Avoidant Restrictive Food Intake Disorder (ARFID)

Medically Reviewed by Jabeen Begum, MD on November 07, 2023
Written by Kendall K. Morgan
8 min read

Avoidant restrictive food intake disorder (ARFID) is an eating disorder. If you have it, you'll limit the amount and type of food you eat. Doctors sometimes call ARFID selective eating disorder. That's because you'll only have a few foods that you think are OK to eat. Sometimes, people with ARFID also will eat only in certain ways, such as eating foods in a certain order. 

If you have ARFID, it may cause you to:

  • Not want to eat
  • Worry that something bad might happen if you eat, such as choking or throwing up
  • Avoid eating foods that don't have a certain color, taste, texture, or smell

If you worry about eating and don't eat enough because of ARFID, it may affect your health in lots of ways. You may lose weight from not getting enough calories. You might not get all the nutrients you need from your diet either.

ARFID vs. picky eating

Sometimes, people do explain ARFID as "extreme picky eating," but ARFID is different than normal picky eating. Many children will have phases of picky eating that come and go. Someone with ARFID doesn’t eat enough for their bodies to work the way they should. In kids, this can slow weight gain and growth. 

When kids are picky eaters, it often goes away as they grow up. But ARFID doesn't just go away without treatment. It may get worse over time. You may have trouble because it's hard to eat with other people. It may take you a long time to eat, too. Unlike picky eating, ARFID can lead to problems that affect your overall health until you get help. 

ARFID vs. anorexia

These are both eating disorders that make people restrict the food they eat. But, unlike anorexia, people with ARFID don't eat less because they're worried about their body image, shape, or size. While ARFID can lead to weight loss, people with this disorder aren't trying to lose weight. 

With anorexia, you'll have a distorted self-image that makes you want to change how you look. With ARFID, you'll avoid certain foods or new foods out of fear that they'll make you choke, get poisoned, or die if you don't.

ARFID in adults

In adults, ARFID can cause dangerous weight loss. It also could keep your body from being able to function the way it should. As with other eating disorders, adults with ARFID often have other mental health problems, including:

  • Depression
  • Anxiety
  • Obsessive-compulsive disorder (OCD)

Doctors don’t know what causes ARFID. Some experts believe that people who get it might have extreme sensitivity to taste or texture. They might have had a bad experience with food – like choking or vomiting – that makes them fearful or anxious about food. It might happen from a combination of personality, genes, and other things that trigger it. 

Genetic factors

As with other eating disorders, genes play a big role in ARFID. One study found that almost 80% of a person's chances of having ARFID come from genetics. The environment a kid grows up in can affect ARFID, but not as much as the genes they were born with. ARFID is likely to run in families.

Doctors don't know what specific genes may affect a person's risk for having ARFID. But researchers are trying to find out. They also want to know how the genes involved in ARFID relate to genes that play a role in other eating disorders.

Social and cultural factors 

Researchers need to study it more, but social or cultural factors may play a role in ARFID. Sometimes, ARFID might start after you have some kind of trauma. You may have choked on food or seen someone else choke. After that, you may connect a certain food with a risk of choking. It's also possible that other types of trauma, such as divorce or moving, can lead to ARFID. The eating disorder might be a way to feel more in control.

Psychological factors

Kids with ARFID more often have social or emotional problems, compared to kids without ARFID. Kids and adults with ARFID often have other mental health conditions, such as anxiety disorders or OCD, too. It's also more likely in kids with attention deficit hyperactivity disorder (ADHD) or intellectual disabilities. But it's not clear exactly how these things are linked to ARFID. 

ARFID and autism

Kids with autism spectrum disorder are more likely to have ARFID, but they are different conditions. The sensory sensitivities that come with autism may be one reason these two conditions often go together. Kids with ARFID often have trouble eating foods that don't have the right color, texture, taste, or smell. If you are worried that your child with autism has ARFID, see your doctor.

