ARFID Isn’t Just Picky Eating—Let’s Talk About ItWhat you need to know about this lesser known eating disorder.
We all know someone (or maybe…are someone) who seems to survive mostly on “picky eater staples” like chicken nuggets and buttered noodles. And, listen, we’re not here to judge the person who turns down oysters because the texture freaks them out. Food preferences are deeply personal and influenced by many different things. But when eating habits become so limited that they end up causing medical issues or interfering with your life, that can be a sign of avoidant/restrictive food intake disorder (ARFID for short).
If you’ve seen videos on your FYP about this eating disorder—a topic which has a cool 70 million views on TikTok—you might be wondering where the line is between picky eating and a diagnosable eating disorder. We can help with that.
Here, check out what ARFID is, what might cause it, and how people with this eating disorder can get help for their symptoms—because it is treatable.
One quick thing before we dive into the details: Mental health is complex and everyone has a unique experience, so don’t go diagnosing yourself just because you read a few articles on the internet (though, we do appreciate you stopping by to learn a few things). If this resonates with you, consider it a jumping-off point in your journey to getting care. OK, let’s get into it...
What is ARFID?
ARFID is an eating disorder where someone limits the amount of food or types of food they eat so much that it impacts their health or how they act around other people, says psychologist and certified eating disorder specialist Lauren Muhlheim, PsyD. More specifically, one or more of the following happens: They lose a ton of weight (or, in kids, they’re lower weight or smaller than what’s considered normal); they have nutrition deficiencies; they have to use a feeding tube or supplements; and/or this causes them to miss out on things like school, work, or social situations, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).
Here’s the thing: People with ARFID don’t restrict what they eat because they’re being stubborn or difficult, says Dr. Muhlheim, who has treated ARFID for many years and runs an ARFID adult support group. Instead, there’s a deeper and pervasive reason that holds them back from eating certain foods, whether it’s an aversion to certain tastes, colors, smells, or textures; a total lack of interest in eating; and/or a fear of what might happen if they eat (they could choke, get sick, etc.), per the DSM-5-TR.
For someone without ARFID, it can be hard to imagine how this fear or aversion to certain foods can mess with your life on such a significant scale. If that’s you, think about what it would be like if someone asked you to eat something that isn’t food (like…a stinky old sponge). The disgust is usually like that, explains Dr. Muhlheim. You might be so grossed out that you gag or throw up, which is how someone with ARFID can react to foods that they have a fear or aversion to, says psychologist and Harvard Medical School associate professor of psychology Kamryn Eddy, PhD.
Now, imagine that you’re expected to be OK with eating stinky old sponges or be around other people eating those sponges every time you go to school, work, or basically any event where you don’t know what’s on the menu. See how awful and anxiety inducing that would be? And, unsurprisingly, this can all make people with ARFID feel embarrassed and want to avoid eating with others.
It’s also worth noting that people with ARFID typically aren’t restricting what they eat because they’re concerned about their weight or appearance, per the DSM-5-TR. And, the person’s avoidance of food isn’t better explained by a medical condition (like IBS or Crohn’s disease) or another mental health disorder (like depression), says Dr. Eddy, also co-director of Massachusetts General Hospital’s Eating Disorders Clinical and Research Program.
What causes ARFID?
ARFID symptoms usually start young, especially for people who just aren’t into eating or who are bothered by the sensory aspect of food, says Dr. Eddy. Kids can show signs of ARFID as early as when they just start eating, and they’re normally diagnosed around 8 or 9, according to James Lock, MD, director of the Eating Disorder Program for Children and Adolescents at Stanford University. That said, people can be diagnosed as adults too, especially if their symptoms were missed as kids or if some food-related event triggered it as they got older (which we’ll get to in a bit).
Researchers are still trying to pinpoint exactly what causes ARFID in young people and adults. There’s some evidence that ARFID runs in families, says Dr. Eddy. Other than that, though, her team is currently testing a few theories, which we’ll talk about here.
For people who avoid eating because they’re afraid of bad things happening to them, they usually experienced or witnessed something scary like choking or getting sick from food, says Dr. Eddy. But a lot of people can choke or get sick and not develop ARFID, so there might be something going on biologically that makes them more likely to hold on to that fear, she explains.
For people with ARFID who have low interest or appetite, one theory is that they may have some sort of difference in how their bodies tell them they’re hungry and full, says Dr. Eddy. “Folks who have ARFID may have different signaling going on with their appetite-regulating hormones that may make them stop eating prematurely or not even know that they're hungry,” she explains.
Lastly, people with ARFID who won’t eat certain food because of texture, smell, taste, or whatever it is, usually weren’t able to grow out of the picky eating that they showed as kids, says Dr. Eddy. “We have some hypotheses that maybe they have preferences towards specific types of foods that may run in families and make them less likely to want to try new things,” she explains. This can create a sort of vicious cycle where it becomes harder and harder to introduce new foods.
How is ARFID treated?
There’s no gold-standard treatment for ARFID yet—researchers are still studying away, notes Dr. Lock. So while some people may be prescribed medication for mental health conditions that might happen alongside ARFID, like ADHD or anxiety disorders, there are no meds officially approved to treat ARFID right now, he says.
That said, people can definitely manage ARFID with therapy, with the goal being to help them feel less anxious about eating and fix any nutritional needs or gain weight if needed, says Dr. Muhlheim. They might still have food preferences, but it’s about getting them to a place where they’re more comfortable with food, she notes.
One therapy that aims to do all this is CBT specifically developed for ARFID by Dr. Eddy and Jennifer Thomas, PhD, the other co-director of Massachusetts General Hospital’s Eating Disorders Clinical and Research Program. CBT for ARFID basically involves facing your fears around eating (aka exposure). The type of exposure will depend on what someone’s goal is, but it could look like a person who’s avoided pizza for years gradually working their way up to a slice by starting with some tomato sauce on something they’re already OK with (like pasta maybe). They’d start eating this with their therapist, and then they might try it again at home and in different restaurants before moving on to the real thing, Dr. Eddy says. “The more that we do things to avoid situations that feel scary, the scarier they become over time. And so, really, the only way out of anxiety is through it,” she explains.
Another therapy that mental health pros might use for kids and teens is something called family-based therapy for ARFID, developed by Dr. Lock and his team, which helps family members be part of the healing process—setting goals, eating, and trying new foods together.
And while therapy is great, managing ARFID might also involve checking in with a primary care provider about any physical symptoms that can come up (like GI issues or muscle weakness) and possibly a dietitian to chat about nutritional deficiencies, the experts say. And, in some cases, residential or inpatient treatment might be necessary if someone’s eating needs to be monitored more closely to help with severe weight loss or deficiencies.
Regardless of how ARFID looks for you or someone you know, help is out there. Here are a few resources for finding a provider with experience treating ARFID:
“We've seen a lot of people who get much better and who no longer meet criteria for ARFID at the end of treatment,” says Dr. Eddy. “Full recovery from ARFID is not only possible but probable."
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