Avoidant/Restrictive Food Intake Disorder (ARFID)

What is avoidant/restrictive food intake disorder (ARFID)?

Avoidant/restrictive food intake disorder (ARFID) is a condition that causes you to limit the amount and type of food you eat. It isn’t the result of a distorted self-image or an attempt to lose body weight, which is common among other eating disorders.

ARFID can cause you to:

• Lose interest in eating.
• Feel anxious about the consequences of eating, like choking on food or vomiting.
• Avoid foods that have an unwanted color, taste, texture or smell.

You might hear your healthcare provider call ARFID “selective eating disorder.” This is because you may only choose a few things that are OK to eat. You may also create rituals or patterns of behavior around the way you eat, like eating your food in a specific order.

ARFID can affect your nutrient intake, which can affect your overall health. It may lead to life-threatening complications if left untreated.

Is avoidant/restrictive food intake disorder (ARFID) the same as picky eating?

No, ARFID isn’t the same as picky eating. Children may be and may avoid certain foods because they don’t like the look, taste, smell or texture. Picky eating usually only targets a few foods and doesn’t affect your child’s appetite or their growth and development. Picky eating can also go away as a child grows. ARFID can cause complications that do affect your appetite and overall health due to a lack of adequate nutrition. This condition doesn’t go away without treatment.

How common is avoidant/restrictive food intake disorder (ARFID)?

Avoidant/restrictive food intake disorder (ARFID) is a newer diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This means that there’s not a lot of data available to estimate how this condition affects a large-scale population.

What are the signs and symptoms of avoidant/restrictive food intake disorder (ARFID)?

Signs and symptoms of ARFID include:

• Significant weight loss.
• Constipation.
• Abdominal pain, stomach cramps or an upset stomach.
• Low body temperature.
• Lethargy.
• Irregular menstrual cycles.
• Fainting or dizziness.
• Fine hair on your body (lanugo).
• Muscle weakness.

Behavioral changes that may be a sign of ARFID include:

• Feeling full before meals or having no appetite.
• Difficulty paying attention.
• Limiting how much food you eat.
• Only eating foods with certain textures.
• Fear of what could happen after eating like vomiting or choking.
• Picky eating gets worse and limits the range of foods able to be eaten.

ARFID isn’t associated with a negative body image or a desire to lose weight.

What causes ARFID?

The exact cause of avoidant/restrictive food intake disorder (ARFID) is unknown. Research suggests it may be the result of:

• Anxiety.
• Fear.
• Genetic changes.
• Social, cultural and environmental influences.
• Trauma.

What are the risk factors for avoidant/restrictive food intake disorder (ARFID)?

Avoidant/restrictive food intake disorder (ARFID) can affect anyone, including adults and children. The condition is most common during childhood. You may be more at risk of developing ARFID if you:

• Had a traumatic experience, especially involving food (food insecurity, force-feeding, choking, etc.).
• Have an underlying condition that affects your neurological functioning or development (anxiety, depression, ADHD).
• Have an aversion to certain textures.
• Fear that food will harm your body.
• Have a biological family history of eating disorders.

What are the complications of avoidant/restrictive food intake disorder (ARFID)?

Complications caused by avoidant/restrictive food intake disorder (ARFID) include:

• Malnutrition.
• Dehydration.
• Electrolyte imbalance.
• Anemia.
• Low blood pressure.
• Osteoporosis.
• Cardiac arrest.
• Delayed puberty.
• Changes to your physical growth.

The consequences of ARFID can be life-threatening. Sometimes, a person diagnosed with ARFID won’t have any signs or symptoms because their body adapts to stress. It’s possible that test results could be inconclusive, even though the condition is life-threatening.

ARFID can also affect how you socialize. You may avoid seeing loved ones or participating in activities that are in the presence of food (family meals, dinner parties, etc.). This can affect your relationships, and can even distract you from work or school responsibilities.

How is avoidant/restrictive food intake disorder (ARFID) diagnosed?

A healthcare provider will look for certain criteria when diagnosing avoidant/restrictive food intake disorder (ARFID). They’ll make an ARFID diagnosis if the following are true:

• Limited food intake leads to significant weight loss and growth difficulties for children; your body isn’t getting enough nutrients; you’re dependent on tube feeding or taking vitamins and supplements to get nutrients and/or food restriction affects your interpersonal relationships.
• Limited food intake isn’t caused by food insecurity, religious fasting or an underlying medical condition or treatment.
• Limited food intake isn’t caused by a negative body image or a desire to lose weight or change your body shape.
• If limited food intake was the result of a medical condition or treatment, it exceeds what’s expected as a side effect and causes major complications to your overall health.

