Imagine the crunch of biting into a perfectly crisp apple, or the creaminess of rich chocolate ice cream. Now imagine your teeth hitting a soft spot on your fruit or discovering a hard nut in your dessert. It would likely be unpleasant, but probably wouldn't upset you for too long. For some people, though, the texture, taste, smell, or even color of certain foods can be extremely upsetting and intolerable.

If this is something you’ve noticed in yourself or a loved one, it may be a sign of avoidant/restrictive food intake disorder (ARFID) due to sensory sensitivities. People with this eating disorder have extreme preferences and aversions when it comes to the sensory qualities of food; for example, they might say that certain textures feel overwhelmingly slimy, specific smells trigger immediate revulsion, or particular colors make food seem completely inedible. This can lead to a very limited number of “safe” foods that they consume, which can cause developmental problems in children and overall health problems in anyone. It also can shrink a person's life, as they often avoid normal activities—like going to a friend's house for dinner or eating lunch at school—because they can't consume anything offered in those places.

If you think you or your loved one may have sensory sensitivity ARFID, know that recovery is possible. With the right support and evidence-based treatment, you can expand food variety, reduce distress around eating, and reclaim the experiences you’ve been missing out on. Read on to better understand this type of ARFID, what causes it, and how to get help.

The three ARFID presentations

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder where a person significantly reduces how much food they eat, the diversity of foods they eat, or both. Unlike eating disorders rooted in body image concerns or weight preoccupation, ARFID stems from other underlying factors that make eating feel challenging, uncomfortable, or unsafe.

There are three presentations, or subtypes, of ARFID, and people may have one or a combination of two or all three of these types.

1. Sensory sensitivity

People with this presentation experience specific foods as genuinely unpleasant or intolerable based on the texture, aroma, appearance, taste, or temperature. Some people also strongly favor foods with particular sensory characteristics—for example, if they have food texture sensitivity, they may prefer only crunchy foods or those with smooth textures. This results in a very short list of "safe" foods that they will comfortably consume.

2. Lack of interest and low appetite

For some people, the drive to eat is fundamentally muted. They may not experience hunger signals the way others do, or they might find eating to be boring and joyless. Hours can pass without them thinking about food, or they may feel satisfied after consuming only a small amount.

3. Fear of aversive consequences

Concerns about choking, vomiting, becoming ill, having an allergic reaction, or other negative outcomes keeps people with this presentation of ARFID from eating certain foods or food groups. This often, but not always, sets in after a traumatic food-related event.

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Understanding ARFID due to sensory sensitivity

“People who have the sensory sensitivity subtype of ARFID are especially sensitive to different sensory properties of food,” explains Michelle Jones, PhD, licensed psychologist and clinical instructor at Equip. Basically, their window of tolerance is a little bit narrower for certain sensory input, she says: for example, they may interpret bitter tastes as extremely harsh, or crunchy textures as jaw-breakingly hard. While people with sensory sensitivity most commonly can't tolerate certain tastes or textures, specific smells, colors, temperatures, and other sensory properties of food may also cause strong aversion.

This sensory sensitivity may lead to excluding entire food groups, such as fruit or vegetables, or only eating one or two types of a food group, such as a certain brand of chicken nuggets but no other protein sources.

People of all ages can have ARFID due to sensory sensitivities. However, it often appears before a child turns 10 and can last throughout adulthood. “It can start very early, even as early as infancy, such as if a baby only tolerates certain types of formula, struggles when solid foods are introduced, or struggles to transition from purees to solid food,” Jones says. (Note that if a very young child is having trouble eating, it may be pediatric feeding disorder, which is a feeding disorder related to developmental issues, and not an eating disorder).

Teens and adults who have this presentation of ARFID have likely had the eating disorder since childhood, but didn’t realize because they were accommodated, adds Rollyn M. Ornstein, MD, clinical professor of pediatrics at UNC School of Medicine. “This doesn't come on later in life,” she explains. “People may go along their merry way, and accommodate themselves or others accommodate them. Then when they become upset about it, either as an adult or an adolescent, they start to address it, so it looks like they're presenting at 16. The fact is, they always had it, and now it's impacting them more.”

ARFID vs picky eating

“A lot of times, people think about this version of AFRID as being extreme picky eating,” Jones says. However, it's not exactly the same thing. Picky eating typically presents between the ages of 3 and 5, but by the preteen or adolescent years, most kids grow out of this developmental phase. “With ARFID, this is not something people grow out of,” Jones says. It’s an eating disorder that requires evidence-based treatment to address.

Signs and symptoms of ARFID due to sensory sensitivity

If you or a loved one has ARFID due to sensory sensitivity, you may notice symptoms such as:

• Eating a limited number of the same foods
• Eating two or fewer foods from one or more major food groups (i.e., grains, proteins, vegetables, fruits, fats, dairy)
• Eating only certain brands of specific foods (since they are predictable)
• Strong hesitancy to try new foods
• Strong reactions (gagging, pushing away, distress) to non-preferred foods
• Eating rituals: Needing food to be prepared or served in specific ways
• Avoiding activities, social events, traveling, and other things because of food anxiety or fears
• Stunted growth (in children) or weight loss (in adults)
• Nutritional deficiencies
• Gastrointestinal problems, such as stomach pain or constipation

What causes ARFID due to sensory sensitivity?

