ARFID Symptoms: Diagnosing Avoidant/Restrictive Food Intake Disorder

The restricting behavior can be due to sensory sensitivity, trauma, or lack of interest in food. ARFID was added to theDiagnostic and Statistical Manual of Mental Disorders (DSM)in 2013, replacing Feeding Disorder of Infancy or Early Childhood and expanding the diagnostic criteria to include individuals across the lifespan.

Approximately 1.5% of children and adolescents develop ARFID,and less than 1% of individuals age 15 and older meet criteria for ARFID.

ARFID Signs and Symptoms

Diagnostic criteria for ARFID is the same in the DSM-5 and the DSM-5-TR. The diagnostic criteria for ARFID are:

If an individual previously met the criteria for ARFID but no longer meets criteria, the diagnosis is specified as in remission.

ARFID Types

Although the DSM does not officially classify different subtypes ofARFID, research has shown that there are different triggers for symptom onset: irritable/impulsive, sensory food aversions, and posttraumatic feeding disorder.

The irritable/impulsivesubtype refers to those who become irritable or emotionally dysregulated at mealtimes. They do not have control over their emotional response and might struggle with body self-control.

Sensory food aversions often occur inneurodivergentindividuals, including autistic people. These individuals struggle with eating due to sensory problems around the texture, appearance, or feel of the food.

Finally, post-traumatic feeding disorder is a trauma response that develops following an aversive feeding experience, such as choking orvomiting. The individual exhibits significant anxiety that another aversive experience will occur while they are eating.

ARFID Comorbidities

ARFID, like other eating disorders, carries risk of malnutrition, unhealthy low weight, heart problems, and sudden death.

People who meet the diagnostic criteria for ARFID may also be diagnosed withanxiety disorders,obsessive-compulsive disorders,autism,attention-deficit/hyperactivity disorder, andintellectual disability.

ARFID Causes

Because the exact cause of ARFID is not known, limited information is available regarding what leads the symptoms to emerge. Many experts believe that a combination of psychological, genetic, and triggering events can lead to ARFID.

Available research suggests that ARFID is equally prevalent in males and females, thoughautistic boysare more likely to develop ARFID than autistic girls.However, autistic individuals of all genders are at higher risk for developing ARFID compared to the general population due to sensory issues around food and eating.

People with a comorbid diagnosis, including anxiety and OCD, are at increased risk for developing ARFID compared to the general population.

Additionally, ARFID symptoms can be atrauma responsein people with a history of traumatic experiences around feeding (such as choking or frequent vomiting).

Finally, like many other disorders, ARFID has ageneticcomponent. Although research surrounding the specific genetic factors that contribute to an individual developing ARFID is still developing,one study suggests that people with a family history of ARFID have a 17% chance of developing the disorder, compared to 1.5% of the general population.

Diagnosing ARFID

Physicians and mental health professionals such aspsychologistscan diagnose ARFID. The assessment will likely include a thoroughdiagnostic interviewwith either the individual or (if they are a minor) a parent or guardian. They may also observe the individual’s behavior.

In order to determine the severity and best treatment approach, the provider may also request a medical assessment to assess for malnutrition and (in children) possible growth delays.

ARFID Treatment

Unfortunately, limited information is presently available regarding effective treatment options for ARFID.Treatment goals forARFIDtypically include maintaining a healthy weight and engaging in healthy eating habits, increasing the variety of foods the person will eat, and addressing anxiety or trauma symptoms surrounding fear of aversive outcomes from eating.

Psychotherapy

Therapy can help address many mental health diagnoses. In particular,cognitive-behavioral therapyhas been found to be effective for various types of eating disorders, though research has not been conducted on its effectiveness with ARFID at this time.

For individuals with post-traumatic feeding disorder,trauma informed therapycould help address the underlying trauma contributing to these symptoms.

Occupational Therapy

Although research onoccupational therapyas a treatment for ARFID has not been conducted, sensory-based occupational therapy interventions can benefit people with sensory issues related to autism and ADHD.If the individual’s food avoidance is due to sensory issues, occupational therapy might help overcome this limitation.

Coping With ARFID Symptoms

Second, they must consume sufficient calories andnutritionto survive. While a long-term goal of ARFID treatment is to increase the variety of foods that the person can tolerate, in the short-term, meal supplements and protein shakes can help maintain healthy nutrient intake.

Connecting with atreatment teamthat you trust is key in coping with ARFID. Finding therapists and doctors that are a good fit for your needs and who can support you in your recovery is important. They can connect you with additional resources, including education and peer support.

A Word From Verywell

Keep in mind that relapse can be part of recovery. This can feel frustrating, but you can overcome a relapse. Symptoms can fluctuate, and this does not mean that recovery is impossible or that you will never get there.

Be prepared to cope with relapses, and have a plan in place with your treatment team for how you will handle this if it occurs. Know that you can always keep moving forward in your recovery.

