorexia or bulimia, this food avoidance or restriction is not related to fears of fatness or distress about body shape, size, or weight. Instead, with ARFID, the selective eating is motivated by a lack of interest in eating or food, sensory sensitivity (strong reactions to taste, texture, or smell of foods), and/or a fear of aversive consequences (choking or vomiting). It can also include a fear of new foods.

Avoidant/Restrictive Food Intake Disorder is a relatively newer diagnosis, first appearing in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, published in 2013. ARFID is more prevalent among individuals with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and anxiety disorders. Current estimates suggest that ARFID affects around 5% of children and can persist into adolescence and adulthood if not addressed. A 2019 study published in the International Journal of Eating Disorders found that up to 3.2% of adults may meet the criteria for ARFID, highlighting its prevalence across age groups.

ARFID is not the same as picky eating. Children may avoid certain foods because they don't like the look, taste, smell, or texture. Picky eating usually only targets a few foods and does not affect a child's overall appetite or their growth and development. Picky eating will also usually go away as a child grows. Although many children go through phases of picky or selective eating, a person with ARFID has a diet that is so limited that it can lead to medical, nutritional, and/or psychosocial problems.

ARFID typically does not go away without treatment. The treatment often involves a multidisciplinary approach - including nutritional support, cognitive-behavioral therapy, and exposure therapy to help expand the range of foods that the individual feels comfortable eating.

Lisa Smith, a functional nutritionist who specializes in neurodiversity, eating disorders, and disordered eating, noted, "Food is a multi-sensory assault on the body." A person with ARFID may feel the need to avoid foods that may contribute to a sensory overload. She added, "If you have something that offers you predictability, consistency, and that doesn't challenge you in any way, obviously you're going to be drawn to that. Unfortunately, the most predictable foods are [ultra-processed foods and fast food]. If you think of McDonald's, they taste the same wherever you are in the world, so you don't have to get any more overwhelmed." This can cause significant issues in social situations, as individuals might avoid meals or settings where certain foods (or new foods) are present.

As ARFID gains more recognition, research continues to improve our understanding of the disorder, leading to more effective treatments. Increased awareness is essential in destigmatizing ARFID and encouraging individuals to seek help - particularly since many people may mistakenly believe that they are simply picky eaters rather than recognizing the serious health implications of their restricted diets.