All eating disorders can be challenging. You might have some understanding of eating disorders like anorexia and bulimia, but one that’s not as well-known is avoidant restrictive food intake disorder (ARFID).
If you or someone you care about is dealing with ARFID, this guide is here to help. We’ll explain what ARFID is, talk about the different types of ARFID and the signs to look out for. We’ll also explore private treatment options for ARFID in the UK.
What is ARFID?
ARFID, which is short for ‘avoidant restrictive food intake disorder’, is a specific type of eating disorder that sets itself apart from more well-known disorders like anorexia nervosa and bulimia nervosa.
Unlike these eating disorders, ARFID doesn’t revolve around concerns about body image or weight. Instead, people with ARFID have a limited variety of foods they’re willing to eat. This restriction can stem from a number of factors, including:
- Sensory sensitivities (such as having an aversion to certain textures or smells)
- Fear of choking or vomiting
- Past traumatic food-related experiences (such as being force-fed as a child)
The impact that ARFID can have on someone shouldn’t be underestimated. It’s not just a case of ‘picky eating’ or ‘fussy eating’. It’s a serious medical condition that can lead to nutritional deficiencies, stunted growth in children and significant disruptions in a person’s daily life.
In the UK, ARFID is gaining recognition as a concerning issue. According to Beat, ARFID makes up approximately 5% of all eating disorder cases in the UK. This highlights the importance of raising awareness about ARFID and ensuring that people have access to the treatment they need.
Types of ARFID
There are three different types of ARFID, each of which has its own characteristics. These are:
- Avoidant type – this form of ARFID causes people to have a strong dislike for certain foods or food groups, often because of sensory issues like texture, smell or taste. People with avoidant ARFID might have a limited range of foods they’re willing to eat, which can make it hard for them to maintain a balanced diet.
- Aversive type - aversive ARFID is when someone experiences intense fear or anxiety relating to food. This often stems from past traumatic experiences involving food, such as choking, vomiting or being force-fed. These people might avoid specific foods or entire food groups to ease their anxiety.
- Restrictive type – in restrictive ARFID, people limit their food choices based on preferences rather than sensory issues or fear. They might develop a strong attachment to certain foods or food groups, which means their diet can lack variety and essential nutrients. They may also show a general lack of interest in eating.
While these categories can help to categorise ARFID, it’s important to remember that people might show a combination of these types and the severity of their symptoms can vary.
People often need to go through a tailored treatment programme for ARFID, helping them to address their unique challenges with the condition.
ARFID can cause a range of symptoms that can look different in adults and children. Understanding these symptoms is essential in order to spot when ARFID might be present and get help as soon as possible.
ARFID symptoms in adults
- Limited food choices – adults with ARFID might have an extremely restricted selection of foods they’re willing to eat. For example, they might only eat plain white rice, chicken breast or a specific brand of peanut butter, and they might exclude entire food groups from their diet. It’s quite common for people with ARFID to have a complete aversion to any type of fruit or vegetables, which can lead to chronic constipation, especially if they replace fruit and vegetables with processed foods instead
- Sensory issues – sensory sensitivities can look different for everyone. For example, some adults with ARFID may avoid foods with slimy textures, such as seafood. Others might avoid foods with grainy textures, like oatmeal. Or you might have an aversion to strong smells, like garlic or onions, which can make lots of dishes unappealing to you
- Food-related anxiety – the anxiety that you feel around food can vary in intensity. Some adults might feel anxious when they’re dining out with friends and family, as they’re worried they won’t find anything on the menu they can eat. Others might experience intense anxiety just thinking about trying new or unfamiliar foods
- Weight issues or nutritional deficiencies – if you avoid a wide range of foods, this can cause weight loss and means you can find it difficult to maintain a healthy body weight. On the other hand, if you limit the things you eat to fatty, sugary or processed foods, this can lead to weight gain. A restricted diet can also result in deficiencies in essential nutrients like iron, calcium or vitamin C, impacting your overall health and wellbeing
ARFID symptoms in children
- Colour-based preferences – children with ARFID might only want to eat foods of a specific colour. For example, they might prefer foods that are white or beige and avoid foods of other colours
- Temperature preferences – some children with ARFID might only eat foods that are a particular temperature, such as hot foods or very cold foods, and refuse to eat anything else
- Shape or presentation preferences – a child might insist on foods that are cut into specific shapes, such as triangles or squares. Or they might only eat foods in certain forms, such as chicken nuggets and chips instead of chicken breast and potatoes
- Brand loyalty – children with ARFID might be very rigid when it comes to the brands of foods they’re willing to eat. They may only accept one brand of a particular product and reject all others
- Texture sensitivities – some children may avoid foods that are slimy, gritty or mushy, even if they are the same type of food as something they would normally eat. For example, children might eat garden peas but refuse to eat mushy peas because of their texture
- Mealtime tantrums – children with ARFID may throw tantrums, cry or become visibly distressed when they’re presented with unfamiliar or disliked food during mealtimes
- Limited food variety – a child with ARFID may eat the same foods day after day, avoiding any foods that fall outside of their comfort zone
- Failure to thrive – in severe cases, young children with ARFID might have stunted growth or developmental delays because of their limited and nutritionally inadequate diet
You can find out more about how we treat eating disorders in children by visiting our private CAMHS page.