The cause of food sensory sensitivity is a bit unclear, but a few factors appear to be at play.

Differences in brain function

First, a region of the brain called the insula may function differently in people who have ARFID. The insula helps with sensory processing by interpreting signals that the body receives (such as a certain taste) into feelings (such as disgust). Research suggests people with sensory sensitivity may have an intensified perception of tastes, so things they like taste amazing, while things they dislike taste absolutely repulsive. In one study, people with ARFID—and especially those with the sensory-sensitivity presentation—self-report heightened sensitivity to taste and smell. However, lab tests showed their actual sensitivity was no greater than people who don't have ARFID.

Genetics

Second, “we suspect this is pretty heavily based in genetics and biology,” Jones says. Often, one or both parents of patients with this type of ARFID are picky eaters, she adds, which suggests a genetic factor. There may also be an environmental factor that doesn't cause ARFID but can heighten susceptibility in those who are genetically predisposed. “If a child has a parent who is a picky eater, they're not seeing a wide variety of foods in the diet being modeled for them. And maybe they're not presented with as much variety in foods because that parent is only eating a limited variety of foods,” Jones explains. “For example, if the parent doesn't eat any vegetables, they may be less likely to be providing vegetables to their child.”

Neurodivergence

There is also a strong link between ARFID due to sensory sensitivities and neurodivergence. According to a 2024 study in the Journal of Eating Disorders, 15 to 30 percent of patients diagnosed with ARFID also have autism spectrum disorder (ASD), and sensory sensitivity is the most common presentation. About 90 percent of children and 95 percent of adults with ASD have sensory hypersensitivity to specific food textures, tastes, smells, or appearances. This means they have faster, more intense, and longer responses to these sensory characteristics. Some may also have hyposensitivity, which can make certain foods very bland and lead them to seek out foods with strong flavors or textures. At Equip, 36% of ARFID patients identify as neurodivergent, and our providers are experienced in working with this unique population.

The 2024 study also points out that people with ADHD tend to be easily distracted and agitated, which may lead to less interest in food and heightened arousal levels at mealtimes. Both of these things can lead to selective eating patterns.

Rigid thinking

“In addition, there can be some cognitive rigidity that can make it more difficult for someone who has ARFID to expand their dietary variety,” Jones says. “They may be less likely to be successful in doing so or less willing to do so without a lot of support from family and providers to help them with that process.” To be clear, though, sensory sensitivity is a trait; on its own, it doesn't mean someone has ARFID or autism, emphasizes Ilana Brodzki Pilato, PhD, a licensed clinical psychologist at Duke Center for Eating Disorders.

Anxiety

Anxiety is also associated with sensory sensitivities in children and adolescents with ARFID. This could contribute to increased awareness of the sensory characteristics of foods, but more research is needed on this theory.

How is sensory sensitivity addressed in ARFID treatment?

In general, ARFID treatment typically begins with psychoeducation to help the patient understand the eating disorder, what they're experiencing, and treatment. For patients with sensory sensitivity, “we want to help them connect their feelings—usually a lot of disgust in response to trying food, sometimes paired with anxiety—to what they want to be different in their life, and then we plan exposures based on that,” Jones explains.

These exposures start small and, in the case of cognitive-behavioral therapy for ARFID (CBT-AR), explore all of the sensory properties of a food—sight, touch, smell,and taste—before finally chewing it. During all of this, the therapist works with the patient to help them manage any anxiety and describe the food objectively. “We don't rely on emotionally charged language like 'gross' or 'nasty.' Instead, we focus on things like, 'This food is smooth, this food is brown, this food smells like chocolate, first it's solid and then it melts and is creamy in my mouth, it tastes sort of sweet,'” Jones says.

Once the patient is ready to take a bite, it might be as small as the size of a pea or a grain of rice at first. Then they gradually work up to larger portions. The types of foods used in exposures will also gradually increase in difficulty: If they like potatoes, for example, and can't tolerate hard foods, they might work their way from experiencing mushy mashed potatoes all the way up to super crunchy chips.

One goal is to add more foods to the list of things they eat on a regular basis. Still, “there's never any expectation that they're going to incorporate all foods that they try,” Jones says. “It's about practicing having these experiences of trying foods. Maybe they're not as bad as they would have expected, or they tolerate it better than they thought they would.”

Every exposure progression is unique to the patient, who gets to select which foods to try, with the guidance of their treatment team. For example, if the patient doesn't eat any foods that provide significant protein—which is necessary for growth and development for kids and daily activities for adults—their therapist might point that out and ask which sources of protein they might be willing to learn about. Or they may discuss foods that would help them psychosocially, such as dishes commonly offered at parties, served in restaurants, or that are easy to take with you and eat before sports practice. By trying these foods, the hope is that the patient can begin to add those social activities back into their life.

