What Is Avoidant-Restrictive Eating Disorder (ARFID): A Guide for Families and Adults
If you are experiencing a crisis related to an eating disorder or would like further resources, contact ANAD’s Eating Disorders Helpline at 1-888-375-7767 from Monday through Friday, 9 am to 9 pm CT.
Healthy food is essential for mental and physical well-being. However, some individuals may struggle to remember to eat, experience texture aversions to food, or fear choking on food. These people might be living with avoidant-restrictive eating disorder (ARFID), an eating disorder listed in the DSM-5 alongside disorders like anorexia nervosa and bulimia nervosa.
Despite misconceptions about how this condition presents, there are many unique symptoms that both adults and children can experience. If you believe you or someone you love might be living with ARFID, a comprehensive look at the condition and its treatments can be valuable.
What is avoidant-restrictive eating disorder (ARFID)?
ARFID is a mental illness that causes avoidant and restrictive eating habits and behaviors. For example, someone with this condition may avoid eating certain meals. This avoidance might come from fear of food, forgetfulness, symptoms of a co-occurring condition, or a lack of hunger. ARFID may present differently in children and adults, so the following are symptoms for each age group.
How does ARFID present in children?
Children with ARFID might show extreme “pickiness” to foods. In addition, these children might have favorite foods they eat frequently and others that they find “disgusting.” They may also showcase a fear of swallowing or vomiting, which could occur when taking pills.
Children with ARFID might fear eating at mealtimes and have panic attacks or avoidant tendencies. They may become malnourished and struggle to get the nutrients their bodies need, which might contribute to depression or anxiety.
How does ARFID present in adults?
ARFID in adults is associated with the above symptoms but may appear differently than in children. Adults are often responsible for their own meals, so individuals with ARFID might struggle to remember to cook. They might prefer to eat small snacks or one meal throughout the day. In some cases, they may forget to eat food at all, avoiding it due to aversion or a lack of hunger.
The following are a few physical symptoms that may occur due to these behaviors:
- Weight loss
- Dizziness or fainting
- A lack of nutrients
- Dry skin
- Pale skin
- Fatigue
- Hair loss
- Missed menstrual periods
- A weak immune system
- Difficulty concentrating
- Digestive challenges
- Insomnia or sleeping too often
Adults with this eating disorder may also have a few foods they will eat, making their selections limited. If they do not have a wide range of nutrients, like iron, protein, or vitamins, in their food, they may start to experience symptoms of malnutrition.
How is ARFID different from anorexia?
Many people associate the restrictive eating behaviors of ARFID with anorexia nervosa, an eating disorder caused by excessive fear of gaining weight or preoccupation with losing weight. However, although ARFID does involve restrictive eating, it does not involve a preoccupation with losing weight. Instead, it may involve forgetfulness or aversion to food.
ARFID is not a choice, like anorexia. It is a serious mental illness that can significantly impact those affected. Those with ARFID may often want to gain weight or improve their eating habits but aren’t sure how to do so. They might feel overwhelmed by the prospect of eating to the point that they avoid it altogether.
What causes ARFID?
The exact cause of ARFID is not known. However, health conditions may be a cause in some individuals. For example, gastroesophageal reflux disease (GERD) can cause uncomfortable heartburn and regurgitation that causes an aversion to eating. In addition, some children or adults might experience trauma surrounding food and eating that reduces their ability to eat healthily.
Food traumas might include not being able to get food or snacks as a child when you wanted to, being withheld food as punishment, being forced to eat when sick or full, being reprimanded for eating at certain times, or being shamed for the amount of food one eats. In addition, childhood poverty and a lack of availability to healthy foods may lead to malnutrition and a lack of value toward food.
If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.
ARFID and ADHD: Are they connected?
Studies have found that severe ARFID is connected to ADHD. People with inattentive symptoms of ADHD may struggle to prioritize eating healthy meals due to difficulty setting a schedule and prioritizing self-care. Instead of eating, they may prioritize other areas of life, such as hobbies, work, or relationships. They might forget that eating is essential and go a few days without a solid meal as they focus on other areas of life. A feeling of hunger might not be present or may be ignored.
In one study, 24% of adolescents with ARFID also had ADHD, showing a potential connection. If you believe you may have ADHD, consider speaking to a mental health professional about managing your symptoms. Managing ADHD symptoms may also improve ARFID symptoms. In addition, many people with ADHD experience sensory concerns. If sensory issues are a result of your ARFID behaviors, you might benefit from looking for foods that fit your sensory profile.
What can you do at home to manage symptoms?
