Avoidant/Restrictive Food Intake Disorder (ARFID)

What is ARFID?

ARFID is a mental health diagnosis that stands for Avoidant/Restrictive Food Intake Disorder. People who have ARFID don’t eat enough food or enough different kinds of food to keep their body healthy and growing. ARFID is different than picky eating because it is more intense and usually lasts longer. People with ARFID have a strong aversion to certain types, textures, smells, or experiences with food. They tend to feel very nervous about food and the act of eating and/or drinking. Because of this, they often avoid meals or act out during mealtimes when they are worried.

How is ARFID diagnosed?

ARFID is usually diagnosed by a mental health provider or medical doctor. They will gather information by doing a physical exam, doing lab bloodwork, and asking many questions. They will likely ask about what a child regularly eats, how many types of foods and how much, as well as how long the problems have been happening. There is no medical test used to diagnose or rule out ARFID. Doctors will also think of other reasons why eating might be difficult, like medical problems, developmental problems, and other mental health problems. They will try to rule out other reasons to make sure that ARFID is the best diagnosis to explain the eating problems.

What are the consequences of ARFID?

Eating enough and different kinds of food helps our bodies grow and stay healthy. But sometimes, when a child has ARFID, they don’t eat enough or don’t eat enough variety of foods. If a child with ARFID doesn’t eat enough, they might lose weight, not gain enough weight, or not grow well. If a child with ARFID doesn’t eat enough and has lost too much weight, they may be diagnosed with malnutrition. Some children with ARFID might eat foods that are not very healthy but have lots of calories. This can make them gain too much weight.

Children with ARFID may also not get enough vitamins and minerals to help their body work properly. For example, not having enough iron can lead to a problem called anemia, which can make them feel tired a lot. Not getting enough calcium and Vitamin D can affect the health of their bones.

How is ARFID treated?

There is usually a team of people who can best help with ARFID. This may include people from medical, mental health, nutrition, and occupational (OT) or speech therapy (SLP) areas. Sometimes a doctor will prescribe medicine to help with appetite and belly pain, if needed. If weight and growth are concerning, oral nutrition and vitamin/mineral supplements may be recommended. These can help provide the calories, protein, vitamins, and minerals that their diet doesn’t provide. They may also help with improving growth and weight gain. If a child with ARFID is very malnourished, they may need a feeding tube to help get them the right nutrition and gain weight. A registered dietitian (RD) may help with a nutrition plan and check back on changes in height and weight.

Mental health providers and therapists (OT, SLP) try to help make a plan to improve eating habits by trying new things in a planned way. This can help reduce worries about eating over time and improve the skills needed to eat and drink what they need to be healthy. If regular outpatient visits do not help after a while, some people need to work with a team more often to make progress. Sometimes, it is necessary for a child to be admitted to the hospital or participate in a special program in order to improve their physical health. Certain hospitals have special programs with teams who specialize in feeding problems for kids who need more advanced help.

How does ARFID affect future health and eating?

It’s important to realize that each person may have a different experience with ARFID, but here are some common concerns families may have about the long-term effects of ARFID.

Persistence of ARFID: If not treated, ARFID can last into adolescence and adulthood. People with ARFID may continue to have a hard time with their eating habits. It is important to work on healthy habits during childhood or as soon as possible. As a person becomes more independent, they may have a hard time making healthy food choices if they are nervous around food. Just like with any behavior, the longer we have been using a habit (like problematic eating), the more difficult it can be to change the pattern to something more healthy.

Impact on Nutritional Health: Nutritional problems and inadequate calorie intake can cause long-term problems for physical health. Making sure children get enough food and enough kinds of food in their diet is important for their long-term health and development.

Mental Health Impact: ARFID may cause long-term mental health problems, including ongoing worries about food and loneliness. People can feel more and more anxious about mealtimes or sad about how difficult it is for them to eat. For many people, eating is a social activity and those with ARFID may feel left out because of their anxiety about food and eating. They may choose to avoid activities where food is an important part or feel embarrassed about their eating problems around others.

Transition to Adulthood: The transition from adolescence to adulthood can present unique challenges for individuals with ARFID. As they become more independent, managing their eating habits and making food choices may become more complex. Ongoing support and intervention may be needed during this transition.

When should I seek help?

Early in life, make sure to discuss your child’s eating habits at each well-child visit to the pediatrician. Risk factors for ARFID include:

• Diagnosis of Autism Spectrum Disorder
• Diagnosis of ADHD
• Males
• Severe picky eating, which does not improve over time with typical interventions
• Diagnosis of anxiety disorder, particularly OCD

Some common symptoms of ARFID include:

• Dramatic weight loss
• Poor growth or weight gain
• Stomach or intestinal problems that seem to have no known cause
• Restriction in amount or type of food accepted
• Fear choking or vomiting
• Lack of appetite or interest in food
• Anemia, low hormone levels, low potassium, and slow heart rate
• Fine or brittle nails

What is the most common outcome for ARFID treatment?

ARFID is similar to some other mental health conditions in that it is a functional disorder and there is not a point when it is considered “cured.” The best outcome of treatment for ARFID is that functional eating behavior is established or restored so that the person can live a healthy life. This may mean learning to eat a better variety of foods, larger volumes of food, or to be more comfortable and relaxed at mealtimes. Since ARFID is a diverse condition with many different presentations, successful treatment means something different to each family and in each situation.

Some people with ARFID go on to have more severe eating and feeding problems which can require higher levels of care in a hospital or treatment center. Although it is difficult to predict who might need this higher level of care, the best thing to do is work on the symptoms as early as possible. This is why it is important to talk with a child’s pediatrician or other healthcare providers about any problems they have with eating and drinking. 

Authors: Katherine Bennett, RD, MPH, CLE and Parker Huston, PhD
Editor: Christine Waasdorp, MD
January 2024