ARFID is different from other types of eating disorders e.g. anorexia nervosa or bulimia nervosa, as food restriction or avoidance is not driven by thoughts around weight, shape or size. Instead, it is a condition characterised by an individual avoiding certain foods or types of food due to:
- A difficulty digesting certain foods.
- The colour or texture of foods.
- Having little or no appetite.
- Being afraid to eat after a frightening episode of choking or vomiting.
- Uncomfortableness after eating leading to smaller portions.
Subtypes of ARFID
As with other eating disorder conditions, there are different types of ARFID, depending on the symptoms the individual is experiencing. The types of ARFID include: sensory, lack of interest, and fear of adverse consequences.
- Sensory: Individuals may experience a sensitivity to how food tastes, feels, looks or smells. With ARFID, this will be more extreme than just disliking certain foods.
- Lack of interest: Some people just do not feel hungry the way others experience hunger, or they may have a ‘poor appetite’ in general. For some they may feel that it is more like a chore than a pleasurable experience. Thus making it hard for them to eat enough in order to stay well.
- Fear of adverse consequences: Individuals may have had a previous experience during eating that has left them scared or upset around food and eating e.g. choking, vomiting, stomach aches, diarrhoea or constipation, relating to certain food types, or eating in general. In order to navigate this, individuals may start to avoid these foods and only eat foods they perceive are safe for them to eat.
Foods that individuals with ARFID feel safe around tend to be plain, so called “beige” foods. Some examples of common ARFID “safe foods” are: white bread, pizza, french fries, sweets, chicken nuggets, plain noodles, crackers, cereal.
Symptoms of ARFID
Some common signs and symptoms of those with ARFID to look out for can include:
- Eating a limited range of foods.
- Eating a reasonable range of foods but eating less than required to maintain a healthy weight.
- Difficulty in recognising when hungry.
- Feeling full after a few mouthfuls and finding it hard to eat more.
- Taking longer during mealtimes/finding eating a ‘chore’.
- Missing meals completely, especially when busy with something else.
- Sensitivity to particular foods, texture, smell, or temperature.
- Appearing to be a “fussy eater”.
- Constantly having the same meals.
- Consistently eating differently from everyone else.
- Only eating food of a similar colour (e.g. beige).
- Avoiding social events where food may be present.
- Anxiety during mealtimes, chewing food carefully, taking small sips and bites, etc.
- Weight loss (or in children, not gaining weight as expected).
- Nutritional deficiencies, for example anaemia caused by not having enough iron in the diet.
- Needing to take supplements to make sure nutritional and energy needs are met.
The Impact of ARFID
ARFID can negatively impact upon a person’s mental and physical well-being in a variety of ways, such as;
- Experiencing difficulty in gaining or maintaining weight: this will be due to the limited variety of their diet and may cause malnutrition. In children, growth may be impacted so they are unable to achieve expected growth milestones.
- Functionality and development: as an impact of only eating a narrow variety of foods due to lack of nutritional requirements.
- Serious weight loss and nutritional deficiencies: this may require treatment such as nutritional supplements being prescribed. If the physical risk is deemed to be high then tube feeding may even be necessary for a period of time until stability is maintained.
ARFID can significantly affect various aspects of an individual's life, including their school, home, work, and social life. These impacts can result in substantial limitations in day-to-day activities, such as attending social events or going on holiday. Additionally, individuals with ARFID may encounter challenges in forming close relationships and making new friends, as social eating often plays a crucial role in these interactions. Consequently, they may actively avoid such situations, leading to heightened levels of anxiety and stress.
ARFID and neurodiversity
Research demonstrates that 55-97% of people diagnosed with an eating disorder also receive a diagnosis for at least one more psychiatric disorder. The most common psychiatric disorders which co-occur with eating disorders include mood disorders (e.g. major depressive disorder), anxiety disorders (e.g. obsessive compulsive disorder, social anxiety disorder), post-traumatic stress disorder (PTSD) and trauma, substance use disorders, personality disorders (e.g. Borderline Personality Disorder, Obsessive-Compulsive Personality Disorder (OCPD)), sexual dysfunction, non-suicidal self-injury, and suicidal ideation.
Autism
Children with Autism Spectrum Disorder (ASD) are up to five times more likely to face eating challenges, including avoidance and sensory sensitivity, compared to those without ASD. Research indicates that ASD often co-occurs with ARFID, affecting 12.5–33.3% of patients. Both ASD and ARFID individuals may struggle with eating difficulties related to sensory characteristics, which may include:
- Routines/rituals that are food focused may be more inflexible
- Complex and heightened sensory issues
- Additional anxiety around change which can be harder to manage
- Difficulties with responding to and recognition of hunger and fullness
- A greater difficulty in communication and interaction with others, making it more challenging to express thoughts, feelings and difficulties with food
Whilst individuals with ASD and ARFID may struggle with eating difficulties, it is important to note that these conditions may also happen independently. Individuals with ASD may struggle with food related difficulties, but also experience a reliance on strict routines outside of eating behaviours. Additionally, an individual can experience ARFID without an ASD diagnosis.
Attention deficit hyperactivity disorder (ADHD)
ADHD is a neurodevelopmental disorder, typically diagnosed in childhood but can be missed and diagnosed later in life. Studies have documented that the overlap of ARFID and ADHD may occur in 15-40% of patients. Symptoms may include difficulty with concentration, impulse control, and hyperactivity, this can lead to the development of ARFID. This may occur due to:
- Inattentiveness, distraction or hyperfocus may cause someone with ADHD to forget or miss out on meals.
- They may eat very quickly, leading to choking, trauma, and more restrictive eating.