There are a few ways children and adults can manage symptoms of ARFID at home, including the following.
Take meal replacement drinks
Not eating can cause malnutrition. However, aversion to foods and anxiety about choking or vomiting can cause someone to avoid food, even when they know it’s hurting their body. In cases when someone cannot eat, taking a meal replacement drink might be more beneficial than eating nothing.
Meal replacement drinks come in many flavors, including chocolate, strawberry, and vanilla. Look for a drink labeled as “high calorie” instead of for muscle gain or weight loss. Drinks with 350 calories or more may help individuals with ARFID gain weight if they are underweight. In addition, look for drinks with vitamins and supplements like Vitamin D, Vitamin B-12, iron, magnesium, zinc, and others.
You can try several drinks if the texture of one doesn’t fit your sensory needs. Some drinks might be grainier, whereas others may be thick and taste like a shake. If a drink leaves residue or a taste of minerals in your mouth, try another. There are many brands on the market.
Set alarms for mealtimes
If you forget to eat at certain times of the day, set alarms for mealtimes. Generally, people benefit from eating three times a day. However, if that schedule doesn’t work for you, you can try eating small healthy snacks throughout the day. Healthy snacks could include:
- Pre-cut fruit
- A vegetable tray
- Granola bars
- Yogurt
- Healthy cereals
- Whole grain toast
- Crackers with peanut butter
- Dried fruit
- Smoothies
- String cheese
- Vegetable chips
- Cucumbers
- Bagels
- Hard-boiled eggs
You can add some snacks to a snack cart to remind you to eat easily. When your alarm goes off, grab a snack or make a meal. If you struggle to make meals due to the time it takes, you might try a recipe meal delivery kit that gives you the ingredients and recipe to make a quick meal. Add your meal replacement drinks to your snack cart, if applicable.
Ask for social support
Living with an eating disorder can feel isolating, especially if you are an adult with ARFID and feel no resources are available. Consider reaching out to someone you trust and telling them about your condition. If you live with someone or have family members to help, you might ask for reminders to eat or support in coming up with easy meals.
Find “safe foods”
“Safe foods” are foods you enjoy eating that do not cause sensory aversion and that you can often eat most of. These foods can be anything. However, try to find healthy foods you enjoy first. Eating any dish may be better than not eating at all, so having food you can turn to on your worst days might be advantageous.
Adults can turn back to foods they enjoyed in their childhood. You don’t have to avoid “childish” foods. For example, if you like dinosaur-shaped chicken nuggets or a kid’s TV dinner, eat them. If there’s a food you ate in your hometown that is difficult to find in a new place, consider ordering the ingredients online and making it from scratch.
Work with your sensory needs
You might benefit from working with your sensory needs if you fear eating certain foods due to a fear of choking, the sensation it causes in your throat, or a fear of vomiting. For example, try soft foods like smoothies, meal replacement drinks, or mashed potatoes instead of eating hard foods that might feel uncomfortable in your throat. You can also cut up your food into small bites.
If you don’t like soft foods or have difficulty eating significant amounts in one sitting due to your gag reflex, you can try eating multiple snacks or saving your meals for later in the day.
How to receive professional support
You’re not alone if you’re living with ARFID. This condition is serious, even if not discussed in the media. Below are a couple of support options you can investigate.
Inpatient or outpatient eating disorder care
In some cases, ARFID symptoms lead to malnutrition, extreme weight loss, and hospitalization. In these cases, individuals might be sent to inpatient eating disorder care, where they can be monitored and work with a nutritionist, doctor, and therapist to develop a healthy eating plan.
If symptoms are not severe or one does not wish to stay in an eating disorder center, one might go through intensive outpatient care to receive weekly sessions with an eating disorder team and monitor vitals. These systems are often in place to ensure the severe impacts of weight loss or malnutrition are not long-term, as they may lead to illness or, in severe cases, death.
Counseling
Counseling can also be a valuable resource for ARFID. However, it may be difficult to leave home when experiencing symptoms like fatigue or stomach upset. In these cases, working with a provider from home could be beneficial. Online therapy through a platform like BetterHelp offers this option.
Online, your therapist can help you develop healthy eating habits in a safe environment. They may also be able to accompany you as you cook a meal during the session and eat it with your therapist. With a set schedule, you might feel better able to control your routine.
Studies also back up the effectiveness of internet-based interventions. One study found that telemedicine was effective in treating eating disorders in children and adolescents. Depression and anxiety symptoms were reduced, as well as restrictive eating behaviors. These results could be promising for the future of ARFID treatment in children and adults.
Takeaway
What is a selective eater?
