ARFID (Avoidant/Restrictive Food Intake Disorder) is an eating disorder where individuals have extreme difficulty eating certain foods due to sensory sensitivities, fear of negative consequences (like choking or vomiting), or a lack of interest in food. It’s not about body image or dieting — it's about food avoidance that impacts health and well-being.

ARFID and co-occurring conditions

This eating disorder is often associated with certain health conditions, including:

• Attention-deficit hyperactivity disorder (ADHD)

• Obsessive-compulsive disorder (OCD)

• Anxiety

• Autism

It's important to note that ARFID can also exist independently, without any accompanying disorders. Individuals may experience ARFID on its own, facing challenges related solely to their eating behaviours.

For clinical reports and studies on ARFID, check out our Resources section.

Avoidant ARFID

Avoidant ARFID is the most common type. People with this form of ARFID avoid certain foods because of their sensory characteristics. Imagine biting into something mushy when you hate mushy textures—it’s a bit like that, but much more intense. These individuals might steer clear of foods based on their texture, smell, or even appearance. This isn’t just picky eating; it’s a strong, often overwhelming aversion that can severely limit their diet.

Aversive ARFID

Aversive ARFID is driven by a fear of negative consequences. Think about a time when you got sick from something you ate—now imagine that fear magnified and spread across many foods. People with aversive ARFID might be terrified of choking, vomiting, or having an allergic reaction, even if there’s no real risk. This fear can become so intense that it severely restricts their eating, leading to nutritional deficiencies.

Restrictive ARFID

People with restrictive ARFID simply don’t have much interest in eating. It’s not that they dislike food or are afraid of it; they just don’t feel motivated to eat. This lack of interest can lead to inadequate calorie intake and significant weight loss. Eating feels like a chore, and these individuals might stick to a very narrow range of foods because they don't derive pleasure from eating.

Adult ARFID

While ARFID is often diagnosed in children, it doesn’t disappear in adulthood. Adult ARFID refers to those who continue to struggle with the disorder as they grow older. The challenges remain, but adults might also face additional issues, such as social stigma or difficulty finding support. Managing ARFID as an adult can be particularly tough, but understanding that it’s a continuation of a childhood disorder can help in seeking appropriate treatment.

ARFID Plus

ARFID plus is a combination of ARFID and other medical or psychological issues. For example, someone with ARFID might also have autism, anxiety, or obsessive-compulsive disorder (OCD). The interplay between ARFID and these additional conditions can make treatment more complex, requiring a more nuanced approach that addresses all underlying factors.

Words Source: SidebySide Nutrition

ARFID was officially recognised as an eating disorder in 2013 when it was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Before that, individuals with ARFID-like symptoms were often misdiagnosed or categorised under broader terms like “feeding disorders” or “selective eating.” The formal recognition helped distinguish ARFID from other eating disorders like anorexia or bulimia, as it is not driven by body image concerns but rather by sensory sensitivities, fear-based avoidance, or a lack of interest in food. Since then, awareness and research have grown, but many people, including medical professionals, are still learning about it.

It is anticipated that it will similarly, make its debut in the World Health Organisation’s next edition of its equivalent (the ICD). Favoured by European countries, the next edition of the ICD (ICD-11) was presented at the World Health Assembly in May 2019 for adoption by Member States, and will come into effect on 1 January 2022. More…

“The difference between a 'picky eater' and a child with ARFID, is that a picky eater won't starve themselves to death. A child with ARFID will.” — Dr. Gillian Harris, Clinical Psychologist

Picky eating is common in young children and often improves with age, encouragement, and exposure. ARFID, however, is much more severe.

It causes significant anxiety, distress, and can lead to malnutrition, weight loss, or reliance on supplements. Unlike picky eaters, children with ARFID do not “grow out of it” without intervention.

Dr. Gillian Harris (Phd, MSc, Ba, AFBPsS, C.Psychol), explains in more detail: “Food refusal is on a continuum. ARFID, when seen in young children, is usually a refusal of food based on its sensory properties. That is, if the food doesn’t taste right, smell right, look right, or the texture is difficult to accept in the mouth, then it will not be eaten.”

Harris continues, “We then need to add in high levels of anxiety about foods that do not match the foods that are already eaten (new foods!). "If it doesn’t look like it should, taste like it should, smell like it should, I am not eating it." All children, at around the age of 2-3 years, will go through a stage like this, when both new foods and foods eaten in the past are rejected - it's called the neophobic stage. This is often called picky eating. But picky eating and avoidant eating are just two ends of the same scale. A child who is very sensory reactive to foods and highly anxious might well get a diagnosis of ARFID, a child who is not very anxious but really doesn’t like food with a ‘difficult texture’ (that is, any vegetable!) will be called picky.”

Symptoms will look different for each individual.

