While there’s (thankfully) been increasing awareness about eating disorders like anorexia, bulimia, and binge eating, many people still haven’t heard of ARFID, an equally serious and common eating disorder. ARFID, which stands for avoidant/restrictive food intake disorder, is characterized by eating an extremely small variety or quantity of food (or both), but for reasons other than body image distress or concerns about weight.

Because of its unique nature, ARFID is often overlooked or left out of the larger conversation around eating disorders, but its effects can be just as detrimental. Understanding the symptoms of ARFID, what to look for, and how to seek help can make all the difference in overcoming the illness and achieving full, lasting recovery.

What is ARFID?

Although ARFID is a complex psychological disorder influenced by biology and neurology, it’s often dismissed as just “picky eating” or written off as a temporary developmental phase. In reality, ARFID is a diagnosable eating disorder that can occur at any age and can have serious mental and physical consequences. People with ARFID don’t restrict their food intake because of body image issues or a desire to lose weight or look a certain way. Rather, people with ARFID have trouble eating for one or more of the following reasons:

1. Extreme sensitivities to the sensory properties of food (smell, texture, taste)

2. Fear of a negative outcome from eating (choking, vomiting, having an allergic reaction)

3. Lack of appetite or interest in food

“ARFID is an eating disorder where a person either doesn’t eat enough food or enough types of food or both,” explains Equip’s VP of Program Development, Jessie Menzel. “Unlike other eating disorders, ARFID isn’t motivated by a desire to lose weight or a fear of gaining weight. Rather, ARFID is driven by one or more of the following things: sensitivity to the sensory properties of food, a fear of something bad happening because of eating, or a lack of interest in food.”

Equip Peer Mentor Kelsey Gilchriest, who has experienced ARFID firsthand, explains that her eating disorder could be attributed to the second reason, fear of a negative outcome. “My ARFID is driven by a fear of vomiting, or emetophobia, due to having a history of chronic nausea and health issues as well as significant anxiety,” Gilchriest says.

What are the symptoms of ARFID?

While the signs and symptoms of ARFID may vary from person to person, there are common physical, behavioral, and psychological indicators and repercussions of the illness:

Physical symptoms of ARFID

According to Menzel, some of the physical symptoms of ARFID include:

• Significant weight loss, or failure to gain weight (in children)
• Falling off the growth curve (in children)
• Fatigue
• Poor digestion
• Constipation
• Abdominal pain
• Vitamin and/or nutrient deficiencies

People with ARFID could also experience many of the physical health effects of other restrictive eating disorders, like anorexia, if they lose a significant amount of weight. That includes impaired immune function, always being cold, and growing fine, downy hair all over the body.

Behavioral symptoms of ARFID

The behavioral symptoms of ARFID can be quite varied, Menzel says, and could include any of these following signs:

• Having an extremely limited range of acceptable foods
• Picky eating that gets worse over time
• Avoidance of certain foods based on texture, color, or taste
• Fear of choking or vomiting
• Rigidity around eating (needing to eat at a certain time or place, refusing to try a different brand, needing food prepared or served a specific way)
• Ritualistic eating patterns
• Gagging when trying new foods
• Taking a long time to eat or finish meals
• Complete avoidance of meals or eating; going long periods of time without food
• Feeling full after eating only a small amount

“There are a wide range of behaviors associated with ARFID, depending on what is driving the eating disorder,” Menzel says. “You may see strong preferences for specific tastes, textures, smells, temperatures, or colors of food, and these strong preferences may also extend to specific brands or preparations of foods.”

“For people who are afraid of something bad happening after eating, they may express fears about adverse outcomes like choking, vomiting, pain, illness, or having an allergic reaction,” she goes on. “They might also seek reassurance that a food is safe, check foods for contaminants or allergens, over-chew food or eat only very small bites, or engage in rituals or superstitious behaviors when eating. In young children, there may be other signs of distress around meals or mealtime, like crying, refusing to sit at the table, or tantrums.”

