Avoidant/Restrictive Food Intake Disorder (ARFID) is a medical diagnosis given to people who are very selective about what they eat, to the point that it makes living a normal life difficult. People diagnosed with the condition are not just ‘picky’ eaters – their aversion to food or lack of appetite has deeper roots than simple preference.
Read on to find out:
What is Avoidant/Restrictive Food Intake Disorder?
ARFID is classed as an eating disorder in the fifth edition of the Diagnostic and Statistical Manual (DSM-V) that doctors use to diagnose mental health disorders. While it first appeared in 2013 as an official diagnosis, the condition is not new. For decades, doctors and psychologists have been treating children and adults who struggle to eat without a formal diagnosis.
ARFID looks different from better-known eating disorders like anorexia or bulimia because it’s not driven by body image or fear of gaining weight. Instead, people with ARFID eat very little or avoid food altogether because of strong sensory reactions, low interest in eating, or fear of getting sick from eating – like choking or vomiting.
Restricted eating can lead to weight loss, poor growth, vitamin and mineral deficiencies, and even a need for tube feeding. It can also make it hard for people to take part in normal activities like eating at restaurants or with friends.
While ARFID can affect anyone, it’s more often seen in children and teens. This isn’t necessarily because it’s more frequent in kids; it’s just that parents are more likely to take their child to the doctor for a diagnosis than an adult is to take themselves.
Before the term Avoidant/Restrictive Food Intake Disorder was introduced, similar symptoms were grouped under ‘feeding disorder of infancy or early childhood’. Experts now recognize that ARFID can affect people at all ages and has many manifestations and causes.
What Are The Signs and Symptoms of ARFID?
People with ARFID often avoid certain foods or eat only very specific items. This might be because of how the food looks, smells, feels, or tastes. Some are scared to eat because they once choked or got sick. Others simply don’t feel hungry or have little interest in food.
These behaviours can lead to physical symptoms like tiredness, dizziness, or being cold all the time. They can also affect mental health. People with ARFID may feel anxious, avoid social situations, or struggle with self-esteem. In children, ARFID can slow growth and delay development.
How is ARFID diagnosed?
What’s the definition?
To be diagnosed with ARFID, according to the DSM-V, a person must fulfil four criteria:
- To have an unusual eating pattern that leads to one or more of the following:
- Their restrictive eating pattern can’t be explained by another mental health diagnosis or a pre-existing medical condition, or is more extreme than what doctors would normally see.Â
- Their eating pattern is not due to food shortages or religious/cultural practices
- The person must not be trying to lose weight because of body image concerns – that would suggest another eating disorder like anorexia.
How Is ARFID Diagnosed?
Doctors usually use a team approach to diagnose ARFID:
- A medical doctor checks for growth delays, weight loss, and nutrient deficiencies.
- A psychologist looks at eating habits, anxiety, and other mental health issues. Experts often use screening tools like the nine-item ARFID screen (NIAS) or the Eating Disturbances in Youth-Questionnaire (EDY-Q) to help make a diagnosis.
- Dietitians might look at what foods the person eats and avoids, and whether their diet meets their nutritional needs.
ARFID is more common in people with conditions like autism, ADHD, or anxiety and so can be overlooked. It’s important to check whether food-related problems experienced by people with these diagnoses are more severe than doctors would normally expect.
Who Gets ARFID?
ARFID can affect anyone, but it’s most often seen in children and teenagers. Boys are more likely to be diagnosed than girls. People with sensory issues, anxiety or neurodevelopmental conditions like autism are at higher risk.
We don’t know the exact number of people with ARFID, but studies give us some clues. In a survey of Swiss schoolchildren, 3.2% met the criteria. In eating disorder clinics, ARFID makes up between 5% and 14% of cases. Rates are even higher in day treatment programmes for teens.
This might not be an accurate picture of the demographics of ARFID, since only people examined by a doctor and reporting symptoms can be diagnosed.Â
How is ARFID treated?
Treating ARFID usually requires a multidisciplinary approach, involving doctors, psychologists and dietitians.Â
The first step is usually to solve immediate health problems caused by ARFID.
