How is ARFID related to autism?

It’s common for people with autism spectrum disorder (ASD) to experience issues with food and eating. These challenges often begin during childhood and may eventually qualify as an eating disorder.

One example is avoidant/restrictive food intake disorder (ARFID), a condition characterized by restricting the type and amount of food you eat. There’s a clear link between ARFID and autism, with some research suggesting that autistic people are more likely to have ARFID ^[1] than the general population. 

How autistic people develop ARFID

Many people with autism develop food obsessions that influence their eating habits. While these preferences and aversions may look like picky eating, they can actually be symptoms of ARFID. 

Unlike most other eating disorders, ARFID isn’t associated with a desire to lose weight or achieve a certain body image. Instead, the condition often stems from anxiety or lack of interest in food. 

Autistic traits that may contribute to the development of ARFID include:

• Sensory sensitivities: Autistic people often have their own way of processing sensory input. As a result, you may be more likely to avoid certain foods based on sensory characteristics like taste, texture, or smell. 

• Rigid routines: For many autistic people, consistency and structure are essential. You may eat certain foods at certain times and feel distressed by any changes to that routine. 

• Special interests: It’s common for people with autism to have fixed interests. If you fixate on a specific food, you may not eat enough to maintain a healthy weight. A general uninterest in food can also impact your physical well-being.

• Increased anxiety: You might avoid eating certain foods because you're anxious about potential consequences. For example, you might fear gagging, choking, or having an allergic reaction.

Can you have ARFID without autism?

ARFID and autism both tend to involve sensory sensitivity and a strong preference for routine ^[2], but they impact your life in different ways. 

As an eating disorder, ARFID affects your food choices and behaviors. Autism more broadly defines how you experience and interact with the world. When a neurotypical person has ARFID, their sensory issues are mainly related to food. For people on the autism spectrum, sensory overload extends to other senses like noises, smells, and lights. 

Experts believe that various risk factors can play a role in the development of ARFID. While we know that autism and ARFID often co-occur ^[3], not everyone with ARFID is autistic. The eating disorder is also linked to anxiety disorders, attention-deficit hyperactivity disorder (ADHD), and medical conditions like irritable bowel syndrome (IBS) and food allergies or intolerances. 

Other potential risk factors for ARFID include:

• A distressing food incident, like a severe allergic reaction or extensive vomiting

• Sensitivity to how foods taste, smell, or feel

• Having a close family member with an eating disorder or food allergy

What ARFID looks like in autistic people

If you’re autistic and you have ARFID, it likely means you have very specific eating habits ^[2]. For example, autistic kids with ARFID may show a strong preference for certain foods based on color, shape, or temperature. They might only eat a few foods ^[4] and be more likely to claim they don’t like a food without even trying it. 

An autistic person’s environment may also influence their eating habits. Sounds, lights, and smells can make it difficult to sit down for meals. For example, busy restaurants and school cafeterias may feel too overwhelming.

Similarly, autistic adults often have their own limited list of acceptable foods. You may even be bothered by smells that people typically enjoy, like freshly baked cookies or lemon zest. So you may choose to skip meals if they don't align with your approved list or avoid eating out and sharing food with friends. 

Encouraging healthy eating in people with autism

To be diagnosed with ARFID ^[5], your food behaviors must lead to at least one of the following:

• Significant weight loss

• Nutritional deficiency

• Reliance on nutritional supplements 

• Difficulty functioning in daily life

Without treatment, these challenges can result in issues like malnutrition and heart problems ^[6]. Fortunately, there are strategies to help people feel more comfortable with food.

When treating an eating disorder, one of the goals is to promote healthy eating. You might work with a nutritional counselor who understands neurodivergence to expand your diet. For example, they might help you grow your list of “safe” foods or learn how to eat enough to meet your nutritional needs. 

Occupational therapy (OT) is another effective approach for people with co-occurring autism and ARFID. OT can help you create mealtime routines that take into account your sensory concerns. Eventually, you may also begin to increase your tolerance for new foods. 

Treatment may also involve therapeutic techniques like cognitive behavioral therapy (CBT). CBT can help you identify and challenge distressing thoughts related to your eating habits. For example, you might explore why your fear of choking prevents you from eating certain foods. 

Exposure therapy is another approach used to overcome ARFID symptoms. This involves gradually and safely introducing new or feared foods over time, helping your body and mind learn that eating them isn’t dangerous.

Depending on your needs, treatment may also include working with a dietitian. This can help support nutrition and allow you to build more balanced eating patterns. Some people also benefit from family-based support or approaches that focus on increasing comfort with different textures and foods.

Clinician’s take

A common misunderstanding is that the person just needs to try harder or be pushed to eat more variety. That approach usually backfires. It can increase anxiety and make foods feel even less safe. What tends to help is a slower, more supportive approach that builds comfort over time rather than forcing change.

Brandy Chalmers, LPC

Clinical reviewer