It’s also important to note that it’s common for ARFID to co-occur alongside other mental health conditions and have symptoms that overlap. Some of the most common conditions that can co-occur with ARFID are:
- Autism – find out more about ARFID and autism
- Attention deficit hyperactivity disorder (ADHD)
- Obsessive compulsive disorder (OCD)
ARFID treatment options
Treatment for ARFID aims to address the unique challenges that someone can face when they have this complex condition. It tends to focus on expanding food acceptance and improving overall wellbeing.
Several approaches to eating disorder treatment can be effective when it comes to helping people with ARFID.
- Cognitive behavioural therapy for ARFID (CBT-AR): CBT-AR is a specialist type of CBT, tailored to ARFID. It helps people to identify and challenge irrational beliefs and fears related to food, gradually exposing them to new foods in a structured and supportive way. CBT-AR can be effective when it comes to increasing food variety and reducing anxiety around mealtimes
- Exposure therapy: This approach involves gradually exposing someone to foods, textures or smells they might fear or avoid. It’s often incorporated into CBT-AR and can help people to expand their food preferences over time
- Eye movement desensitisation and reprocessing (EMDR): EMDR is a technique that was originally designed to treat trauma. However, it’s been adapted to address the emotional and sensory aspects of ARFID. It can help people to reduce anxiety when it comes to specific foods, or situations involving eating
- Nutritional counselling: Registered dietitians or nutritionists can work with people to create balanced meal plans that aim to accommodate their selective eating habits. This means they can still get the nutrients they need. This normally happens alongside therapeutic elements of treatment
- Family based treatment (FBT): FBT involves the entire family in the treatment process, educating them about ARFID and providing strategies for meal planning and support. This approach can be particularly effective when it comes to treating children and young people
- Medication: In some cases, medication might be prescribed to someone with ARFID to help manage any co-occurring mental health problems, such as anxiety, which could be making their ARFID symptoms worse. An example could be selective serotonin reuptake inhibitors (SSRIs), which are a type of antidepressant
The effectiveness of these treatments can vary depending on individual circumstances and how severe someone’s ARFID is. Often, a combination of therapies is needed to fully address this complex condition and help someone get back on track.
Get help for ARFID
If you think you may be showing the signs of ARFID, it’s important that you get the help you need. ARFID is treatable and the sooner you get help, the sooner you’ll be able to take steps towards recovery.
As an initial step, it’s a good idea for you to reach out to your GP. They’ll be able to assess your symptoms and make recommendations for next steps. This might include a referral to a private provider of eating disorder treatment, such as Priory. Alternatively, you can speak to Priory directly.
At Priory, we can deliver specialist interventions for ARFID, designed to help you to expand your diet and address your underlying fears and anxiety.
Private treatment for ARFID is tailored to your individual needs, and our multidisciplinary team is dedicated to supporting you every step of the way towards achieving a healthier relationship with food.