Avoidant Restrictive Feeding Intake Disorder, called ARFID, is a type of eating disorder that’s characterized by many of the same symptoms as anorexia, but it differs in that the reason for food restriction is not driven by a desire for weight loss. People with ARFID are unable to meet their body’s nutritional and caloric requirements, which results in physical, cognitive, and emotional symptoms. They may also experience social anxiety and isolation, since eating with others can be difficult for them.
There are three main ways a person with ARFID, a type of eating disorder, restricts food:
- Eating enough food: someone with ARFID may be disinterested, dysregulated, or disgusted by food, which leads them to under-eat even if they know they should and/or want to eat.
- Eating regularly: someone with ARFID may forget to eat or not notice their hunger signals, which leads them to skip meals and snacks, creating a vicious cycle of under-eating and over-hunger that sometimes but doesn’t always result in binge eating.
- Eating a variety of food: someone with ARFID may have a very limited list of foods they are willing and/or able to eat, which can lead to missing certain nutrients and negative impacts on their ability to eat in social settings.
How do I know if my child has ARFID or another eating disorder?
Typically a person with ARFID does not have eating disorder symptoms like a drive for weight loss or body image disruptions. However, because we live in a weight-conscious society, weight changes due to ARFID can become entangled in the disorder. For example, if ARFID results in weight loss and people praise the weight loss, the person with ARFID may develop a weight-loss mentality. In this way, a drive for weight loss can become a secondary symptom of ARFID. Other times the disorder may shift to a different eating disorder like anorexia, bulimia, or binge eating disorder.
People with ARFID typically show signs early in life, and are frequently identified as “picky eaters.” The average age of diagnosis is 12 years old. But it has been documented in children as young as six years old. Unlike other eating disorders, the rate of diagnosis for ARFID is equal for boys and girls.
Why does a child with ARFID struggle to eat?
ARFID is still a new diagnosis, meaning the research is in its early stages. There appears to be a link between ARFID and highly sensitive nervous systems. This includes the five senses (sight, sound, smell, taste, and touch), interoception (internal organ feedback), and neuroception (the sensation of how other people are feeling). ARFID may be likely to show up alongside neurodivergent conditions like autism and ADHD. People with ARFID are also likely to have anxiety and mood disorders, which are also associated with a highly sensitive nervous system.
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People with ARFID struggle to eat because of many reasons, including:
- Extreme sensitivity to the experience of eating as it impacts smell, touch, taste, temperature, appearance, and sounds of themselves eating and other people around them eating.
- Very high sensitivity to internal cues and sensations like hunger, nausea, appetite, and fullness.
- Extreme emotional dysregulation and anxiety around mealtimes, particularly when others are feeling stressed, upset, worried, etc.
- Anxiety about having a negative outcome from eating like vomiting or choking.
- Lack of interest in eating and/or forgetting to eat.
- Chronic abdominal pain with no known cause.
Importantly, someone can have any one of these, a combination, or all of them. Eating issues are complex and layered. Beyond the food itself, eating is social and emotional by design, so relationships can both impact and maintain disordered eating. One person with ARFID rarely looks like another person with ARFID—there are countless presentations of the disorder.
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What is the impact on families when a child has ARFID?
Raising a child with ARFID makes something we tend to take for granted, feeding our child, full of stress and strain. Most parents spend years feeling frustrated. They hope their child will naturally grow out of their picky eating habits. It can take years before they realize that there’s something more serious going on.
Here are some of the things parents who have kids with ARFID say:
- Her doctor says I have to feed her more because she’s lost weight, but I’m at my wits’ end about how to do that.
- Weight loss and malnutrition mean that I have to get my kid to eat, but he doesn’t want to, so every meal feels like a battle of wills.
- He was always picky, but before he could eat enough to keep growing. Then he hit puberty, and his menu got even more restricted. Every meal is a battle. I thought getting a diagnosis would help, but I still feel confused by it.
- My child never eats the same things everyone else wants to eat, so I end up being a short-order cook.
- She refuses to try things that every other child in her class loves, no matter what we do.
