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ARFID (Avoidant/Restrictive Food Intake Disorder)

Eating disturbance with food avoidance unrelated to body image, leading to nutritional or psychosocial consequences.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →

What is ARFID (Avoidant/Restrictive Food Intake Disorder)?

Avoidant/Restrictive Food Intake Disorder (ARFID) was introduced in DSM-5 as a feeding and eating disorder characterized by persistent failure to meet appropriate nutritional and energy needs, with weight loss, nutritional deficiency, dependence on enteral feeding or supplements, or marked psychosocial impairment. Unlike anorexia nervosa, the disturbance is not motivated by body image or weight concerns.

Three clinical phenotypes are recognized: (1) sensory sensitivity (avoidance based on appearance, smell, texture, taste, or temperature), (2) lack of interest in eating or low appetite, and (3) fear of aversive consequences (typically choking, vomiting, contamination after a triggering event). Many patients have features from multiple phenotypes.

ARFID often begins in childhood and may persist into adulthood. Comorbid conditions include autism spectrum disorder, ADHD, anxiety disorders, GI conditions, and trauma-related disorders. Diagnosis requires comprehensive medical, nutritional, and psychiatric assessment. Treatment combines family-based therapy (FBT-ARFID), cognitive behavioral therapy (CBT-AR), nutritional rehabilitation, and management of comorbid conditions, occasionally including medications targeting anxiety, appetite, or comorbidities.

Symptoms

Avoidance of specific foods based on sensory features
Eating only narrow range of foods (often beige, processed)
Lack of interest in food or low appetite
Fear of choking, vomiting, or food contamination
Weight loss or failure to grow (children)
Nutritional deficiencies (iron, B12, vitamin D, zinc)
Dependence on nutritional supplements or tube feeding
Anxiety or distress around eating or new foods
Avoidance of social eating situations
Fatigue, dizziness from undernutrition
Constipation, abdominal pain
Brittle hair, dry skin, brittle nails
Mood changes, irritability around mealtime
Family conflict at meals
Delayed puberty (in adolescents)
Bradycardia, hypothermia (severe undernutrition)

Risk Factors

Autism spectrum disorder
ADHD
Anxiety disorders, OCD
Sensory processing disorder
Childhood feeding difficulties
Choking or vomiting traumatic event
Severe food allergies or intolerance
GI conditions (reflux, IBS, EoE)
Family history of eating disorders
Selective eating in family members
Trauma related to eating or feeding tubes
Female sex (adolescent presentations)
Picky eating in early childhood
Premature birth
Cleft lip and palate or oromotor difficulties

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Significant weight loss or failure to thrive
  • Severely restricted food range (under 20 foods)
  • Avoidance causing social or family disruption
  • Suspected nutritional deficiency
  • Dependence on supplements or tube feeding
  • Choking or vomiting fear after traumatic event
  • Persistent picky eating beyond developmental norms
  • Adolescent or adult new food avoidance
  • Coexisting anxiety or autism with feeding issues
  • Bradycardia or other medical complications

Treatment Methods

01
Multidisciplinary assessment: pediatrics or internal medicine, eating disorder psychiatrist, registered dietitian, occupational therapist (sensory)
02
Medical workup: weight trend, growth chart, electrolytes, CBC, ferritin, vitamin B12, vitamin D, zinc, lipid panel, EKG
03
Differentiate ARFID from anorexia nervosa, OCD, depression, GI disorders
04
Screen for autism, ADHD, anxiety comorbidities
05
Family-based therapy adapted for ARFID (FBT-ARFID): parental support during refeeding
06
CBT-AR (cognitive behavioral therapy for ARFID) for older adolescents and adults: graduated exposure, sensory habituation, anxiety reduction
07
Sensory-based feeding therapy with OT/SLP for sensory subtype
08
Systematic desensitization for fear-based subtype
09
Appetite stimulants (cyproheptadine, mirtazapine) in low-appetite phenotype (limited evidence)
10
SSRIs for comorbid anxiety, OCD
11
Nutritional rehabilitation: gradual introduction of feared foods
12
High-calorie, nutrient-dense supplementation if needed
13
Multivitamin and mineral supplementation
14
Refeeding monitoring (electrolytes, fluid status, cardiac)
15
Tube feeding only for severe weight loss or refusal
16
Hospitalization for medical instability (severe bradycardia, hypothermia, electrolyte imbalance)
17
Treat comorbid GI conditions (eosinophilic esophagitis, reflux)
18
Address autism spectrum disorder coexistence with structured supports
19
Family education and parental coaching
20
School accommodations and meal plan support
21
Long-term follow-up: weight trajectory, food range expansion
22
Prevention of relapse during transitions (school changes, illness)

Which Department to Visit?

You can visit our Psikiyatri department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.