Psychological symptoms

Though the psychological symptoms of ARFID look quite different from the psychological symptoms of other eating disorders, they can be just as distressing. According to Menzel, potential psychological symptoms of ARFID include:

• Anxiety related to food intake
• Lack of interest in eating
• Irritability
• Feeling down or depressed
• Social anxiety or shame (e.g., due to having different eating habits)
• Social withdrawal due to eating habits

Gilchriest herself experienced significant anxiety related to her fear of vomiting and food-related contamination. As a result, she tended to avoid eating new foods, which included food from unfamiliar restaurants or grocery stores as well as food cooked by someone unfamiliar. These symptoms led her to feel both shame as well as significant distrust in her body's ability to handle food, digestion, germs, and more.

“The lack of body trust has impacted so many of these other psychological symptoms, and has been one of the most difficult aspects of my healing journey,” Gilchriest says. “Healing my relationship to my body has taken time, the patience of my providers, and a lot of trauma-informed therapy interventions.”

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What causes ARFID?

Like all eating disorders, ARFID is not caused by a single factor, but rather the complex interaction of a variety of biological and environmental components. “We’re just beginning to learn about the genetic and biological basis of ARFID,” Menzel says. “For years, patients have told me that symptoms of ARFID run in their family. A study out just last year confirms that ARFID indeed has a strong genetic component—just as strong as the genetic basis of anorexia nervosa.”

Menzel explains that leading experts in the field theorize that neurobiology is likely one of the main contributors to the development of ARFID. “Early research has found associations between rigid, inflexible thinking styles, sensory processing, and ARFID,” she says. “Other really interesting findings are emerging that link alterations in appetite-regulating hormones and a lack of interest in eating. Research in this area, though, is still very new and we have a long way to go to understand what causes ARFID.”

Menzel also notes that ARFID has been linked to gastrointestinal disorders, anxiety disorders and autism spectrum disorder (ASD). A 2013 meta-analysis found that children with ASD were five times more likely than those without ASD to have feeding problems, and a 2023 study indicated children with ASD face significantly more eating challenges than those without it. Research has also found that compared to people diagnosed with anorexia, those with ARFID were shown to have higher rates of anxiety disorder, pervasive developmental disorder, learning disorder, attention-deficit hyperactivity disorder (ADHD), and obsessive compulsive disorder (OCD).

Diagnosing ARFID

ARFID wasn’t added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) until the publication of the DSM-5 in 2013. Previously identified as “feeding disorder of infancy or early childhood,” ARFID was redefined in the DSM-5 as an eating or feeding disturbance characterized by significant weight loss and nutritional deficiencies, as well as “marked interference with psychosocial functioning,” among other criteria.

“ARFID is typically diagnosed by a mental health professional after gathering a full psychosocial history,” Menzel says. “An evaluation by a medical provider or specialist like a gastroenterologist may also be helpful for identifying nutritional deficiencies, assessing growth impairment in children, or ruling out other medical conditions that could explain or contribute to ARFID symptoms. There are also psychological measures and assessments that can help professionals screen for and diagnose ARFID.”

What is the prognosis for ARFID?

When it comes to the short- and long-term outlook on ARFID, experts are still putting the pieces together. “This is another area where research is really lacking,” Menzel says. “We only have a handful of studies that have looked at the long-term prognosis of ARFID. Right now, it does seem that ARFID can persist well into adulthood and many adults report struggling with ARFID symptoms throughout their lifetime.”

That said, ARFID is fully treatable—but it doesn’t go away on its own. Research has shown that ARFID is unlikely to get better without intervention, making evidence-based treatment critical in overcoming the illness. “This point is important because so often, parental concerns about children’s eating—particularly pick eating—are dismissed or minimized as something kids will grow out of,” Menzel says. “As with other psychological disorders, our sense is that early intervention is crucial. The sooner that ARFID can be diagnosed and treated, the better. And as with other eating disorders, involvement of family members in treatment is critical. It is very hard for children and teens to recover from eating disorders without the involvement of family members.”

Supporting someone with ARFID

While every person is different, Gilchriest says that in both her personal and professional experience, she has noticed that validation goes a long way. “Even if family members don't necessarily understand or even ‘believe’ their child's anxiety around food, trust that this fear is very real to them,” she says. “Those with ARFID can often feel invalidated by medical providers, peers, or even family, so offering a safe space to listen and offer compassion and validation is crucial.”

