Everything You Need To Know About 'ARFID'—A Newly Discovered Eating Disorder

For people with 'ARFID', food can be a source of fear, not fuel. Here's why, and how to overcome it.

By Mark Travers, Ph.D. | July 31, 2024

We all have our tastes and preferences when it comes to food—what one person finds delicious, another might consider disgusting. For many, this variety of likes and dislikes is just part of enjoying life's culinary offerings. However, for others, their personal list of palatable foods can be severely limited—or even non-existent. The texture, smell or even the sight of certain foods can trigger such intense aversion that they may avoid eating altogether.

While many might label these individuals as "picky eaters," this oversimplification fails to capture the reality of their daily struggle. "Picky eaters" won't avoid certain foods—or even entire food groups—at the expense of their physical and mental health. In reality, this is the experience of those living with Avoidant/Restrictive Food Intake Disorder (ARFID). For them, food isn't just a matter of preference; it becomes a source of profound fear and anxiety that can significantly impact their physical health and overall quality of life.

What Is 'ARFID'?

In 2013, ARFID was officially recognized as a diagnosable feeding and eating disorder—making it a relatively "new" and understudied condition. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-V), ARFID is characterized by eating or feeding disturbances that lead to persistent failure in meeting appropriate nutritional and/or energy needs. To be diagnosed with ARFID, individuals must meet one or more of the following criteria:

• Significant weight loss or failure to achieve expected weight gain, or faltering growth in children
• Significant nutritional deficiency
• Dependence on enteral feeding or oral nutritional supplements
• Marked interference with psychosocial functioning.

According to a 2021 study from the International Journal of Eating Disorders, ARFID manifests in three different forms; some individuals may experience one, while others struggle with two or all three types simultaneously:

1. Restrictive ARFID. This is characterized by an apparent lack of interest in eating or food. For instance, a child with restrictive ARFID might show no enthusiasm for mealtime—picking at their food and eating only small amounts. They may not feel hungry or express a desire to eat, which can lead to noticeable weight loss or poor growth.
2. Avoidance ARFID. Here, individuals avoid food based on its sensory characteristics, such as taste, smell, texture, or appearance. Take, for example, someone who refuses to eat any foods with certain textures—like crunchy vegetables or mushy fruits. They might gag or feel nauseous at the sight or smell of these foods, and severely limit their diet to a few "safe" options.
3. Aversive ARFID. This subtype involves deep concern about the aversive consequences of eating, such as choking vomiting, or gastrointestinal distress. This may manifest, for instance, in someone who had a traumatic experience with choking, and now avoids many foods out of fear. They might stick to soft, easy-to-swallow foods—and may experience intense anxiety when faced with anything outside their comfort zone.

Like many eating and feeding disorders, ARFID typically begins in childhood. Given this, ARFID is often minimized as a "picky eating habit" that children will eventually "outgrow." And in adults, it may be mistakenly identified as a body-image related disorder—such as anorexia or bulimia nervosa. Therefore, it is crucial to differentiate ARFID from other conditions:

1. Anorexia nervosa. Unlike anorexia, ARFID is not driven by a fear of gaining weight or a desire to be thin. Individuals with ARFID avoid food for reasons entirely unrelated to body image.
2. Bulimia nervosa. ARFID does not involve binge-eating episodes followed by compensatory behaviors like vomiting, excessive exercise or fasting. Certain foods are consistently feared or avoided, or hunger cues may be persistently absent.
3. "Picky eating." While picky eating is common, it generally doesn't lead to major nutritional deficiencies, weight loss or reliance on nutritional supplements. Picky eaters typically have a far broader range of "safe" foods compared to those with ARFID, who may only have a handful.

How To Overcome 'ARFID'

ARFID can be truly debilitating and isolating. Sufferers' physical health can be severely compromised by malnutrition or emaciation. And for parents of young children with ARFID, the condition can be terrifying; they may struggle to help their child meet developmental milestones and worry excessively that they're the cause of their child's failure to thrive.

Moreover, ARFID can be mentally exhausting; food becomes a source of fear and disgust, and meal times and outings to restaurants cannot be enjoyed in the same way others do. This isolation extends beyond the dining table, and can take a deep toll on one's social interactions and overall quality of life.

Given the grave mental and physical consequences that ARFID can have, it's crucial to identify and treat it as early as possible. According to a 2019 study from Current Pediatric Reports, both medical and psychological interventions are being increasingly relied on and tested. Medical interventions often focus on promoting weight gain and ensuring nutritional adequacy, while psychological interventions address fears and sensory issues related to food. Both approaches show promise in helping individuals with ARFID improve their relationship with food and their overall health.

Most inspiringly, social media has become an avenue for individuals with ARFID to document their recovery journey. Many individuals—from young children to adults—are sharing their experiences of trying new dishes, discovering new safe foods and shedding light on this widely unknown disorder. These stories offer hope and encouragement to others facing similar struggles, showing that recovery is always possible, and that they are not alone.

If these symptoms and experiences resonate with you, don't listen to people who may brand you as "dramatic" or "picky," and know that you are not alone in your struggles. There are significant strides being made in identifying and treating this condition, so seek help if you need it; there are people all around the world just like you who have benefited from doing so. Food is fuel, and any steps taken towards being able to fuel your body—whether it's a single bite of a fear food or a newly discovered safe food—is one that should be celebrated.

A similar version of this article can also be found on Forbes.com, here.