What does ARFID look like in adults?

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder that’s been recently added to the Diagnostic and Statistical Manual of Mental Disorders ^[1] (DSM). People with ARFID restrict the amount and type of foods they eat in ways that harm their physical and mental well-being. 

Other eating disorders, like anorexia or bulimia, are also characterized by restrictive eating. The key difference is that with those conditions, disordered eating often results from a fixation on an idealized body shape or size. With ARFID, restrictive eating stems from anxiety or discomfort around food itself, not a desire to achieve a certain weight or appearance.

While it’s typically diagnosed in childhood, ARFID can impact people of all ages, including adults. Research on how common ARFID is in adults is limited. But it’s believed to affect about 1% of women and 1% of men ^[2]. Learning more about ARFID in adults can help you spot the signs of disordered eating and know when to seek help. 

Signs and symptoms of ARFID in adults

There’s nothing wrong with liking or disliking certain foods. But an adult with ARFID isn’t just a picky eater. 

Their food restrictions are so intense that they are unable to eat enough to fuel their bodies and maintain their health. 

In children, signs of ARFID can be easier to identify. This is because adults are largely responsible for feeding their children. As a result, they’re more likely to notice when a child is unwilling to eat — especially if they’re losing weight or failing to meet developmental milestones. 

ARFID in adults might be concealed by long-established coping strategies. For example, an adult is likely aware of their eating challenges. To compensate, they might not eat in public or with friends or family. Adults may also have a longer list of “safe” foods. So they may be able to eat enough calories to maintain their weight. Without exhibiting dramatic weight loss or other signs of malnutrition, ARFID in adults might go unnoticed.  

If you think you might have ARFID, reviewing the following symptoms and subtypes ^[2] can help you know when it might be time to seek professional help. However, keep in mind that someone can still have ARFID even if they don’t seem to fit into one of these exact subtypes. It’s also possible to show behaviors from multiple subtypes, and ARFID symptoms can evolve throughout life.

ARFID subtype #1: Avoidance based on sensory characteristics of food

With this type of ARFID, a person will only eat foods with a certain appearance, texture, taste, or smell. They may restrict themselves to a short list of “safe” foods or processed foods to ensure a more uniform sensory experience. 

This form of ARFID may lead to anxiety around cooking or food odors, pressure to try new foods, or eating food that someone else (or a restaurant) prepared.

ARFID subtype #2: Fear of aversive consequences associated with food

Adults with this form of ARFID worry about choking, vomiting, and other physical problems that could occur while eating. They may adopt rigid eating behaviors — like chewing very slowly or blending their food — in an attempt to prevent these outcomes. 

For people with this subtype, chewing, swallowing, and eating are stressful. This can lead to malnourishment. 

ARFID subtype #3: Lack of interest in eating

With this subtype, people don’t experience typical hunger cues or pleasure from eating. Food just doesn’t interest them, so they might skip meals or rely on shakes or supplements as meal replacements. 

Not having the motivation to shop for food or prepare and eat meals can make it harder to eat a balanced diet and maintain a healthy weight. 

What causes adults to develop ARFID?

We aren’t yet sure what causes ARFID. 

But researchers have uncovered some factors ^[3] that may lead to ARFID in adulthood:

• Lack of treatment in childhood: Children with ARFID who don’t receive treatment are more likely to grow up to be adults with ARFID. Like most mental health concerns, without support, ARFID symptoms may get worse over time.

• Co-occurring medical or developmental conditions: People with medical conditions that make eating uncomfortable or developmental disorders like autism spectrum disorder (ASD) may be at greater risk of ARFID.

• Co-occurring mental health conditions: Having another mental health concern may make you more vulnerable to ARFID. For example, ARFID frequently occurs alongside attention-deficit hyperactivity disorder (ADHD), anxiety disorders, and depression. 

What happens when ARFID is left untreated

Left untreated, ARFID can negatively impact a person’s mental and physical well-being in many ways. And in severe cases, it can be life-threatening. 

Without support, ARFID can lead to ^[4]:

• Malnutrition

• Dangerously low body weight

• Heart issues

• Bone-density problems

• Hypotension (low blood pressure)

• Dehydration

• Social isolation

• Relationship challenges

• Difficulty functioning

Coping with & treating ARFID in adulthood

If you think that you have ARFID, one of the best things you can do is to seek professional help. Integrated care from a therapist, nutritionist, doctor, and psychiatrist can help ensure you receive the care you need to help your mind and body heal. While there’s no cure for ARFID, it can be managed with the right support. 

ARFID is a relatively new diagnosis and one that’s typically made in childhood. So we currently have limited data on effective ARFID treatment for adults. 

However, cognitive behavioral therapy (CBT) is showing promise. CBT helps people gain insight into unwanted behaviors and interrupt unhealthy patterns. According to the first study on ARFID treatment in adults ^[5], 47% of participants no longer met the criteria for ARFID after 20 to 30 sessions of CBT. 

While not a replacement for professional help, self-care can also be an important part of ARFID recovery. 

This might include:

• Challenging stigma: If you’re living with ARFID as an adult, try to remember that what you’re experiencing isn’t stubbornness or a lack of willpower. Just like other eating disorders, ARFID is a serious clinical mental health concern. It’s not a sign of weakness or just being an overly picky eater.

• Being patient with yourself: Most likely, if you’re an adult with ARFID, you’ve been experiencing disordered eating for some time. Healing takes time, and there may be some bumps along the way. Try to show yourself some patience and compassion throughout this experience, much like you would show a friend in a similar situation.

• Creating calming routines: If you experience a spike in anxiety when it’s time to eat, creating a grounding ritual may help reduce stress. For example, you might set a timer for one minute, take slow, paced breathing, relax your shoulders, and use a simple coping statement like, “I’m safe, and I can take this one bite at a time,” before starting your meal.

• Starting small: You can slowly and gently begin to expand your list of safe foods by engaging with food outside of mealtimes. For example, looking at images of food or walking the aisles of a grocery store can be a way to increase your comfort level with new foods without the pressure to eat them.

Clinician’s take

Many adults frame ARFID-related behaviors as being ‘just picky,’ having a ‘low appetite,’ or being ‘sensitive,’ rather than recognizing it as anxiety-driven restriction that impacts nutrition or daily life.

Brandy Chalmers, LPC

Clinical reviewer