Avoidant/restrictive food intake disorder (ARFID)

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: 

  • They might be very sensitive to the taste, texture, smell, or appearance of certain types of food, or only able to eat foods at a certain temperature. This can lead to sensory-based avoidance or restriction of intake
  • They may have had a distressing experience with food, such as choking or vomiting, or experiencing significant abdominal pain. This can cause the person to develop feelings of fear and anxiety around food or eating, and lead to them to avoiding certain foods or textures. Some people may experience more general worries about the consequences of eating that they find hard to put into words, and restrict their intake to what they regard as ‘safe’ foods. Significant levels of fear or worry can lead to avoidance based on concern about the consequences of eating
  •  In some cases, the person may not recognise that they are hungry in the way that others would, or they may generally have a poor appetite. For them, eating might seem a chore and not something that is enjoyed, resulting in them struggling to eat enough. Such people may have restricted intake because of low interest in eating

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.

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.