Avoidant restrictive food intake disorder, more commonly known as ARFID, is a condition characterised by the person avoiding certain foods or types of food, having restricted intake in terms of overall amount eaten, or both.
Someone might be avoiding and/or restricting their intake for a number of different reasons. The most common are the following:
It is very important to recognise that any one person can have one or more of these reasons behind their avoidance or restriction of food and eating at any one time. In other words, these examples are not mutually exclusive. This means that ARFID might look quite different in one person compared to another. Because of this, ARFID is sometimes described as an ‘umbrella’ term – it includes a range of different types of difficulty. Nevertheless, all people who develop ARFID share the central feature of the presence of avoidance or restriction of food intake in terms of overall amount, range of foods eaten, or both.
Other key aspects of ARFID are that it can have a negative impact on the person’s physical health and as well as on their psychological wellbeing. When a person does not take in enough energy (calories), they will lose weight. Children and young people may fail to gain weight as expected and their growth may be affected, with a slowing in height increase. When a person does not have an adequate diet because they are only able to eat a narrow range of foods, they may not get essential nutrients needed for their health, development and ability to function on a day-to-day basis. In some people, serious weight loss or nutritional deficiencies may develop, which need treatment. In people whose food intake is very limited, nutritional supplements may be prescribed. In some cases a period of tube feeding may be recommended if physical risk is judged to be high.
Being limited in terms of what they can eat often causes people to experience significant difficulties at home, at school or college, at work and when with friends. Their mood and day-to-day functioning can be negatively affected. Many people with ARFID find it difficult to go out or to go on holiday, and their eating difficulties may make social occasions difficult to manage. They may find it difficult to make new friends or establish close relationships as social eating occasions are often part of this process.
ARFID is different from anorexia nervosa, bulimia nervosa and related conditions; in ARFID, beliefs about weight and shape do not contribute to the avoidance or restriction of food intake. A diagnosis of ARFID would not be given at the same time as one of these other eating disorders, although it could precede or follow. A diagnosis of ARFID would also not be given if there is another clear reason for the eating difficulty, such as a medical condition that results in appetite loss or digestive difficulties.
Anyone of any age can have ARFID. It occurs in children, teenagers and adults. People with ARFID can lose weight and become very underweight, their weight may be in a “normal” range, or they may gain weight or have high weight (particularly if their diet is restricted to foods that are high in calories). ARFID can be present on its own, or it can co-occur with other conditions; those most commonly co-occurring with ARFID are anxiety disorders, autism, ADHD and a range of medical conditions. The eating difficulties someone with ARFID has, can have been present for a very long time, in some cases almost as long as they can remember. In other people, it might have a more recent onset.
Because ARFID includes a range of different types of difficulty that contribute to the avoidance or restriction of food intake, there is a wide range of possible signs and symptoms, not all of which would necessarily occur in one person. Possible signs of ARFID include:
If you think you might have ARFID, you should make an appointment to discuss this with your GP. If you are concerned that a family member or friend has ARFID, it is important to talk with them to support and encourage them to seek the right help and support. It is usually best that this help and support is in place as soon as possible after the difficulties have been recognised. You may feel daunted by idea of trying to change your eating, or the person you care about may be scared or may not be as concerned about their eating as others. People with ARFID may not be able to see any possibility that they can ever change their eating behaviours. This may lead to them being reluctant to reach out for help, or saying that everything is okay. However, ARFID can lead to serious malnutrition and be associated with significant impairment to psychological wellbeing, so it is important that they receive this support.
The first port of call when seeking help is through your GP or the GP of the person you care about. It could be helpful to go with someone close to you, or suggest that you go to this appointment together if you are concerned about someone else. It is often helpful to go prepared with notes about your concerns and to explain clearly why you think the difficulties are related to ARFID. If you are taking your child to see the GP, it is always best to explain to them why you are going and what you are concerned about, again taking some prompts or notes to the appointment. For example, think about how long things have been going on and any symptoms or behaviours that you are worried about. If going to the GP is something you are anxious about, you can speak to our Helpline about your worries.
Due to the varied forms ARFID may take, people may receive treatment in one or more of a number of different types of services from a range of different types of professionals. Currently, treatment for ARFID is not included in the NICE guidelines for eating disorders; however, this certainly does not mean it does not need to be taken seriously. The GP should still make a referral to the relevant service. Young people may be treated by their local community eating disorders service for children and young people, generic Child and Adolescent Mental Health Services (CAMHS), community paediatric services, in the local acute paediatric service, or by a range of private practitioners, including dietitians, speech and language therapists, psychologists and occupational therapists. Adults with ARFID may be treated by specialist eating disorders services, general mental health services (particularly those offering treatment for anxiety), as part of hospital-based liaison work when the ARFID occurs in the context of a chronic medical condition, or by private practitioners.
Treatment for ARFID is usually best tailored to the needs of the individual, based on the specific nature of the difficulties the person is experiencing and what is considered to be maintaining these. Most often, treatment can be delivered in an outpatient setting. Treatment commonly involves evidence-based treatments such as family-based treatment (for young people), cognitive behavioural therapy, behavioural interventions such as exposure work, and anxiety management training. Sometimes some medication may be suggested, most often to help with anxiety. The person’s physical health should also be monitored and managed, for instance by their GP or a physician or paediatrician. Treatment may also involve nutritional management through support from a dietician, and help with sensory problems.
Beat’s free, confidential Helplines are open 365 days a year 12–8pm Monday to Friday and 4–8pm Saturday, Sunday and bank holidays.
You can also join one of our online support groups, which are anonymous and give you the opportunity to speak to people going through similar experiences to you:
The Nest: A confidential, inclusive and welcoming space for anyone wanting to share their eating disorder experiences, open daily from 5:30–7:00pm.
The Aviary: A confidential, inclusive and welcoming space for anyone that is supporting someone with an eating disorder. Open Tuesday from 7:00–8:15pm.
Dove: For anyone aged 18 or over with an eating disorder, open Thursday from 7:00–8:15pm.
Phoenix: For anyone under 18 with an eating disorder, open Thursday from 7:00–8:15pm.
Blue Jay: For mothers of someone affected by an eating disorder, open Wednesday from 7:00–8:15pm.
This information was produced for Beat by Dr. Rachel Bryant-Waugh, an experienced Consultant Clinical Psychologist and Lead of the National CAMHS ARFID Service at the Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED). Rachel is passionate about ensuring that the voices and experiences of young people, parents, carers and other family members are heard, respected and included in efforts to improve knowledge and treatment of feeding and eating disorders.