In one small study of adults, 20 to 30 sessions of CBT-AR helped patients add an average of 18 foods to their diet and significantly reduce sensory sensitivity—to the point where almost half of the patients no longer met the criteria for ARFID. In another study of CBT-AR, adolescents had significant reductions in sensory sensitivity and ARFID severity after treatment, and 70 percent no longer met ARFID criteria. CBT-AR is most beneficial for those 10 and older.

For children younger than 10, Feeling and Body Investigators (FBI) shows a lot of promise.

This treatment is similar to CBT-AR in that exposures help the patient slowly work through a hierarchy of sensory aspects of food so they can get used to those sensations. To help children use nonjudgemental language to describe food, there are characters that each align with a different sensation. “This helps them be more specific about what they do and don't like about food, and can help guide them in what foods they may be more likely to accept,” Pilato explains. “It also helps them decouple that negative emotional valence that's tied to trying a food by being more neutral about it.” So rather than “disgusting”, a smoothie is mushy, not as liquidy as they like, and has more banana than they prefer.

Again, kids try foods in session and out of session, with the goal of working up to taking a bite by the end of session and more bites at home.

Family-based treatment (FBT)—the gold standard for treating eating disorders in children—can also incorporate exposures during sessions. At Equip, we use FBT-ARFID, a version of FBT designed specifically for ARFID that includes exposures and other aspects of the evidence-based treatment approaches described above.

What to do if you or a loved one are struggling with sensory sensitivity ARFID

If you believe that you or a loved one may have sensory sensitivity ARFID, Jones recommends seeking treatment with providers who are knowledgeable about ARFID, have experience treating people with sensory sensitivity, and who use evidence-based interventions.

All of these criteria are crucial: Since ARFID is a newer diagnosis, it's less understood than other eating disorder diagnoses, even by eating disorder professionals. “There is also such diversity within the ARFID diagnosis that somebody who has very limited experience may not have worked with someone who has the presentation of ARFID you do or may not have experience working on the ways in which ARFID affects you,” Jones says. ARFID requires different treatment approaches than other eating disorders, so it’s important to work with providers who understand which evidence-based treatments have been shown to help. Equip is the largest ARFID treatment provider in the United States and has helped thousands of adults and children recover from ARFID.

While a robust multidisciplinary care team is ideal, Jones recommends working with at least a therapist and a dietitian. Both can provide education and do different interventions, including exposures. “Having them work together is the foundation of any effective treatment team,” Jones says. You also should include a medical provider, who can monitor your vitals and make sure you don't have any medical complications or nutritional deficiencies.

If you’re concerned that you or a loved one may be dealing with ARFID due to sensory sensitivities, our free, five-minute ARFID screener can help you better identify if you should seek treatment. You can also schedule a call with our team to learn more about our comprehensive, evidence-based ARFID treatment program.

Whatever treatment route you choose to take, know that recovery is possible, and you’re not alone. “Not a lot of people know about ARFID, so it can feel isolating. Having a sense of community and knowing others are dealing with the same thing can make people feel less alone,” Jones says.

FAQ

Is sensory sensitivity a sign of ARFID?

Sensory sensitivity can be a sign of ARFID. People with this presentation of ARFID have strong negative responses to the texture, taste, smell, appearance, and/or temperature of certain foods. They may also strongly favor foods with specific sensory properties. Note that there are other types of ARFID, including fear of aversive consequences and lack of interest, and some people have symptoms from more than one type.

When does food texture sensitivity indicate an eating disorder?

Providers use four criteria to determine if someone's food texture sensitivity indicates an eating disorder. Note that a person only needs to be meet one or more of these criteria to be diagnosed with ARFID, not all four:

• Weight loss: In children, the person is not gaining weight or not growing as expected, and in adults, the person has lost significant weight with no explanation
• Significant nutrition deficiency: As indicated by blood tests
• Over-reliance on nutritional supplements: The person consumes half or more of their nutritional intake from products such as Boost or Pediasure
• Interference with psychosocial functioning: The person skips out on social events due to their sensitivity and/or sensitivity negatively impacts their mood and causes anxiety

How can I get over food texture issues or other sensory aversions?

Working with a therapist who is experienced in treating patients with ARFID due to sensory sensitivities is the best way to overcome food texture sensitivity or other sensory aversions. They can safely and gradually lead you through exposures to expand the number of foods you consume and also address any food anxiety or other co-occurring mental health concerns.

What causes food sensory sensitivity?

The cause of food sensory sensitivity is complex. It seems to involve genetics, environmental factors, and changes in the brain. People with food sensory sensitivity are also more likely to have ADHD or autism, and vice versa, though this relationship is not well understood.

How is sensory sensitivity addressed in ARFID treatment?

Treatment for ARFID due to sensory sensitivity typically includes exposure therapy. During these sessions, the patient identifies which foods they would like to learn about. Over time, they gradually explore all sensory aspects of these foods, including the look, touch, smell, and finally the taste and chew. They also learn to use objective language to describe foods, such as “red”, “smooth”, and “bittersweet”, rather than emotionally charged language like “gross” or “nasty”.