- Our family meals are uncomfortable, sometimes even impossible, because he’s so angry and resistant.
- My child demands the exact same meal every day, and I worry that she’s not getting the nutrition she needs.
- At most meals he gets into a bad mood. He’s rude and aggressive at mealtimes, making everyone uncomfortable.
- My child won’t eat at school, family functions, events, or anywhere there are other people who might look at her or make fun of her for what she’s eating or not eating.
- It seems like we can’t go to restaurants at all anymore because they almost never have something on the menu that works for his restrictive diet.
- I feel so sad knowing that her peers don’t understand, tease, and even bully her for her food and eating choices at school.
What does ARFID treatment look like?
As with all eating disorders, the first treatment task is weight restoration if needed. Weight restoration is highly individualized and typically a trained healthcare provider should establish the goals. Professionals who typically have the most training in this are registered dietitians (RDs). They have undergone specialized eating disorder training, particularly those who have received training in family-based treatment.
Typically but not always, weight restoration means bringing the child in line with their historical growth curve. Usually a child has steady growth along a weight trajectory before the eating disorder impacts weight and growth. For example, a child was in the 50th percentile for weight at ages 2, 4, 6, and 8. The historical weight data should drive weight restoration goals.
Beyond weight restoration, ARFID treatment focuses on:
- Building emotional regulation skills for eating situations
- Eating regular meals and snacks with support from others
- Normalizing eating enough food regularly
- Reducing anxiety around food and eating experiences
- Gradually increasing food variety and/or adding supplements to balance nutritional needs
Treating ARFID doesn’t end when weight is stabilized, because it’s about much more than weight. Being underweight can increase symptoms. However, gaining weight doesn’t remove the underlying sensitivities that likely drove the disorder in the first place.
What can parents do to help kids with ARFID?
While recovery from ARFID is hard, it’s possible. And there’s a lot of evidence that family participation makes a big difference!
The most common method for weight restoration is family-based treatment for ARFID (FBT-ARFID). This can be done with a therapist, coach, dietitian, or DIY using books and online resources like FEAST. The parent-based training program Supportive Parenting for Anxious Childhood Emotions-ARFID (SPACE-ARFID) is also effective.
While parents can certainly DIY eating disorder recovery, it’s usually best to get support and expert advice along the way. ARFID, like any eating disorder, is a difficult and frustrating condition to parent through. When parents are on the frontline, they really benefit from getting help and training.
Signs of recovery from ARFID
Recovery from ARFID, like any eating disorder, is definitely possible! Your child may always be sensitive to food and eating situations. However, they can leave disordered behavior behind and learn healthy, adaptive coping methods that help them thrive.
Here are some of the things parents who have kids who recovered from ARFID say:
- It took effort, and we all played a part in recovery, but today things are a lot easier for her, and she’s able to maintain her energy levels and eat socially, which is our primary goal.
- I’ve noticed so much less stress at mealtimes, and now we’re all enjoying our time together so much more.
- Getting to that goal weight was so important, and I feel like in many ways I got my sweet boy back from the brink. His mood improved and his anxiety levels dropped with every month he stayed within his weight range, and things have been going really well!
- It feels like a chicken and an egg situation! She was so resistant to eating anything, but it took eating a little more at each meal, eating more regularly, and slowly trying new things to start being able to eat like she had before the disorder.
- The biggest difference is that he’s so much less depressed and anxious. I thought we were looking at a lifetime of medication, but it turns out that the things we learned in recovery have turned everything around, and the future looks much brighter now.
All types of eating disorders are hard to manage, but recovery is possible, and parents can help!
Ginny Jones is on a mission to empower parents to help their kids recover from eating disorders, body image issues, and other mental health conditions. She’s the founder of More-Love.org, an online resource supporting parents who have kids with eating disorders, and a Parent Coach who helps parents who have kids with mental health issues.
Ginny has been researching and writing about eating disorders since 2016. She incorporates the principles of neurobiology and attachment parenting with a non-diet, Health At Every Size® approach to health and recovery.