Symptoms of Avoidant Restrictive Food Intake Disorder (ARFID)

As the name suggests, avoidant restrictive food intake disorder involves eating only certain kinds of foods, to the point where your diet is severely limited. The disorder was previously called “selective eating disorder.”

At first glance, ARFID might look like an extreme version of picky eating. You might avoid certain foods or entire food groups to the point where you can’t bring yourself to eat them. Or, you might struggle to eat in general and severely limit the amount of food you eat overall.

For many people with ARFID, the drive to limit food intake comes from a fear of something bad happening if you eat. This could include food poisoning, choking, or vomiting.

These fears may come from previous experiences with food. For example, if you had an allergic reaction to a certain food, you might experience fear when faced with any food that reminds you of that experience.

You might also struggle to cope with certain smells, tastes, textures, or colors of food.

Autistic people are more likely to have ARFID, possibly because sensory sensitivity is a common characteristic of autism.

The signs and symptoms of ARFID include:

• inability to eat certain types or textures of food
• aversion to foods with a certain color, smell, or taste
• a lack of interest in food
• fears of choking, vomiting, nausea, or food poisoning
• a lack of energy due to poor nutrition
• cold intolerance
• gastrointestinal issues, including stomach pain or constipation
• dread and anxiety around mealtimes
• difficulty chewing or swallowing food
• avoiding social events that relate to food, such as dinner parties

Some people with ARFID might avoid eating with others to hide their symptoms. This can feel lonely and isolating, especially if you think others won’t understand what you’re experiencing.

According to the Diagnostic and Statistical Manual of Mental Health Disorders (5th ed.), a healthcare professional can only diagnose ARFID if it leads to one or more of the following:

• significant weight loss, or in children, not reaching an expected weight or height
• significant nutritional deficiency
• dependence on nutritional supplements or feeding tubes
• marked interference with social life and mental health

For ARFID to be diagnosed, your doctor or therapist will rule out other eating disorders, such as anorexia.

They will also check to see if your symptoms could be explained by a medical condition or another mental disorder, or if the eating disturbance relates to a lack of available food or cultural practice, such as fasting.

ARFID is a relatively new term. The DSM first recognized the condition in 2013. This means there’s a lack of research and awareness around it, although this is slowly changing.

The key difference between ARFID and other eating disorders is that ARFID is not characterized by distress about weight, size, or body shape.

As with anorexia, people with ARFID avoid certain types of food or limit the amount of food they eat. However, this is not driven by a desire for weight loss. Additionally, the symptoms of ARFID do not include overexercising or purging.

Another difference between ARFID and other eating disorders is the cause. People develop ARFID because of sensory sensitivity, a lack of interest in eating, or a fear of food due to distressing experiences in the past.

If you have a very limited diet, your body may not be getting the nutrients that it needs to thrive. Left untreated, this can lead to malnutrition and physical health problems.

Health risks linked to AFRID could include the following:

• extreme weight loss
• lethargy
• brain fog and poor concentration, known as cognitive issues
• stomach or gut issues
• poor immune system function
• damage to major organs, including the heart

In children, malnutrition can lead to poor physical and mental development and a lack of growth. In some cases, ARFID can be fatal.

The good news is that ARFID, like all eating disorders, is treatable. If you suspect you have ARFID — or that a loved one has it — you can talk with a doctor or a therapist. They will be able to guide you in the right direction.

ARFID treatment usually involves talk therapy, also called psychotherapy. You can look for a therapist in your area that specializes in eating disorders.

Because of the physical health risks associated with ARFID, you may also benefit from talking with a primary care doctor. Treatment centers that specialize in eating disorders can also help.

If you have a loved one with ARFID, remember to be patient with them. Try not to take it personally if they can’t eat your food or if they avoid eating on social occasions. Punishing children with ARFID is unlikely to help. Instead, try to be understanding and seek help for parents of children with ARFID.

If you or a loved one has ARFID, you might find it useful to look for compassionate resources on the topic. The following websites may be helpful:

• The National Eating Disorders Association (NEDA)
• ARFID Awareness UK
• Picky Eating Adult Support
• Ask ARFID

You could also find forums and support groups, either online or offline. There are a few Facebook pages, including:

• Selective Eating Disorder (SED) and ARFID Parents/Carers Support Group
• ARFID Awareness UK

There’s also an ARFID subreddit.

Remember that you are not alone. Many people manage to cope well and overcome their eating disorder. Together with healthcare professionals, you can get better.