Sixteen-year-old Jeremy was surviving on just three foods—mostly frozen, pre-packaged snacks he could eat immediately or throw in the microwave. He ate twice a day at most, his disinterest in food severely impacting his nutrition and development.

"He would essentially choose not to eat most of the day," Michelle Jones, PhD, licensed psychologist and clinical instructor at Equip, recalls. "It was very difficult for his parents to support him in eating more."

Jeremy’s case illustrates what avoidant/restrictive food intake disorder (ARFID) can look like—but his story is just one example of the way this eating disorder shows up. ARFID is an extremely varied and individualized diagnosis, and it can manifest in three distinct ways, known as “presentations.” Certain individuals avoid foods due to sensory issues like texture or smell, others restrict eating out of fear that something bad will happen, and some, like Jeremy, simply lack interest in food altogether. People with ARFID may experience one, two, or all three presentations.

Each type of ARFID has different causes and symptoms, and requires different treatment approaches —making real understanding and identification crucial for recovery. Read on to learn more about the different types of ARFID, how to identify them, treatment options, and more.

What is ARFID?

ARFID is an eating disorder where a person consistently avoids or restricts food so much that it harms their health. The disorder affects between 0.3% and 15.5% of the general population and can lead to problems like significant weight loss, nutritional deficiencies, and developmental delays. While ARFID is often associated with children or adolescents, it can occur at any stage of life, and adults experience ARFID too.

Unlike other eating disorders like anorexia nervosa or bulimia nervosa, ARFID behaviors aren’t driven by body image concerns or fear of weight gain. Instead, their food avoidance comes from other factors. The reasons behind their food avoidance—whether it’s a fear of choking, extreme selectivity around food texture, never feeling hungry, or something else—determine which presentation (or presentations) a person is experiencing.

What are ARFID “presentations” or types of ARFID?

The DSM-5 identifies three main types of ARFID, also known as “presentations.” “The three ARFID presentations are like three different roads leading to the same place. In this case, that destination is an individual not eating enough variety or quantity of food to support their health and development,” says Janessa Slatky, RDN, and eating disorder-informed dietitian.

The three different presentations or ARFID types are:

• Lack of interest or low appetite: When someone has little natural drive to eat, doesn't find food particularly enjoyable, and often feels full very quickly or simply forgets to eat.
• Sensory-based avoidance: When someone finds certain textures, smells, tastes, temperatures, or appearances of food overwhelming or disgusting, leading them to eat only a narrow range of "safe" foods.
• Fear-based avoidance: When someone avoids foods due to worry about negative consequences like choking, vomiting, having an allergic reaction, or experiencing pain, usually caused by a past traumatic event.

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While ARFID is more commonly diagnosed in children than adults, it affects people of all ages, and certain presentations tend to show up at different times in the lifespan.

“It's more about the timing at which they first present,” says Jones. “For example, we typically see the fear-based presentation in older children, adolescents, and even in adults. That’s because symptoms typically don't emerge until later, because some kind of traumatic event or perceived trauma precipitates it. Signs of sensory sensitivity and lack of interest, however, can appear as early as infancy.”

Lack-of-interest ARFID

Lack-of-interest ARFID is when someone doesn’t have a natural drive to eat. "They don't have the natural, biological hunger cues that normative eaters get,” says Michelle. “For these people, eating becomes a chore, something that requires a lot of effort and doesn't have a lot of payoff."

While this type of ARFID can be tricky to identify, people with this eating disorder often:

• Experience weak or absent hunger cues throughout the day
• Get little to no pleasure from eating experiences
• Express that eating feels like a waste of time
• Feel full quickly after eating small amounts of food
• Take an unusually long time to finish eating when they do eat
• May need to "push themselves" to eat or require external motivation

Often, parents wonder if their children’s lack of interest in food is due in part to other underlying issues, like depression or ADHD. “With depression, loss of appetite comes with other mood symptoms, like sadness and irritability. ADHD usually involves impulsivity and forgetfulness, but not a long-standing disinterest in food itself,” explains Jones.

Sensory sensitivities ARFID

The most common subtype, ARFID driven by sensory sensitivity involves avoiding foods based on how they look, smell, taste, feel, or sound. While preferring certain textures of food can be normal and appropriate, ARFID related to sensory sensitivities is much more acute.

"We refer to people who have this presentation as 'super tasters,' because they have a greater ability to differentiate between different flavors and textures of food compared to normative eaters. So, when they dislike a food, it feels very intense for them," says Jones.

Symptoms of this type of ARFID often include:

• Strong reactions (gagging, pushing away, distress) to non-preferred foods
• Loyalty to brand-name foods because they're predictable
• Avoidance of entire food categories (all vegetables, all meat, anything "wet")
• Very specific preparation requirements (cut a certain way, specific temperature)
• Severe anxiety and distress around eating

Because of these ‘super taster’ abilities, trying new foods can be a bit of an overwhelming experience for people with this presentation. “People who have this presentation will limit themselves to foods that they've tried before and can accept—we call them ‘safe foods,’” says Slatky. “In turn, kids might appear difficult at mealtimes, refuse to get school lunch, or not want to go out to eat.”