Medical treatment focuses on:
- improving nutrition
- gaining weight
- correcting any vitamin or mineral deficiencies
- in severe cases, supplements or tube feeding might be needed at first.
The next step will be to address ARFID itself. Evidence suggests that talking therapy is effective at helping people to try more foods.
Common approaches include:
- Cognitive Behavioural Therapy for ARFID. CBT-AR is one approach that helps people gradually try new foods while managing fear and anxiety.Â
- Family-Based Treatment (FBT) can help children, especially those with sensory issues, get back to regular eating. Other strategies like Food Chaining slowly introduce new foods by building on what the person already eats.Â
- For younger kids, play-based programmes like FBI (Feeling and Body Investigators) help them get used to hunger and fullness cues.
In some cases, doctors may use medications to help with anxiety, appetite, or rigid thinking. Examples of drugs that can ease anxiety and improve appetite include cyproheptadine and mirtazapine, amongst others. These drugs are prescribed off-label for this condition and only when needed.
Families can work with a dietitian to create menus to help patients satisfy their nutritional needs while respecting that some foodstuffs may be ‘off the menu’.
Every person with ARFID is different, so doctors must tailor treatment plans to fit individual needs. Support from a patient’s family and/or caregivers is especially important.
What Causes ARFID?
There’s no single cause of ARFID. Instead, it seems to come from a mix of factors.
Some people are very sensitive to how food tastes, smells, or feels in their mouth. Others might stop eating after a bad experience, like choking or vomiting. Some just don’t get hungry often or don’t enjoy eating. Family habits, early feeding experiences and even cultural norms can also play a role. Often, these factors overlap - that’s why ARFID can look very different from person to person.
Research suggests that ARFID may have roots in brain biology. Experts describe three core patterns in ARFID: sensory sensitivity, fear of getting sick, and low interest in food. Many people fall into more than one of these categories.
Brain scans show that people with strong sensory reactions to food may have more activity in areas like the insula, which processes taste and body signals. Those with fear-based avoidance may have an overactive amygdala, the part of the brain involved in fear and threat. People who aren’t interested in eating may have differences in reward systems or hunger signals, possibly linked to dopamine.
This growing evidence suggests that ARFID isn’t just about behaviour – it may reflect real differences in how some people’s brain works.
Conclusion
ARFID is more than picky eating. It’s a genuine disorder that can affect health, growth, and quality of life. It’s often linked to anxiety, sensory issues or past trauma around food. Thanks to new research, we now understand that ARFID might have roots in neurodevelopment – not just personal choice.
With the right support and treatment, recovery is possible. The key is recognizing the problem early and finding a team that understands how to help. As awareness grows, so does our ability to help people with ARFID lead healthier, fuller lives.
Bibliography
Administration SA and MHS. Table 22, DSM-IV to DSM-5 Avoidant/Restrictive Food Intake Disorder Comparison. June 2016. Accessed July 18, 2025. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t18/.org/10.1016/j.cppeds.2017.02.005
Białek-Dratwa, A., Szymańska, D., Grajek, M., Krupa-Kotara, K., Szczepańska, E., & Kowalski, O. (2022). ARFID – Strategies for Dietary Management in Children. Nutrients, 14(9), 1739. https://doi.org/10.3390/nu14091739
Brigham, K. S., Manzo, L. D., Eddy, K. T., & Thomas, J. J. (2018). Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents. Current Pediatrics Reports, 6(2), 107–113. https://doi.org/10.1007/s40124-018-0162-y
Dyck Z van, Hilbert A. Eating Disorders in Youth-Questionnaire. Published online June 21, 2016.
Murray HB, Dreier MJ, Zickgraf HF, et al. Validation of the Nine Item ARFID Screen (NIAS) subscales for distinguishing ARFID presentations and screening for ARFID. Int J Eat Disord. 2021;54(10):1782-1792. doi:10.1002/eat.23520
Zimmerman, J., & Fisher, M. (2017). Avoidant/Restrictive Food Intake Disorder (ARFID). Current Problems in Pediatric and Adolescent Health Care, 47(4), 95–103. https://doi1.
