Understanding ARFID: More Than Just Picky Eating

Emma Summers, MSCP is a therapist in the Feeding and Eating Disorder Center at Children’s Hospital New Orleans.

Each year, the medical community observes National Eating Disorder Week, an opportunity to increase understanding and recognition of various eating disorders and to encourage affected individuals and families to seek support and treatment. Recently, there has been an increasing awareness of a specific type of eating disorder known as Avoidant Restrictive Food Intake Disorder (ARFID), a condition that goes beyond what many may dismiss as mere picky eating. ARFID illuminates the complex nature of eating behaviors and their significant effects on individuals' health and social functioning.

What is ARFID?

ARFID is a condition characterized by a highly selective eating habit, often described as extreme picky eating, that significantly impairs an individual's physical or psychological health, as well as their ability to function in everyday social settings. Unlike other eating disorders that might focus on body image or an intense fear of gaining weight, ARFID is primarily concerned with the act of eating itself and the sensory characteristics or consequences of food.

Though estimates vary, research suggests that ARFID affects about 0.5% to 5% of the population. Based on observations within the field as well as our own clinical practice, diagnoses are becoming more prevalent as well. This apparent increase in cases may be due to heightened awareness and better diagnostic practices rather than a true rise in incidence. As the medical community becomes more familiar with ARFID, diagnoses are becoming more common.

Many children experience picky eating, which is often considered a normal part of a child’s development. However, most children naturally outgrow picky eating as they become more open to trying new foods. On the other hand, children with ARFID represent a more severe and persistent pattern of food avoidance, often rooted in underlying psychological factors, such as anxiety related to food, extreme sensory sensitivities, or an absence of normal hunger cues.

Individuals with ARFID exhibit extreme selective eating, which represents a significant and profound disturbance in their eating habits rather than a mere preference or minor dislike. This selectivity often leads to noticeable weight loss or a failure to maintain expected growth curves, stemming from inadequate nutritional intake. Untreated, ARFID can lead to severe complications, including malnutrition, stunted growth, delayed puberty, and significant social impacts.

In addition, the implications of ARFID stretch into the daily lives of those affected; the intense selectivity associated with the disorder can severely disrupt routine activities, impacting social functions, educational settings, and family gatherings or vacations. Children in particular may experience social isolation and mealtime stress and tension. These disruptions underline the severity of ARFID and the importance of recognizing its symptoms for timely and effective intervention and treatment.

Causes of ARFID

The underlying causes of Avoidant Restrictive Food Intake Disorder remain largely unknown, although several contributing factors have been identified through ongoing research and clinical observations. Sensory sensitivity can play a significant role; individuals with ARFID may experience heightened sensitivity to the taste and texture of foods, classifying them as 'super tasters.' This heightened sensitivity can make the act of eating certain foods intolerable.

Traumatic events, such as instances of choking or vomiting, are also known to precipitate ARFID, instilling a deep-seated fear of eating that can be difficult to overcome. Additionally, some individuals may experience an abnormal sense of satiety, meaning they do not consistently feel hungry at mealtimes, or they feel full quicker than what is typical, which naturally leads to a reduced intake of food. ARFID has also been associated with various mental health and developmental conditions, including autism, where sensory sensitivities are more prevalent. These elements collectively contribute to the complex development of ARFID, highlighting the need for a multifaceted approach to treatment and support.

ARFID vs. Anorexia

While both Avoidant Restrictive Food Intake Disorder and anorexia nervosa are characterized by significant restrictions in food intake, the motivations and concerns underlying these behaviors are distinctly different.

In the case of ARFID, restricted food intake is not motivated by concerns over body image or an intense fear of weight gain, which are hallmark characteristics of anorexia nervosa. Instead, individuals with ARFID often avoid food due to its sensory properties, such as taste, texture, or smell, or due to a past negative experience like choking or vomiting, leading to a fear of adverse effects from eating. This fundamental difference highlights the unique nature of food avoidance in ARFID compared to the calorie-focused avoidance seen in anorexia.

In addition, there exists a societal component to these disorders; the stigma surrounding anorexia is well-documented, and this stigma can sometimes lead individuals to falsely claim they have ARFID, as it may be perceived as more socially acceptable or less associated with mental health issues. Societal misconceptions can influence how individuals and families understand disordered eating symptoms and whether they choose to seek treatment for these conditions. The distinction between ARFID and anorexia nervosa emphasizes the need for tailored approaches in treatment and increased public awareness to address the unique challenges faced by those with each disorder. 

Seeking Care

At Children's Hospital New Orleans, we understand the challenges children with ARFID face and are dedicated to providing comprehensive support through our Feeding and Eating Disorder Center, which is the first hospital-based feeding and eating disorder treatment program in Louisiana and the Gulf South.  ​

Our center embraces a multi-disciplinary approach, bringing together psychologists, dieticians and physicians who work collaboratively with families to create a personalized plan that addresses the unique needs of each child. We offer innovative treatments such as Cognitive Behavioral Therapy (CBT) and Family-Based Treatment (FBT), both evidence-based methods that have shown promise in helping children overcome ARFID, and we are dedicated to being at the forefront of new treatments and therapies as they are developed.

If you find yourself worried about your child or a loved one's eating habits, we encourage you to speak to your pediatrician and consider reaching out to our clinic for specialized care. We are committed to supporting your child’s journey to better health and well-being through a comprehensive, multidisciplinary strategy grounded in the most current evidence-based research. Our goal is to help guide your child on their path to improved health, ensuring they receive the care and guidance they need for a healthier future.