What is ARFID? Causes, symptoms, and treatment options

With nearly 29 million Americans reporting an eating disorder at some point in their lives, there’s a good chance that someone you know has struggled with their eating habits or their relationship with food. You’ve probably heard of some of the more prevalent eating disorders, like binge eating disorder, but avoidant/restrictive food intake disorder (ARFID) may be new to you. 

Officially recognized just over a decade ago, ARFID is an eating disorder that causes people to avoid certain foods due to anxiety or a disinterest in eating. Here, we review how ARFID differs from other eating disorders and some of the best therapy options for treating symptoms.

What is ARFID?

ARFID is a condition that causes people to limit the amount and type of food they consume. Unlike eating disorders like anorexia nervosa and bulimia nervosa, these behaviors aren’t based on body image or losing weight. Instead, people choose to limit their food intake because:

• They have little or no interest in eating.
• They’re scared or anxious about the consequences of eating, like choking on food or having an allergic reaction.
• They avoid certain foods based on sensory characteristics, like taste, texture, or smell.

ARFID versus picky eating

Because ARFID often occurs in children and adolescents, some people confuse it with picky eating. ARFID and picky eating both cause people to avoid certain foods, but people with ARFID tend to have more extreme restrictions which can eventually lead to nutritional deficiencies.

Signs and symptoms of ARFID

ARFID symptoms vary by person, but there are several warning signs that someone is struggling with unhealthy food behaviors.

Physical signs of ARFID:

• Weight loss
• Limited appetite 
• Tiredness and lack of energy
• Feeling cold all the time
• Sleep problems
• Low immune system 
• Hair loss, dry skin, brittle nails, and other signs of malnutrition 
• Gastrointestinal issues, like stomach cramps or constipation 

Emotional and behavioral signs of ARFID:

• Lack of appetite or interest in food
• Distress around food 
• Fear of vomiting or choking on food 
• Only eating certain textures of food
• A limited list of acceptable foods
• Eating foods with similar characteristics, such as soft textures
• Slow eating 
• Food limitations that affect normal social behaviors

Over time, ARFID can cause nutritional deficiencies, dehydration, osteoporosis, anemia, and low blood pressure in adults. ARFID is also associated with co-occurring mental health conditions, like depression, anxiety disorders, obsessive-compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD). 

What causes ARFID?

ARFID affects people of all ages but is most commonly diagnosed during childhood and adolescence. Although experts don’t yet know the exact cause of ARFID, research suggests that environmental, psychological, and biological risk factors may all play a role. 

People who experienced a traumatic food incident, such as vomiting or a severe allergic reaction, may be more likely to develop ARFID. Misinformation around food, like a poor understanding of choking risk or concerns about “dangerous foods,” can also influence a person’s food aversions. 

Individual and family health history may affect a person’s chances of developing ARFID too. For example, having a caregiver or close family member with an eating disorder or anxiety disorder creates an increased risk for AFRID. ARFID has also been linked to medical conditions that make eating painful or uncomfortable, as well as autism spectrum disorder (ASD).

Therapy and other treatment options for ARFID 

Treating an eating disorder like ARFID involves a coordinated effort from primary care physicians, mental health specialists, and nutritionists or dieticians. In addition to reducing mental health symptoms and concerns, treatment focuses on helping people maintain a healthy weight and prevent associated health complications. 

For the mental health piece, there are several therapeutic approaches and lifestyle changes that can effectively address symptoms and reduce distress about food and eating. 

1. Cognitive behavioral therapy (CBT)

CBT is a type of talk therapy that can help you understand the connection between your thoughts, feelings, and behaviors. By addressing negative thought patterns related to food, people with ARFID can create better coping methods and develop healthier habits around food. CBT can be particularly helpful for improving sensory sensitivity and reducing concerns about negative consequences.

2. Exposure therapy

Exposure therapy allows people to confront their fears in a safe and controlled environment. With the support of a therapist, you’ll gradually expose yourself to triggers, such as certain foods, so you can learn to feel less vulnerable and more confident in your ability to cope with distressing emotions. 

3. Family-based treatment (FBT)

FBT is a therapeutic approach that empowers families to help their loved ones manage and overcome mental health challenges. Frequently used for children and teens with eating disorders, FBT is typically divided into three phases: restoring a person’s weight to a healthy level, empowering people to manage their own eating habits, and addressing any family issues that may have contributed to the condition. 

4. Nutritional counseling 

Nutritional counseling is another important component of treating eating disorders like ARFID. Working with a registered dietitian or nutritionist can help people develop healthier eating habits, manage nutritional deficiencies, and improve dietary variety. Nutritional counseling can also educate people about portion sizes and meal times, which may help reduce fears and concerns about food. 

5. Non-therapeutic techniques 

In addition to therapy, lifestyle changes can help people with ARFID build healthier habits and improve their overall well-being. 

• Mealtime routine: For some people, creating a consistent schedule for meals and snacks can reduce food anxiety. Eating meals in a calm environment, instead of on the go or in busy restaurants, can also help prevent distress.

• Food exploration: It’s common for people with ARFID to avoid foods with certain characteristics, like smells or textures, or even certain food groups altogether. Another way to help reduce food aversions is to become more curious about new foods, even if it just means taking a trip to the grocery store or helping a friend cook a new recipe.

• Community support: ARFID can make it difficult for people to eat or spend time with others, but connecting with trusted family and friends is important for recovery. Whether you confide in loved ones or find relief in an eating disorder support group, don’t underestimate the power of community support. 

Find care with Rula

Recovering from an eating disorder like ARFID begins with access to the right resources and support, including a qualified mental health professional. 

At Rula, we connect you with a therapist who accepts your insurance so you can get the support you need. With Rula’s easy-to-use therapist-matching program, you can find the right provider for your needs in less than 30 seconds and begin treatment as early as this week. 

Find a therapist with Rula