Avoidant restrictive food intake disorder (ARFID)

Avoidant/restrictive food intake disorder (ARFID) is previously known as feeding disorder or selective eating disorder. Someone with ARFID avoids eating certain foods, limits how much they eat, or does both.

When a person develops ARFID, they are less worried about their body weight or shape and develop the eating disorder for other reasons, which include:

a dislike of the smell, texture or taste of certain foods.
feeling anxious following a negative experience with food, for example choking or sickness.
previous fussiness with eating which develops into a more severe dislike of certain foods.
a lack of interest in food and not feeling hungry.

Seek urgent help if you have rapidly lost weight for longer than a few weeks, lost weight over three months, or think your eating is out of control. Speak to your family doctor (GP) if any of these happening to you or a young person you care for.

What is ARFID?

ARFID is a mental health condition where the avoidance or restriction of food is not motivated by preoccupation with body weight or shape. ARFID is an eating disorder, where a child or young person has one or more of the following issues present: significant nutritional deficiency; dependence on enteral feeding or oral supplements; marked psychosocial issues; or weight loss/growth faltering, in the absence of body image issues, such as in anorexia. It is as a psychiatric diagnosis, where the primary drivers for a child or young persons feeding problems are psychological. For a professional to assign an ARFID diagnosis, they should be a psychiatrist, psychiatric nurse, psychologist or another mental health professional who is qualified to give psychiatric diagnoses. Prior to diagnosing, it is important to consider whether there are on-going skills deficits (e.g. oral motor or self-feeding) and/or medical complications e.g. congenital conditions such as cleft palate, down syndrome, heart and lung diseases, Neurological conditions (such as autism), Learning Difficulties intolerances, allergies, reflux, constipation etc. These may be considered as possible exclusionary criteria for ongoing treatment within our mental health treatment pathway for ARFID and should be fully assessed and addressed prior to referral for mental health intervention.

ARFID Key considerations

There are three subtypes of ARFID: 1. restrictive; 2. avoidant; and 3. aversive.

Restrictive May show little to no signs of interest in food. It can mean one forgets to eat altogether, have a low appetite, or gets extremely distracted during mealtimes. It can also include extreme pickiness of food, resulting in limited intake.

Avoidant Individuals will avoid certain types of food in relation to specific sensory features, causing a sensitivity or overstimulation (which differs from wider sensory processing difficulties such as sensory dysregulation that might prevent the child from being able to sit and eat). These individuals are sensitive to the smell, texture, or appearance.

Aversive May experience psychological, fear-based reactions to food. Evokes a fear of choking, vomiting, nausea, pain and/ or swallowing, meaning the individual avoids the food altogether.

ARFID assessment and treatment criteria

ARFID Signs and symptoms

It is important to remember that someone may be avoiding and/or restricting their intake for a number of different reasons, which means that ARFID presentations can differ in one person to the next. Because of this, there is a wide range of possible signs and symptoms. Please ensure that an in-depth assessment is offered prior to diagnosing.

Difficulty recognising when hungry.
Always having the same meals.
Appearing to be a “picky eater”.
Only eating similar foods (e.g. only beige coloured foods).
Weight loss, or not gaining weight as expected in children.
Sensitivity to certain textures, smells, etc. Finding eating and mealtimes a ‘chore’.
Eating a reasonably varied diet, but still eating less food than is needed.
Missing meals due to being busy with other things.
Needing to take supplements to ensure nutritional needs are met.

ARFID pathway

Treatment Approaches offered include:

CBT for ARFID,
Family Based Treatment for ARFID.
Exposure and Response Prevention therapy,
CBT for anxiety/phobias,
Mental Health Occupational Therapy and Dietetics (nutrition/refeeding)

We also offer training and consultation for clinicians.

ARFID Referral guide

Feeding and Eating Difficulties Pathway leaflet

ARFID or PFD?

Due to the cross-over in symptoms, the most obvious being limited oral intake, there is sometimes confusion between the (Paediatric Feeding Disorder) PFD and ARFID diagnoses. PFD is a developmental, multidisciplinary (MDT) diagnosis that includes challenges in any one or several of the four domains, medical, nutrition, feeding skill, or psychosocial. It can be diagnosed following an MDT assessment (for example SLT, OT and Dietitian), that has investigated medical history, nutritional, feeding skills and psychosocial domains.

When a child has significant feeding difficulties, the standard of care should involve a multidisciplinary assessment that considers the four domains of PFD to ensure that skill and/or medical factors are not contributing to the child’s feeding struggles, prior to considering an ARFID diagnosis. For PFD consider referrals to Community Paediatric Services rather than a mental health service. (See ARFID and PFD - Feeding Matters for further information).

PFD: Key considerations

Feeding is an intricate combination and coordination of skills. It is the single most complex and physically demanding task an infant will complete for the first few weeks, and even months, of life. Paediatric Feeding Disorder (PFD) is included in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). It is defined as impaired oral intake that is not age appropriate, and is associated with medical, nutritional, feeding skill and psychosocial dysfunction. PFD is characterised by the skills and difficulties related to feeding and eating, often associated with medical factors that result in nutritional and psychosocial consequences. The diagnosis takes into account the functional impact of these difficulties for the child (their overall development, growth, and participation in daily activities) and the family (the social and environmental consequences).

PFD: Signs and symptoms

Learning to eat is a progressive developmental process. Children are instinctively driven to engage in mealtimes when body systems are well functioning. A child is at risk for developing PFD when any system is not functioning optimally. Children with PFD often have difficulties with Feeding from early infancy. Early identification of signs and symptoms is important for the long-term health and well-being of affected children, and their family.

Medical: Gastro symptoms associated with eating/drinking (vomiting, constipation), food allergies, crying, arching, coughing, choking, sweating, breathing / colour changes when eating and /or drinking, physical discomfort when eating/drinking, recurring upper respiratory tract infections.

Nutritional: Difficulty eating/drinking enough to grow and stay hydrated, nutritional deficiencies, need for nutritional supplements, limited dietary diversity. Skill based: Difficulty chewing food, difficulties self-feeding, only able to manage a limited range of textures, difficulties with postural control, need for special strategies, positioning or equipment, excessively long (> 30 minutes) or short meals (<5 minutes), difficulty managing the sensory properties of mealtimes (tastes, smells, sounds, feel, sight of food).

Avoidant restrictive food intake disorder (ARFID)

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