A healthcare provider may offer a physical exam in addition to blood or urine tests to check your general health and nutrient levels and monitor your organ function. Side effects of this condition can be life-threatening or cause complications that can affect several different parts of your body.

How is avoidant/restrictive food intake disorder (ARFID) treated?

Treatment for ARFID focuses on:

• Helping you gain and maintain a healthy weight.
• Preventing complications that affect your overall health.
• Navigating mental health, sensory aversions and fears regarding food.

The main treatment for ARFID is cognitive behavioral therapy (CBT). This therapy will help you:

• Recognize problematic thoughts and behaviors that affect your health.
• Feel less fear or anxiety around food.
• Be more comfortable with sensory challenges.

A healthcare provider may offer medications to help restore your mind and body to good health and prevent life-threatening complications. These medications can be antipsychotic medications, antidepressants or medications that stimulate your appetite. Talk to your healthcare provider about the side effects of any medication before you start taking it.

In some cases, your healthcare provider will give you nutrition via a temporary feeding tube (enteral nutrition). This is a flexible tube that goes through your nose or directly into your stomach or small intestine. The feeding tube allows you to get nutrients into your body by bypassing your mouth.

Who treats avoidant/restrictive food intake disorder (ARFID)?

Your care team for ARFID may include a:

• Primary care physician.
• Mental health professional or cognitive behavioral therapist.
• Gastroenterologist.
• Speech-language pathologist.
• Specialist to treat any complications.

How soon after treatment will I feel better?

Treatment for avoidant/restrictive food intake disorder (ARFID) takes time. There’s no specific amount of time when you’ll feel better because each person is different. You may feel relief from your symptoms as you become more comfortable getting the nutrients your body needs. You’ll likely need continued support from your care team throughout your life to monitor your progress and watch for complications that may arise.

Can avoidant/restrictive food intake disorder (ARFID) be prevented?

There’s no known way to prevent avoidant/restrictive food intake disorder.

What can I expect if I have avoidant/restrictive food intake disorder (ARFID)?

Avoidant/restrictive food intake disorder (ARFID) is a mental health condition that affects your body physically. Many cases may look similar to picky eating in its early stages, but the consequences of restricting food intake can be serious and life-threatening if left untreated. While children usually grow out of picky eating, ARFID requires medical intervention that can be lifelong, to help you feel better. Hospital visits and stays with ARFID are common.

While the condition is relatively new, there isn’t a singular treatment that works for everyone. Most people make progress with combined methods of treatment, like medications and cognitive behavioral therapy.

When should I see a healthcare provider?

Visit a healthcare provider if you:

• Can’t eat or drink.
• Feel anxious during meals.
• Don’t have any interest in eating.
• Lose a significant amount of weight.
• Experience signs or symptoms of ARFID.

It isn’t easy for a person with a mental health condition to see that they need help or want help. The support of loved ones may encourage someone to get the care they need.

What questions should I ask my doctor?

• What’s my diagnosis?
• Do I need to see a mental health therapist?
• Are there side effects to the medication you prescribe?
• What can I do to get enough nutrients if I’m unable to eat?
• Do I need a feeding tube?

What’s the difference: ARFID vs. anorexia?

Avoidant/restrictive food intake disorder and anorexia nervosa are both mental health conditions that cause you to restrict your food intake. Anorexia happens when you have a negative self-image and restrict food intake to change the way your body looks. ARFID is restrictive eating that isn’t caused by a distorted image of yourself.

Is ARFID a form of autism spectrum disorder?

No. ARFID may include characteristics similar to autism spectrum disorder, but they’re different conditions. A person may have an aversion to foods with certain textures with either condition. People diagnosed with ARFID can have severe complications like malnutrition due to their sensory aversion.

A note from Cleveland Clinic

ARFID (avoidant/restrictive food intake disorder) is a complex mental health condition that won’t go away without treatment. While the condition may look like picky eating, ARFID can have dangerous complications on your body if you’re not able to consume the nutrients you need to survive. Treatment is available, but it won’t resolve in one day. It takes the help of your care team and support from your loved ones to get you back to good health.