When it comes to supporting loved ones, Menzel says she always tells parents and other concerned loved ones to trust their instincts. “If you feel that something isn’t quite right with your child’s eating, it’s worth consulting your pediatrician,” she says. “But because the ARFID diagnosis is relatively new, some pediatricians may not be familiar with the diagnosis. If this is the case, I recommend asking your pediatrician for a referral to speak with a mental health professional who has experience with eating disorders.”

For those who don’t know where to start in supporting their loved ones, Menzel says to focus on one basic goal: ensuring they’re getting enough to eat. “While you are going through the steps of getting a diagnosis and a treatment plan, do whatever it takes to make eating feel safe and easy, even if that means feeding your child only their preferred or safe foods,” she advises.

The Equip takeaway: What to remember about ARFID symptoms

ARFID is still a lesser-known eating disorder, and this lack of awareness can make things even more difficult for those struggling. Spreading education and awareness is key to helping everyone with ARFID get the help they need to fully recover. Here’s what to remember about ARFID and its symptoms:

• ARFID stands for avoidant/restrictive food intake disorder, and it is a serious and common eating disorder. It often occurs in children and teens, but can affect people of any age.
• ARFID is characterized by eating a very small quantity or variety of food, or both. People with ARFID don’t restrict food out of body image issues or a fear of weight gain, as with other restrictive eating disorders. Rather, people with ARFID struggle to eat for one of three reasons: 1) Extreme sensitivity to the sensory properties of food (taste, smell, texture, etc); 2) Fear of an adverse outcome from eating (getting sick, choking, etc.); 3) Lack of appetite or interest in eating.
• ARFID can show up differently in different people, but there are certain symptoms to look out for that can indicate you or a loved one might be struggling with ARFID.
• Physical symptoms of ARFID include significant weight loss or failure to gain weight in children; falling off the growth curve (in children or teens); fatigue; poor digestion; constipation; abdominal pain; vitamin and/or nutrient deficiencies.
• Behavioral symptoms of ARFID include eating an extremely limited range of acceptable foods; picky eating that gets worse over time; avoidance of certain foods based on texture, color, or taste; ritualistic eating patterns; rigidity around eating; taking a long time to eat or finish meals; and feeling full after eating only a small amount.
• Psychological symptoms of ARFID include anxiety related to food intake; lack of interest in eating; and social withdrawal due to eating habits.

ARFID is fully treatable but doesn’t go away on its own. Research has shown that evidence-based treatment works, and that early intervention leads to better outcomes. If you or a loved one is struggling with ARFID, or are worried that might be the case, it’s important to get help. Talk to your doctor or a trusted mental health professional, or schedule a call with a member of our team.

Frequently asked questions about ARFID

ARFID can be a tricky diagnosis to navigate, and many questions may come up in the process. Menzel offered her expert insight into some of the most commonly asked questions about ARFID.

1. What are the differences between ARFID and typical picky eating?

Picky eating is having strong preferences when it comes to food—whether it’s preferences for certain tastes or textures or types of foods or brands. Many people identify as picky eaters—even among adults! And it’s very normal for children to narrow their food preferences while they are young.

Picky eating does have the potential to become ARFID if it is taken too far—when someone’s preferences become so extreme or rigid that it starts to impact their physical or mental health. Picky eating crosses over into ARFID when it starts to result in weight loss or poor growth, nutritional deficiencies (based on labs or bloodwork), reliance on nutritional supplements (like Ensure or Carnation Instant Breakfast), or significant problems in your family or your child’s life. Other early warning signs that picky eating may actually be ARFID include a narrowing of preferences over time, refusal to try new foods, and increasing conflict at meals.

2. Can adults have ARFID?

Absolutely! Adults can also suffer from ARFID. ARFID is an eating disorder that can onset at any point in a person’s life and it’s not uncommon for ARFID that starts in childhood to persist into adulthood.

3. How can ARFID affect a child's development?

ARFID can affect a child emotionally and physically. One seminal study from 2014 showed that even moderate levels of picky eating in toddlerhood could put a child at risk for the development of psychological disorders and social problems. Physically, ARFID can significantly limit a child’s growth and contribute to fatigue, difficulty concentrating, gastrointestinal problems, and ultimately lead to malnutrition.