ARFID is an eating disorder that causes people to avoid eating certain foods. Symptoms may include picky eating, fear of choking, weight loss and poor appetite, but they can vary widely. If often affects children.
Like anorexia, ARFID involves consuming too few calories and nutrients. However, unlike anorexia, ARFID does not involve a desire for thinness or a fear of being overweight.
Medical experts do not know exactly what causes ARFID. However, co-occurring conditions — such as autism spectrum disorder, attention deficit hyperactivity disorder (ADHD), and anxiety disorders — may increase a person’s risk.
“ARFID” is the current name for the condition that doctors previously called selective eating disorder.
Unlike anorexia, ARFID does not involve fears of being overweight or concerns about body shape or size.
People with ARFID do not consume enough calories to support basic body functions or to grow and develop properly. In adults, this results in weight loss, while in children, it stalls weight gain and growth.
- be aged 4–11
- be male
- have experienced the symptoms for a long time
Heather’s story: Symptoms in childhood
“ARFID has been a part of my life long before it even had a name to use for diagnosis. My parents can pinpoint parts of my life as a baby that I’d refuse certain textured baby foods, but I remember it most as a child.
Growing up, I was always the ‘picky-eating’ family member and friend in my loved ones’ lives. Sitting at the dinner table as a kid, I’d be faced with the same pressure most children face, but I’d sit there for hours facing the fear of taking a simple bite of food.
When I would finally muster enough courage to eat food I wasn’t familiar with, my gag reflex would instantly trigger and it would send me into an anxiety attack. I now know I have aversions to specific textures and tastes.”
The signs and symptoms may affect psychological and physical health.
Psychological and behavioral
- significant weight loss
- restrictions in the amount and types of food a person eats
- consistent, unexplained gastrointestinal problems during mealtimes
- cold intolerance, constipation, lethargy, and abdominal pain
- fears of vomiting or choking
- dressing in layers to keep warm or hide weight loss
- small appetite
- desire to consume only foods with certain textures
- picky eating that progressively worsens
Physical health signs and symptoms include:
- nonspecific gastrointestinal complaints, such as reflux, constipation, and stomach cramps
- difficulty concentrating
- sleep problems
- a constant cold feeling
- brittle nails
- dry skin
- fine hair on the body (lanugo)
- muscle weakness
- slow wound healing
- menstrual irregularities
- thin, dry, brittle hair
- mottled cold hands and feet or swelling in feet
- impaired immune functioning
Kelsey’s story: Undetected symptoms
“I was raised by picky eater, so in my family, it wasn’t really seen as abnormal.
This all really started when my younger brother was sitting in his high chair. He would shove too much food in his mouth and he would often choke or gag on his food. My parents would have this huge reaction and rush to him. And
I was like, oh, that’s something that I need to fear and I became very avoided it. Anytime he did it, I would run away. I was really scared. That’s when I think my anxiety started.
Then, started struggling with chronic gastrointestinal (GI) symptoms and chronic nausea. The more I struggled with these things the more I didn’t have any answers.”
Because ARFID has varied, nonspecific symptoms, it can be difficult to know whether a person has the condition. People who think they may have ARFID can assess their symptoms by judging their responses to the following questions:
- Are you picky about food?
- Do you have difficulty eating foods that you used to eat?
- Are you afraid of choking on foods or vomiting?
- Do you avoid foods with certain textures?
- Do you eat slowly?
- Are you excluding more and more foods from your diet?
- Have you experienced weight loss?
If a person answers “yes” to one or more of these questions, it is a good idea to contact a doctor to discuss their eating habits.
Researchers do not know the exact causes of ARFID, but a
- oversensitivity in taste perception
- decreased activity of the brain’s appetite-regulating centers
- a traumatic eating experience that leads to a phobic response
Like other eating disorders, ARFID has risk factors that involve a range of sociocultural, psychological, and biological components. Specifically, the following groups may be at higher risk:
- children with anxiety disorders
- children who do not outgrow picky eating or whose picky eating is severe
- individuals with autism spectrum disorder, intellectual disabilities, or ADHD
Heather’s story: Receiving another diagnosis
“Not long after receiving my ARFID diagnosis and seeing an eating disorder specialist, I was diagnosed with an anxiety disorder. I never really noticed symptoms of anxiety until my collegiate years, but I didn’t receive an official diagnosis until I was 27 or 28.”