A selective eater is a person who restricts their diet severely due to their unwillingness to try to eat foods that are unfamiliar. Selective eating as a condition is not simply “picky eating;” while it is normal for younger children to go through phases of mild selective eating, extended or intense periods of selectivity – such as refusing to eat entire food groups or having a diet limited to only a handful of foods for an extended period of time – may be a sign of a selective eating disorder, which is a challenging mental health condition that can make receiving proper nutrition difficult.
The food intake disorder ARFID, which stands for avoidant restrictive food intake disorder, is a type of selective eating that can deeply affect a person’s mental and physical health if left untreated.
What is an example of restrictive eating?
Selective eating may present itself as a person having a few “safe” foods and meals – sometimes specified down to the brand of food and its preparation method – and experiencing severe anxiety and discomfort when presented with unfamiliar foods outside of this “safe” range. For example, a selective eater may eat a particular brand and kind of cereal, prepared with a particular brand and kind of milk, as their only breakfast. They may present with anxiety or anger if asked to eat a different brand of the same kind of cereal or to eat the cereal with a different milk or no milk at all.
How common is ARFID?
Avoidant Restrictive Food Intake Disorder (ARFID) is a selective eating disorder that was newly categorized with the introduction of the DSM-V. Estimated rates for ARFID range from around 2.02 cases per 100,000 to 3.01 cases per 100,000 in youth eating disorder diagnoses, making it roughly as common as other eating disorders like anorexia nervosa and bulimia nervosa.
How does ARFID affect the brain?
By nature, avoidant restrictive food intake disorder (ARFID) has two major symptoms – avoidance and restriction. An avoidant food intake disorder means that the patient will refuse unfamiliar or new foods completely, while a restrictive food intake disorder means that they will be physically unable to bring themselves to eat certain foods. Because of this, ARFID and other eating disorders like it can lead to malnutrition, which can have serious effects on the brain including creating electrolyte imbalances, delaying puberty, and slowing or changing physical growth patterns.
Other physical symptoms of selective eating and ARFID specifically include significant weight loss, low blood pressure, anemia, and dehydration. Extended periods of severe weight loss and low blood pressure can lead to potential osteoporosis and potential cardiac issues.
Is ARFID caused by autism?
While it’s unclear whether ARFID is caused by autism spectrum disorder, it is often comorbid with the condition. It’s theorized that the sensory sensitivities presented by ASD may contribute to the development of selective eating disorders like ARFID. That being said, ARFID and other disorders like it can and do present in people who are not on the autistic spectrum.
Is ARFID a genetic disorder?
Avoidant restrictive food intake disorder (ARFID) is not considered to be primarily based in genetics, though certain genetic factors may make the development of the condition or another selective eating disorder more likely.
What is the main cause of ARFID?
The exact or “main” cause of ARFID is unknown, though there are some risk factors that can make the condition statistically more likely to develop. These include
- a personal or family history of psychological symptoms and conditions like anxiety, phobias, and eating disorders,
- Social and environmental factors such as cultural food expectations
- Trauma, especially trauma related to food
- Sensory sensitivities
What age is ARFID diagnosed?
ARFID is typically diagnosed in children (often under 6 years old), though it can present at any age and is diagnosable at any age. In the DSM-IV, symptoms associated with ARFID were attributed to a different selective eating condition labeled "feeding disorder of infancy or early childhood," though this term is now considered outdated.
Who is most affected by ARFID?
Because ARFID is a restrictive food intake disorder, it most severely affects children and adolescents whose growth may be impeded by malnutrition. It can also be severely impactful to those who have other conditions that make maintaining a normal weight vitally important such as diabetes or other hormone regulation disorders.
Selective eating due to ARFID or another similar condition may be treated with therapy, nutrition counseling, or, in some more severe cases, hospitalization and inpatient treatments. There are currently no medications available for ARFID.
What are the three types of ARFID?
The symptoms of ARFID, like many eating disorders, fall into a few categories based on their physical or psychological source. These are the mental reasonings behind the selective eating patterns, whether conscious or unconscious.
The three types of ARFID are
- Lack of Interest. The patient has no genuine interest in eating at all and may get full quickly. Their selective eating may come from a view of eating as a chore.
- Sensory Avoidance. The patient has serious sensitivities to certain food smells, appearances, textures, and flavors, making it physically uncomfortable for them to eat it and so influencing their selective eating.
- Fear of Adverse Consequences. The patient has an intense fear of food-related dangers and risks including food-borne illnesses, choking, and allergies. They may view certain foods as actively dangerous, contributing to their selective eating.
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