ARFID, or avoidant restrictive food intake disorder, is an eating disorder in which a person avoids certain foods, limits how much they eat, or both. The avoidance is not driven by beliefs about weight or body shape, which is what separates ARFID from anorexia nervosa and bulimia nervosa.
Key points
- ARFID is food avoidance or limited intake that is not driven by concerns about weight or body shape.
- Three drivers are recognised: the sensory qualities of food, fear of choking or being sick, and low interest in eating.
- What separates ARFID from picky eating is impact: nutritional problems, reliance on supplements, effects on weight or growth, or interference with daily life.
- ARFID often occurs with autism, ADHD and anxiety. In a UK study of children with ARFID, 43.9% were autistic.
- NICE guideline NG69 states that it does not cover ARFID, and few UK adult services accept ARFID referrals.
Symptoms
- A narrow range of accepted foods, often eaten in the same form each time; strong reactions to taste, texture, smell, appearance or temperature.
- Difficulty noticing hunger, or eating feeling like a chore; anxiety before or during meals, including fear of choking or being sick.
- Nutritional problems, effects on weight or growth in children; avoiding meals with others, eating out, or school and work lunches.
Causes and risk factors
- Autism: sensory differences and a need for sameness are common in autistic people and map onto ARFID drivers.
- ADHD, anxiety disorders and intellectual disability are commonly present alongside it.
- Earlier medical difficulties - choking, reflux, vomiting - can come before the avoidance begins.
Treatment
- Cognitive behavioural therapy adapted for ARFID (CBT-AR) has the strongest emerging evidence, though studies remain small.
- Family-based approaches for children and young people; anxiety treatment combined with graded practice with feared foods and dietitian input.
- No medication is established as a treatment for ARFID; SSRIs are sometimes used off label for food-specific anxiety.
When to speak to a professional
- Food avoidance is affecting your health, weight, growth if you are young, or your ability to work, study or eat with others.
- Contact your GP or NHS 111 the same day if you feel faint or dizzy, cannot keep fluids down, or have chest pain or an irregular heartbeat.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.