- nutritional monitoring
- close medical monitoring
- hospital-based feeding
- parental education
- medications, such as low dose antipsychotic drugs like olanzapine (Zyprexa)
- psychotherapy, such as cognitive behavioral therapy (CBT), individual therapy, and family therapy
Treatment goals include:
- medically stabilizing the person
- restoring weight and growth
- managing the pain or fear associated with eating
- increasing the variety of foods the person will eat
- restoring the joy of eating
Kelsey’s story: Seeking treatment
“There was an incident where my co-worker got food poisoning. I had my first panic attack at least that I kind of recognized as a panic attack. I googled my symptoms, and I remember bringing it to my therapist at the time, and saying this feels like this fits! She said, no, you don’t have an eating disorder.
Luckily, I ended up moving around that time and I got a therapist who pretty immediately said, yes, you have ARFID and you need to go to treatment right now.
I started doing about 10 hours a day, six days a week, then tapered down as I continued to move through the program. I remember on the second day, I texted my parents from the bathroom and was like, ‘I’m leaving, I’m not doing this. This is too hard. They’re expecting too much of me.’ I had to start learning skills and tools right away to help manage my distress.
After I left treatment, my therapist at the time really wanted me to do eye movement desensitization reprocessing (EMDR). It’s a trauma therapy to target my emetophobia (fear of vomiting) because even though I didn’t have eating disorder behaviors anymore, I was still really struggling.
When I tried EMDR, it was incredible. Now, if I have an intrusive thought pop into my head, I have the skills to think ‘not right now.’ And it doesn’t translate into somatic anxiety for me anymore.”
Editor’s note: EMDR is not a first-line treatment for ARFID and does not work for everyone, but research has shown that it may be helpful for people with traumatic experiences around food.
- severe malnutrition
- substantial weight loss that results in low blood pressure and slow heart rate
- micronutrient deficiencies
- low bone mineral density
- dependence on external nutrition
Additionally, because people with ARFID do not consume the necessary nutrients to fuel typical physiological functions, all their body processes slow down to conserve energy. This can have serious negative effects.
Kelsey’s story: Mental health and social life
“It was very difficult. I actually remember right before I went into treatment, I went on a double date and we went ice skating. I skated like a couple of feet and I was like, ‘I haven’t eaten in so long and I’m so tired,’ and I remember being very embarrassed.
I remember like I really, really wanted to eat and wanted to just be able to enjoy the skate. We went out to eat after, and I was making all these excuses. I just felt like I was living outside of my values.
I don’t even remember the date beyond my own internal thoughts.”
Heather’s story: Physical health effects
“After years of having ARFID, I am only just now starting to see the physical health impacts of it.
Slightly-elevated cholesterol, lower iron intake, and some recent weight gain have been the primary ways in which ARFID has shown it could be impacting my physical health lately. But for most of my life, I have had no major issues.”
Limited research is available on the outlook for people with ARFID.
In an older
They found that 1 year after discharge, 62% of people met the criteria for remission, but 21% needed to be admitted to the hospital again.
Kelsey’s story: Supporting others
“Recovery was made that much harder because I didn’t know anyone else who was going through what I was going through
Now, I work with patients who have ARFID. I get to teach them skills and stuff that worked for me and hopefully they work for them, so don’t have to suffer the way that I did. So, that’s really powerful for me.”
People who have ARFID do not have a fear of gaining weight like people with some other eating disorders do. Possible symptoms of ARFID include dramatic weight loss, poor appetite, and physical health issues such as dizziness and muscle weakness.
ARFID can be difficult to diagnose. If a person or their loved one or child shows any symptoms of the condition, it is a good idea to contact a doctor.