Avoidant/Restrictive Food Intake Disorder (ARFID) is a medical diagnosis given to people who are very selective about what they eat, to the point that it makes living a normal life difficult. People diagnosed with the condition are not just ‘picky’ eaters – their aversion to food or lack of appetite has deeper roots than simple preference.
Read on to find out:
What is Avoidant/Restrictive Food Intake Disorder?
ARFID is classed as an eating disorder in the fifth edition of the Diagnostic and Statistical Manual (DSM-V) that doctors use to diagnose mental health disorders. While it first appeared in 2013 as an official diagnosis, the condition is not new. For decades, doctors and psychologists have been treating children and adults who struggle to eat without a formal diagnosis.
ARFID looks different from better-known eating disorders like anorexia or bulimia because it’s not driven by body image or fear of gaining weight. Instead, people with ARFID eat very little or avoid food altogether because of strong sensory reactions, low interest in eating, or fear of getting sick from eating – like choking or vomiting.
Restricted eating can lead to weight loss, poor growth, vitamin and mineral deficiencies, and even a need for tube feeding. It can also make it hard for people to take part in normal activities like eating at restaurants or with friends.
While ARFID can affect anyone, it’s more often seen in children and teens. This isn’t necessarily because it’s more frequent in kids; it’s just that parents are more likely to take their child to the doctor for a diagnosis than an adult is to take themselves.
Before the term Avoidant/Restrictive Food Intake Disorder was introduced, similar symptoms were grouped under ‘feeding disorder of infancy or early childhood’. Experts now recognize that ARFID can affect people at all ages and has many manifestations and causes.
What Are The Signs and Symptoms of ARFID?
People with ARFID often avoid certain foods or eat only very specific items. This might be because of how the food looks, smells, feels, or tastes. Some are scared to eat because they once choked or got sick. Others simply don’t feel hungry or have little interest in food.
These behaviours can lead to physical symptoms like tiredness, dizziness, or being cold all the time. They can also affect mental health. People with ARFID may feel anxious, avoid social situations, or struggle with self-esteem. In children, ARFID can slow growth and delay development.
How is ARFID diagnosed?
What’s the definition?
To be diagnosed with ARFID, according to the DSM-V, a person must fulfil four criteria:
- To have an unusual eating pattern that leads to one or more of the following:
- Their restrictive eating pattern can’t be explained by another mental health diagnosis or a pre-existing medical condition, or is more extreme than what doctors would normally see.Â
- Their eating pattern is not due to food shortages or religious/cultural practices
- The person must not be trying to lose weight because of body image concerns – that would suggest another eating disorder like anorexia.
How Is ARFID Diagnosed?
Doctors usually use a team approach to diagnose ARFID:
- A medical doctor checks for growth delays, weight loss, and nutrient deficiencies.
- A psychologist looks at eating habits, anxiety, and other mental health issues. Experts often use screening tools like the nine-item ARFID screen (NIAS) or the Eating Disturbances in Youth-Questionnaire (EDY-Q) to help make a diagnosis.
- Dietitians might look at what foods the person eats and avoids, and whether their diet meets their nutritional needs.
ARFID is more common in people with conditions like autism, ADHD, or anxiety and so can be overlooked. It’s important to check whether food-related problems experienced by people with these diagnoses are more severe than doctors would normally expect.
Who Gets ARFID?
ARFID can affect anyone, but it’s most often seen in children and teenagers. Boys are more likely to be diagnosed than girls. People with sensory issues, anxiety or neurodevelopmental conditions like autism are at higher risk.
We don’t know the exact number of people with ARFID, but studies give us some clues. In a survey of Swiss schoolchildren, 3.2% met the criteria. In eating disorder clinics, ARFID makes up between 5% and 14% of cases. Rates are even higher in day treatment programmes for teens.
This might not be an accurate picture of the demographics of ARFID, since only people examined by a doctor and reporting symptoms can be diagnosed.Â
How is ARFID treated?
Treating ARFID usually requires a multidisciplinary approach, involving doctors, psychologists and dietitians.Â
The first step is usually to solve immediate health problems caused by ARFID.