For ADHD symptoms, medication may be prescribed by a psychiatrist or physician to help improve focus, impulse control, and overall functioning. Studies have shown that the use of stimulant medication is safe in individuals with ARFID, however, medication alone is typically not sufficient to address ARFID.
Anxiety
Anxiety Is one of the most prominent comorbid psychiatric diagnoses alongside ARFID, with a persistent anxiety around the consequences of eating. It may start with a gradual increase of fear, such as choking on food (possibly causing an automatic gag reflex) or fear of an allergic reaction (anaphylaxis). A person’s fear may start from a physical illness from vomiting, diarrhoea, constipation or stomach aches.
Read more: How to explain anxiety to someone
Treatment for ARFID
Treatment may require more than one type and from a range of services from different types of professionals. The services that may be provided will vary throughout the country. Currently there are no specific guidelines available for the treatment of ARFID, as is not included in SIGN or NICE guidelines for eating disorders.
The most effective treatment option for ARFID is Psychotherapy. There are three main approaches that are suitable:
- Cognitive Behavioural Therapy (CBT)
- Exposure Therapy
- Dialectical behavioural therapy (DBT)
ARFID will occur differently in each patient and any treatment will only be a success if it is based on the patient's individual problems and their specific challenges. It will also depend upon the severity, health status and locality of treatment which is most often conducted within a community setting. Goals will need to be set which focus upon eating which may include:
- Eating a wider range of foods
- Over time, becoming more comfortable eating in front of other people
- Reducing fear of vomiting or choking
- Increasing one’s interest towards foods
- Reduction in anxiety around food items
- Correcting any deficiencies
The goal of therapy for ARFID is to help with exposure, anxiety, and the thought processes that surround the ARFID. The therapist will work on a list of fear foods from the least fearful to most anxiety-provoking until the individual is comfortable around all of their feared foods. This type of work includes mental visualisation, writing and talking through steps to exposure. The exposure work includes practising coping skills for distressing situations and using cognitive behavioural therapy to address negative thoughts. Additionally, therapy will involve practice sessions to help desensitise patients to a variety of situations and foods that may occur in everyday life. The main goals of treatment are to support the individual in maintaining healthy eating habits and patterns, to learn ways of eating without experiencing fear and increase the variety of foods they eat.
What ARFID is not:
- This disorder is not a child specific disorder: Individuals can be diagnosed at any age and it should not be disregarded in adults. The actual prevalence of ARFID remains uncertain since the majority of research concentrates on paediatric populations, and there's a recognition of underdiagnosis stemming from misidentification and limited awareness of this eating disorder among individuals.
- A weight-centric eating disorder: An individual may lose weight or have low weight, but it is important to be aware that this is not a criteria for ARFID and this can occur at any weight. A person would not be given a diagnosis of ARFID at the same time as another eating disorder e.g. anorexia nervosa, although it could precede or follow. If an individual were restricting their food intake due to weight and shape concerns, they may be given a diagnosis of anorexia nervosa if the criteria is met.
- “Picky eating”: AFRID is often misdiagnosed as “picky eating”, especially in children. ARFID goes beyond this, it's a complex eating disorder characterised by significant limitations in food intake, often due to sensory issues, fear of adverse consequences, or lack of interest in eating.
- Only experienced by individuals with autism: It is possible for ARFID to be stand alone however it can also co-occur with other diagnoses such as autism, anxiety disorders, ADHD or certain medical conditions. An individual's experience of ARFID could be either long term or a more recent onset.
Additionally, a diagnosis of ARFID would not be given to someone for example if they are fasting for religious or cultural reasons, or if there was a lack of availability of certain foods or avoidance of food types due to allergies, or due to a medical condition such as dysphagia (a swallowing difficulty), digestive issues or other eating difficulties.
If You Are Worried
If you are concerned that you or a loved one is struggling with ARFID, we recommend that you book an appointment with a GP or a Mental Health Practitioner (MHP) to discuss this further.
Some handy tips for your appointment:
- Read the BEAT GP leaflet to ensure you have all the information you require to explain your situation to your GP or MHP.
- If you feel nervous, you could have someone with you during your appointment to ensure you feel seen and heard, and get all important information across to the clinician.
The thought of changing your eating habits may feel daunting, however getting support from your GP or MHP will allow you to gain support so you don’t have to navigate this on your own.
If you meet the criteria for ARFID, your GP or MHP will make a referral to the appropriate service, including CAMHS or community-based services for children and adolescents, or a specialist eating disorders service, community based general mental health service or hospital based liaison services for adults. Some medication may also be considered and prescribed often to help with the levels of anxiety which creates more distress.
If you are concerned that a family member or friend has ARFID, talk with them to support and encourage them to seek the right help and support. They may not be as concerned as you about their eating habits, however it’s important to give them time to think about the situation and meet them where they are ready.
ARFID can lead to serious malnutrition and have a devastating impact upon a person's everyday life experience, however recovery and support is possible so it is important to receive the help they need to get better.
Further Resources:
- England Helpline: 0808 801 0677 | help@beateatingdisorders.org.uk
- Scotland Helpline: 0808 801 0432 | Scotlandhelp@beateatingdisorders.org.uk
- Wales Helpline: 0808 801 0433 | Waleshelp@beateatingdisorders.org.uk
- Northern Ireland Helpline: 0808 801 0434 | NIhelp@beateatingdisorders.org.uk
- The Nest: A confidential, inclusive and welcoming space for anyone wanting to share their eating disorder experiences, open daily.
- Hummingbird: A confidential, inclusive and welcoming space for anyone with an ARFID diagnosis and/or experiencing ARFID symptoms
- Arfid Awareness UK: the UK’s only registered charity dedicated to raising awareness and furthering information about Avoidant/Restrictive Food Intake Disorder.
