Avoidant/Restrictive Food Intake Disorder (ARFID)

What is ARFID?

Avoidant/Restrictive Food Intake Disorder (ARFID) is a recently recognized eating disorder that affects children, adolescents and adults. People with ARFID have an unsafe aversion to certain foods—or, in some cases, all foods. ARFID is an eating disorder recognized by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which catalogs and classifies various conditions. It differs significantly from more widely known EDs like anorexia nervosa, bulimia nervosa and binge eating disorder.

According to the DSM-5, ARFID’s diagnostic criteria are:

1. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
   1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
   2. Significant nutritional deficiency.
   3. Dependence on enteral feeding or oral nutritional supplements.
   4. Marked interference with psychosocial functioning.
2. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
3. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
4. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

In less technical terms, a person with ARFID has a need to avoid or restrict certain foods, or all foods, to an extent that it harms their health. For some people, the disorder focuses on specific textures, colors or types of foods that might be associated with a traumatic event. For other people, the disorder applies to feeding in general. As a result, someone with ARFID doesn’t get enough nutrition to meet their needs, and their overall health declines if the disorder is untreated.

Who it affects: ARFID often affects young children, who depend on adequate nutrition to grow and thrive. It can also occur in adolescents and even adults.

How it develops: People with ARFID have an aversion to eating, or to certain kinds of foods. It could start with a traumatic incident, such as choking on a bite of food. Or it can start if a person has difficulty digesting certain foods. To compensate, a patient might rely on nutritional supplements.

How ARFID is different: ARFID is different from anorexia, bulimia and other eating disorders. ARFID patients have no desire to lose weight or improve their body image. ARFID doesn’t apply to people who follow occasional fasting rituals for religious or other reasons. It doesn’t apply to patients who lose their appetite temporarily, such as while undergoing chemotherapy. It’s different from eating disorders that result from another medical condition. Finally, it is different from food preferences, such as a child who refuses to eat liver.

Signs to look for: People with ARFID might be fearful of eating in general or of eating certain specific foods. They might seem to never have an appetite. They might eat only very small portions or move food around on the plate without eating it. They might use nutritional supplements regularly.