Medical treatment focuses on:
- improving nutrition
- gaining weight
- correcting any vitamin or mineral deficiencies
- in severe cases, supplements or tube feeding might be needed at first.
The next step will be to address ARFID itself. Evidence suggests that talking therapy is effective at helping people to try more foods.
Common approaches include:
- Cognitive Behavioural Therapy for ARFID. CBT-AR is one approach that helps people gradually try new foods while managing fear and anxiety.Â
- Family-Based Treatment (FBT) can help children, especially those with sensory issues, get back to regular eating. Other strategies like Food Chaining slowly introduce new foods by building on what the person already eats.Â
- For younger kids, play-based programmes like FBI (Feeling and Body Investigators) help them get used to hunger and fullness cues.
In some cases, doctors may use medications to help with anxiety, appetite, or rigid thinking. Examples of drugs that can ease anxiety and improve appetite include cyproheptadine and mirtazapine, amongst others. These drugs are prescribed off-label for this condition and only when needed.
Families can work with a dietitian to create menus to help patients satisfy their nutritional needs while respecting that some foodstuffs may be ‘off the menu’.
Every person with ARFID is different, so doctors must tailor treatment plans to fit individual needs. Support from a patient’s family and/or caregivers is especially important.
What Causes ARFID?
There’s no single cause of ARFID. Instead, it seems to come from a mix of factors.
Some people are very sensitive to how food tastes, smells, or feels in their mouth. Others might stop eating after a bad experience, like choking or vomiting. Some just don’t get hungry often or don’t enjoy eating. Family habits, early feeding experiences and even cultural norms can also play a role. Often, these factors overlap - that’s why ARFID can look very different from person to person.
Research suggests that ARFID may have roots in brain biology. Experts describe three core patterns in ARFID: sensory sensitivity, fear of getting sick, and low interest in food. Many people fall into more than one of these categories.
Brain scans show that people with strong sensory reactions to food may have more activity in areas like the insula, which processes taste and body signals. Those with fear-based avoidance may have an overactive amygdala, the part of the brain involved in fear and threat. People who aren’t interested in eating may have differences in reward systems or hunger signals, possibly linked to dopamine.
This growing evidence suggests that ARFID isn’t just about behaviour – it may reflect real differences in how some people’s brain works.
Conclusion
ARFID is more than picky eating. It’s a genuine disorder that can affect health, growth, and quality of life. It’s often linked to anxiety, sensory issues or past trauma around food. Thanks to new research, we now understand that ARFID might have roots in neurodevelopment – not just personal choice.
With the right support and treatment, recovery is possible. The key is recognizing the problem early and finding a team that understands how to help. As awareness grows, so does our ability to help people with ARFID lead healthier, fuller lives.
Bibliography
Administration SA and MHS. Table 22, DSM-IV to DSM-5 Avoidant/Restrictive Food Intake Disorder Comparison. June 2016. Accessed July 18, 2025. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t18/.org/10.1016/j.cppeds.2017.02.005
Białek-Dratwa, A., Szymańska, D., Grajek, M., Krupa-Kotara, K., Szczepańska, E., & Kowalski, O. (2022). ARFID – Strategies for Dietary Management in Children. Nutrients, 14(9), 1739. https://doi.org/10.3390/nu14091739
Brigham, K. S., Manzo, L. D., Eddy, K. T., & Thomas, J. J. (2018). Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents. Current Pediatrics Reports, 6(2), 107–113. https://doi.org/10.1007/s40124-018-0162-y
Dyck Z van, Hilbert A. Eating Disorders in Youth-Questionnaire. Published online June 21, 2016.
Murray HB, Dreier MJ, Zickgraf HF, et al. Validation of the Nine Item ARFID Screen (NIAS) subscales for distinguishing ARFID presentations and screening for ARFID. Int J Eat Disord. 2021;54(10):1782-1792. doi:10.1002/eat.23520
Zimmerman, J., & Fisher, M. (2017). Avoidant/Restrictive Food Intake Disorder (ARFID). Current Problems in Pediatric and Adolescent Health Care, 47(4), 95–103. https://doi1.