ARFID can be especially challenging to diagnose because it has such a wide range of symptoms. The most common include:

• Sensitivity to the texture, smell or temperature of foods

• Extreme food avoidance based on texture, smell, taste, temperature, or appearance

• Fear of choking, vomiting, or other food-related harm

• Feeling full after eating only a few mouthfuls and struggling to consume more

• Taking a long time over mealtimes or finding eating a chore

• No desire to eat or low appetite without a medical cause

• Limited diet with little variety, often "safe" foods only

• Anxiety or distress at mealtimes

• Poor growth, weight loss, nutritional deficiencies, malnutrition

• Eating the same meals repeatedly or eating food only of the same colour, such as beige

“Very few foods are eaten, and they will often be ‘brand specific’, and no new foods are tried. Food acceptance will also often be context specific. A food might be eaten at school but not at home. “ — Dr. Gillian Harris, Clinical Psychologist

Anyone of any age can have ARFID. It occurs in children, teenagers and adults. It tends to be most commonly diagnosed in children.

Although people with ARFID may lose weight or have low weight, this is not a criteria for ARFID. It can occur at any weight and varies in different people.

It is often linked to sensory processing differences, anxiety disorders, or past negative food experiences. It can also co-exist with conditions like autism and ADHD.

Probably. Without sounding too bleak, current evidence suggests that ARFID is not something your child will grow out of, it’s always there. Dealing with ARFID can feel overwhelming, especially when it’s your child or loved one struggling - and the road is long.

BUT…

With the right support, therapy, and gradual exposure, many children with ARFID can expand their diet and develop a healthier relationship with food. However, progress takes time, patience, and understanding.

“Above all, don’t give up! Feeding a child with ARFID can be a challenging and frustrating experience. However, it is imperative not to give up. With patience, support, and professional help, your child can learn to expand their diet and receive proper nutrition.” — Sally Dorfzaun, MS, RD, CDN, is a registered dietician at Columbia University Irving Medical Center

ARFID can affect a child’s growth, energy levels, and overall health. It can also create social challenges — avoiding birthday parties, school lunches, or family meals due to fear or anxiety around food.

Parents may feel overwhelmed trying to ensure their child gets enough nutrition.

Children and teens with ARFID face several health risks due to their restricted diets and inadequate nutrient intake. Some of the most common risks include:

Malnutrition & Nutrient Deficiencies

A severely limited diet can lead to deficiencies in essential vitamins and minerals, such as iron, calcium, zinc, and vitamin D. This can impact growth, energy levels, and immune function.

Stunted Growth & Delayed Development

Since ARFID often results in inadequate calorie and protein intake, children may experience slow or stunted growth, delayed puberty, and lower bone density, increasing the risk of fractures later in life.

Low Weight & Poor Muscle Development

Many children with ARFID struggle to maintain a healthy weight, leading to low body mass index (BMI) and reduced muscle strength. This can result in fatigue, weakness, and difficulty keeping up with physical activities.

Gastrointestinal Issues

A highly restricted diet can affect digestion, leading to constipation, bloating, and stomach pain. Additionally, some children with ARFID have difficulty transitioning to new foods, which can make digestive issues worse.

Weakened Immune System

Poor nutrition can lower immunity, making children more susceptible to illnesses and infections.

Anxiety & Mental Health Struggles

ARFID is often linked to anxiety, obsessive-compulsive tendencies, and sensory sensitivities. The stress of mealtimes, social situations involving food, and pressure to try new foods can lead to heightened anxiety, social withdrawal, and even depression.

Social & Emotional Challenges

Children and teens with ARFID may struggle in social settings, avoiding parties, school lunches, or sleepovers due to food-related anxiety. This can lead to isolation, low self-esteem, and difficulties forming friendships.

Dependence on Supplements or Medical Feeds

In severe cases, children may require nutritional supplements, fortified drinks, or even feeding tubes to maintain adequate nutrition, especially if they cannot tolerate solid foods.

Dental Issues

A diet limited to certain food types (such as highly processed or carbohydrate-heavy foods) may contribute to poor dental health, including cavities and weakened enamel.

Increased Risk of Eating Disorders in the Future

Children with ARFID may be at a higher risk of developing other eating disorders later in life, particularly if their food-related anxieties and restrictive patterns go untreated.

Why Early Intervention Matters

Early recognition and support can help prevent long-term health complications. If ARFID is affecting your child’s growth, health, or well-being, seeking guidance from healthcare professionals, including dieticians, therapists, and paediatricians, is essential.

ARFID doesn’t have a single cause, but it can develop due to:

• Sensory processing difficulties (strong reactions to textures, smells, or tastes)

• Fear-based experiences (choking, vomiting, illness)

• Low appetite or lack of interest in food

• Anxiety disorders or neurodivergent traits (autism, ADHD, OCD)

A healthcare professional, such as a pediatrician, psychologist, or dietitian, can diagnose ARFID by assessing a child’s eating habits, nutritional status, and any underlying fears or sensory issues. There is no single test—diagnosis is based on symptoms and impact on daily life.

• Food therapy (gradual exposure to new foods in a safe, supportive way)

• Cognitive Behavioral Therapy (CBT) (to address food-related anxiety and fears)

• Occupational therapy (for sensory challenges related to food)

• Nutritional support (to prevent deficiencies and ensure proper growth)

• Be patient—forcing or pressuring food can make things worse

• Offer safe foods while gently introducing new ones

• Avoid shame or frustration around mealtimes

• Seek professional support if food refusal is affecting health

• Remember: Your child isn’t being difficult on purpose—ARFID is real, and they need your support