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Fear of aversive consequences ARFID

The third type of ARFID, fear of aversive consequences, involves someone avoiding food because they're worried that something negative might happen when they eat. The specific fear can take a variety of different forms, but according to Jones, fears of choking and vomiting are most common. This type of ARFID can co-occur with certain mental health conditions like anxiety and obsessive-compulsive disorder (OCD).

Unlike lack of interest and sensory sensitivities, this type of ARFID commonly occurs after one or more traumatic eating events, such as choking on something, experiencing food poisoning, or having an allergic reaction. “For example, someone might have had a really terrible stomach bug once. That experience then causes them to avoid foods associated with that experience in order to prevent themselves from becoming sick and vomiting again."

People with this type of ARFID may:

• Avoid foods (often called “fear foods”) associated with a past negative experience
• Show anxiety symptoms (rapid heartbeat, sweating, panic) around fear foods
• Express specific worries about choking, vomiting, allergic reactions, or pain
• Only eat foods they perceive as "safe"
• Have a sudden onset of eating restrictions rather than long-term pickiness
• Avoid eating in certain situations or around other people

While this type of ARFID often starts after someone experiences a traumatic event firsthand, it can also develop or get worse just by watching something scary happen to someone else. “I've had patients who maybe have always been a little bit afraid of vomit. Then they watch a movie where there's an intense vomiting scene, and then they start to worry it's going to happen to them," says Jones. “A child's world is so small, so a fear like that...it's their whole world."

It’s also important to note that sometimes, people can have this presentation without experiencing a triggering event either firsthand or secondhand.

Is it possible to have multiple presentations or types of ARFID?

While symptoms of only one type of ARFID are required for diagnosis, having multiple types is quite common.

"More than 50% of the time, we'll see multiple presentations, with fear of aversive consequences and sensory sensitivity being the most common pairing,” says Jones. “If parents are noticing that their child is picky in terms of variety, but also really seems uninterested in even foods that they're willing to accept, that's a good indication that they have multiple presentation types.”

What does treatment for each type of ARFID look like?

While treatment for each type of ARFID usually depends more on the individual person than the specific subtype, there are some common treatment approaches for each—all of which tend to focus on helping people get proper nutrition, build coping skills, and improve their daily life.

Treatment for lack-of-interest ARFID

“In treatment for lack-of-interest ARFID, it’s often not going to be possible or realistic to have all of the symptoms go away completely because patients are limited by their biology,” says Jones. “So treatment becomes more about reducing the impact of symptoms on everyday life, health, and functioning.”

Often, that involves teaching parents (or adult patients) how to create structured eating routines and building interoceptive awareness. According to Slatky, this external structure helps patients actually tune into their own hunger and fullness signals.

Treatment for sensory sensitivities ARFID

When treating this type of ARFID, the goal is often to expand the variety of foods a person eats.

To do this, providers often use systematic desensitization, where the goal isn't to force foods, but to help the patient slowly get used to different textures and smells in a non-threatening way. This is a form of exposure therapy, which is a core component of all ARFID treatment. Food exposures are individualized, gradual, and introduced in a thoughtful and safe way.

“In extreme cases,” says Slatky, “We'll spend many, many days just looking at the food, or being in the room with the food. So, one day we smell the food, the next day we touch it to our lips. The next day, we lick it. The next day, we might put it in our mouth and take it out.”

Fear of aversive consequences ARFID

Addressing ARFID related to fear of aversive consequences typically involves cognitive behavioral therapy (CBT), an approach that has been shown to have fairly high success rates: in a recent study, 85% of children who received CBT for ARFID improved their food variety and anxiety after just 12 weeks.

Exposure-based therapy can also be an effective intervention here, allowing patients to face their fears in small, safe steps. “I tend to think of exposure-based therapy as a typical bell curve. The more exposures you do, anxiety is going to rise, but then over time that anxiety will eventually come back down,” says Slatky.

Providers might also teach coping strategies for anxiety, like deep breathing techniques, and work with families to encourage positive food experiences, like involving children in meal planning.

What to do if you or a loved one is struggling with ARFID

If you think you or someone you care about might have ARFID, it's important to get professional help. However, because ARFID is a relatively new diagnosis, not all providers are familiar with its presentations and treatment approaches. “Working with a professional without ARFID specialization can put parents or patients in a difficult position of feeling like they’re educating providers instead of the other way around,” says Jones.

At Equip, we provide expert, individualized ARFID treatment through multidisciplinary teams specifically trained in evidence-based approaches. As the leading U.S. provider of ARFID care, we adapt our treatment to address sensory sensitivities, lack of interest in eating, fear of aversive consequences, or combined presentations—so you can get the exact care and help you or your loved one need to feel better.

If you're unsure whether you or your loved one might have ARFID, consider taking this free ARFID quiz—this can help guide conversations with a trusted doctor or mental health. You can also schedule a call with Equip to learn more about our specialized ARFID treatment options.