Some of the physical signs of ARFID include:

  • Severe weight loss
  • Lack of appetite
  • Abnormal menstrual periods
  • Stomach cramps and pain
  • Constipation
  • Trouble concentrating
  • Low iron or thyroid levels
  • Slow heart rate
  • Dizziness or fainting
  • Feeling cold all the time or having a low body temperature
  • Dry hair, skin, and nails
  • Fine body hair growth
  • Thinning of hair on the head
  • Muscle weakness
  • Weakened immune system
  • Poor wound healing
  • Cold hands and feet
  • Swollen feet
  • Low energy

People with ARFID might have behavioral or psychological symptoms, as well. For example:

  • The need to dress in layers to hide weight loss or stay warm
  • Drastic restriction in the types or amount of food they'll eat
  • A hard time eating with others
  • Fear of vomiting or choking
  • Trouble paying attention
  • Feeling full before a meal

If you think you or your child may have ARFID, your doctor will look for signs they don't want to eat. They'll look to see if you or your child is avoiding foods so much, they aren't getting needed nutrients or energy. These include:

  • Losing a lot of weight or, in kids, not gaining weight or growing
  • A lack of certain vitamins or minerals
  • Needing to be tube-fed or use liquid nutritional supplements
  • Problems with mental health or socially related eating difficulties

Your doctor will ask you questions. They may also give you a physical exam to check your height, weight, and general health. They may order blood or urine tests to see if you're getting enough nutrients and check how your organs are working. 

For a doctor to diagnose ARFID, the signs can't be explained by a lack of food. They can't be related to a cultural practice. To tell ARFID from other eating disorders, they'll also check that you aren't worried about how your body looks or your weight. 

They'll also make sure your trouble eating isn't related to some other health or mental health condition. Or, if you do have another condition, they'll look at whether the eating problems you have are more than what would normally happen with the other condition.

Anyone can have ARFID. It usually happens in kids, but adults can get it, too. You're more likely to have ARFID if you:

  • Had trauma, and especially trauma related to food, such as not having enough food to eat, being force-fed, or choking
  • Have another mental health condition, such as anxiety, depression, or ADHD
  • Don't like certain textures in food
  • Worry that food might hurt you
  • Have other people with ARFID or other eating disorders in your family

Your doctors will focus on helping you get enough nutrients and calories. They'll also deal with your feelings about food and eating. Your treatments might include:

  • A personalized meal plan by a dietitian
  • Nutritional supplements
  • Speech therapy to help with your motor skills for eating
  • Medicines to help your appetite or ease anxiety
  • Meetings with a psychiatrist or psychologist to treat other mental health conditions that could affect your ARFID
  • Cognitive behavioral therapy to help you notice the thoughts and feelings you have around food and help you manage them

In some rare cases, you may need help getting enough nutrition from a temporary feeding tube (enteral nutrition). If your eating disorder or symptoms are severe, you may need to stay at the hospital to help with weight gain or more serious medical needs related to your ARFID.

If you have severe ARFID and don't treat it, you may get other health problems, including:

  • Malnutrition
  • Dehydration
  • Electrolyte imbalance
  • Low red blood cells (anemia)
  • Low blood pressure
  • Weakened bones (osteoporosis)
  • Heart attack
  • Delayed puberty
  • Changes in growth

Like other eating disorders, ARFID can be a life-threatening condition. It's important to get help if you or a loved one has it. ARFID also can affect all aspects of life, including how you relate to other people. You may avoid people or activities you love. It can lead to trouble in school, work, or other parts of life.

Doctors can't explain why you have ARFID. There isn't any way to prevent it either. It comes about from a combination of your genes and things in your environment, most of which you can't control. 

The best thing you can do if you think you or a loved one may have ARFID or is at risk for ARFID is to see a doctor about it for help and advice. ARFID doesn't usually go away on its own. If you treat it sooner, you can take steps to help with the eating disorder. You may be able to prevent some of the other more serious health and social problems that sometimes come with ARFID.

Avoidant restrictive food intake disorder (ARFID) is an eating disorder that causes you to eat less. When you have ARFID, you won't want to eat certain types of food because of how they look, taste, or feel. You may also have a fear that food will hurt you somehow. Because you won't eat enough, ARFID can cause lots of other health problems, including severe weight loss, malnutrition, and social issues. It's important to see a doctor for help since ARFID doesn't go away on its own and can get worse over time.

  • What are the types of ARFID?

You can have ARFID for different reasons. Sometimes these may be called different types of ARFID. These include sensory ARFID, which happens when you are very sensitive to the way foods look, feel, taste, or smell. Some people with ARFID may just lack interest in eating certain foods, while still others may worry more about choking, nausea, vomiting, or pain. Because ARFID happens for many reasons, it may be different for each person.

  • Is ARFID a form of autism?

No. ARFID and autism are separate conditions. But sometimes, people with autism also have ARFID. And certain traits that people with autism often have may make ARFID more likely.

  • What are examples of ARFID?

ARFID may look different for different people. A child with ARFID might not only say no to a new food, but they may gag or choke. They may be worried if they eat a new food, they'll be poisoned or even die. ARFID can keep you from getting enough calories and nutrients for your body to work as it should. It also can get in the way of work, school, or your social life.