What is Avoidant Restrictive Food Intake Disorder (ARFID)?
By Kelsey Chadwick, MS RDN
Thursday February 29th, 2024
For National Eating Disorder Awareness Week 2024, we are sharing information about the types of eating disorders. We hope this can serve as a resource for folks looking to learn more about the distinctions between different disorder types.
Avoidant Restrictive Food Intake Disorder (ARFID) is a relatively new diagnosis in the DSM-5. ARFID is an eating disorder characterized by limiting the volume and/or variety of foods they consume. Unlike other eating disorders, food avoidance or restriction does not involve distress about body weight, shape and size. Someone with ARFID experiences selective eating that is motivated by a lack of interest in eating or food, sensory sensitivity such as strong reactions to texture or smell of foods, and/or fear of aversive consequences like choking or vomiting.
ARFID affects both children and adults and it most commonly develops during infancy or childhood and can persist into adulthood or develop at any age. Diagnostic criteria for ARFID includes an eating or feeding disturbance based on persistent failure to meet appropriate nutritional needs associated with one or more of the following: significant weight loss, significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements and marked interference with psychosocial functioning and the disturbance is not explained by lack of available food or by an associated culturally sanctioned practice. Additionally, the eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa. Lastly, the eating disturbance is not attributable to a medical condition or mental disorder.
The following are behavioral, psychological and physical signs of ARFID:
Behavioral and Psychological Signs
Dramatic weight loss or faltering growth
Constipation, abdominal pain, lethargy, cold intolerance
Only eating certain texture of food
Fear of choking or vomiting
Limited range of preferred foods
Physical Signs
Menstrual irregularities
Thinning hair
Muscle weakness
Dizziness
Fainting
Feeling cold all the time
Abnormal laboratory findings
Health consequences of ARFID are variable depending on an individual but some individuals may experience significant deficiencies of key nutrients which can have a wide range of effects on the body. Treatment for ARFID involves working with a multidisciplinary team. A treatment team includes a physician, psychiatrist, psychotherapist, dietitian and psychiatric nurse. There have been recent studies supporting the effectiveness of cognitive behavioral therapsy for ARFID (CBT-AR), family based therapy for ARFID (FBT-ATFID) and supportive parenting for anxious childhood emotions for ARFID (SPACE-ARFID). Unfortunately, since ARFID is a new diagnosis, there is limited research on effective treatment.
Additional Statistics
Studies show that 0.5-% of children and adults in the general population have ARFID (1)
While there is limited research on the prevalence of ARFID, studies have found that between 0.5%-5% of children and adults in the general population have the disorder. (1)
The rates of ARFID have ranged from 5% to 14% among pediatric inpatient ED programs and as high as 22.5% in a pediatric ED day treatment program. (2)
Studies have consistently demonstrated that, compared to those with AN or BN, ARFID patients are younger, have higher proportion of males, and are commonly diagnosed with comorbid psychiatric and/or medical symptoms. (2)
Kennedy, H. L., Dinkler, L., Kennedy, M. A., Bulik, C. M., & Jordan, J. (2022). How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (ARFID). Journal of eating disorders, 10(1), 53. https://doi.org/10.1186/s40337-022-00578-x
Norris ML, Spettigue WJ, Katzman DK. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatr Dis Treat. 2016 Jan 19;12:213-8. doi: 10.2147/NDT.S82538. PMID: 26855577; PMCID: PMC4725687.