11 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed., American Psychiatric Association, 2013. DSM-V,doi-org.db29.linccweb.org/10.1176/Eddy KT, Thomas JJ, Hastings E, et al.Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network: Avoidant/Restrictive Food Intake Disorder.Int J Eat Disord. 2015;48(5):464-470. doi:10.1002/eat.22350Cerniglia L, Marzilli E, Cimino S.Emotional-behavioral functioning, maternal psychopathologic risk and quality of mother–child feeding interactions in children with avoidant/restrictive food intake disorder.IJERPH. 2020;17(11):3811. doi:10.3390/ijerph17113811Iwajomo T, Bondy SJ, de Oliveira C, Colton P, Trottier K, Kurdyak P.Excess mortality associated with eating disorders: population-based cohort study.Br J Psychiatry. 2021;219(3):487-493. doi:10.1192/bjp.2020.197Dovey TM, Kumari V, Blissett J.Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (Arfid), autistic spectrum disorders or picky eating: Same or different?European Psychiatry. 2019;61:56-62. doi:10.1016/j.eurpsy.2019.06.008Zimmerman J, Fisher M.Avoidant/restrictive food intake disorder(Arfid).Current Problems in Pediatric and Adolescent Health Care. 2017;47(4):95-103. doi:10.1016/j.cppeds.2017.02.005Kennedy HL, Dinkler L, Kennedy MA, Bulik CM, Jordan J.How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (Arfid).J Eat Disord. 2022;10(1):53. doi:10.1186/s40337-022-00578-xKoomar T, Thomas TR, Pottschmidt NR, Lutter M, Michaelson JJ.Estimating the prevalence and genetic risk mechanisms of arfid in a large autism cohort.Front Psychiatry. 2021;12:668297. doi:10.3389/fpsyt.2021.668297Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders. Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004Schoen SA, Miller LJ, Flanagan J.A retrospective pre-post treatment study of occupational therapy intervention for children with sensory processing challenges.The Open Journal of Occupational Therapy. 2018;6(1). doi:10.15453/2168-6408.1367

11 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed., American Psychiatric Association, 2013. DSM-V,doi-org.db29.linccweb.org/10.1176/Eddy KT, Thomas JJ, Hastings E, et al.Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network: Avoidant/Restrictive Food Intake Disorder.Int J Eat Disord. 2015;48(5):464-470. doi:10.1002/eat.22350Cerniglia L, Marzilli E, Cimino S.Emotional-behavioral functioning, maternal psychopathologic risk and quality of mother–child feeding interactions in children with avoidant/restrictive food intake disorder.IJERPH. 2020;17(11):3811. doi:10.3390/ijerph17113811Iwajomo T, Bondy SJ, de Oliveira C, Colton P, Trottier K, Kurdyak P.Excess mortality associated with eating disorders: population-based cohort study.Br J Psychiatry. 2021;219(3):487-493. doi:10.1192/bjp.2020.197Dovey TM, Kumari V, Blissett J.Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (Arfid), autistic spectrum disorders or picky eating: Same or different?European Psychiatry. 2019;61:56-62. doi:10.1016/j.eurpsy.2019.06.008Zimmerman J, Fisher M.Avoidant/restrictive food intake disorder(Arfid).Current Problems in Pediatric and Adolescent Health Care. 2017;47(4):95-103. doi:10.1016/j.cppeds.2017.02.005Kennedy HL, Dinkler L, Kennedy MA, Bulik CM, Jordan J.How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (Arfid).J Eat Disord. 2022;10(1):53. doi:10.1186/s40337-022-00578-xKoomar T, Thomas TR, Pottschmidt NR, Lutter M, Michaelson JJ.Estimating the prevalence and genetic risk mechanisms of arfid in a large autism cohort.Front Psychiatry. 2021;12:668297. doi:10.3389/fpsyt.2021.668297Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders. Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004Schoen SA, Miller LJ, Flanagan J.A retrospective pre-post treatment study of occupational therapy intervention for children with sensory processing challenges.The Open Journal of Occupational Therapy. 2018;6(1). doi:10.15453/2168-6408.1367

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed., American Psychiatric Association, 2013. DSM-V,doi-org.db29.linccweb.org/10.1176/Eddy KT, Thomas JJ, Hastings E, et al.Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network: Avoidant/Restrictive Food Intake Disorder.Int J Eat Disord. 2015;48(5):464-470. doi:10.1002/eat.22350Cerniglia L, Marzilli E, Cimino S.Emotional-behavioral functioning, maternal psychopathologic risk and quality of mother–child feeding interactions in children with avoidant/restrictive food intake disorder.IJERPH. 2020;17(11):3811. doi:10.3390/ijerph17113811Iwajomo T, Bondy SJ, de Oliveira C, Colton P, Trottier K, Kurdyak P.Excess mortality associated with eating disorders: population-based cohort study.Br J Psychiatry. 2021;219(3):487-493. doi:10.1192/bjp.2020.197Dovey TM, Kumari V, Blissett J.Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (Arfid), autistic spectrum disorders or picky eating: Same or different?European Psychiatry. 2019;61:56-62. doi:10.1016/j.eurpsy.2019.06.008Zimmerman J, Fisher M.Avoidant/restrictive food intake disorder(Arfid).Current Problems in Pediatric and Adolescent Health Care. 2017;47(4):95-103. doi:10.1016/j.cppeds.2017.02.005Kennedy HL, Dinkler L, Kennedy MA, Bulik CM, Jordan J.How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (Arfid).J Eat Disord. 2022;10(1):53. doi:10.1186/s40337-022-00578-xKoomar T, Thomas TR, Pottschmidt NR, Lutter M, Michaelson JJ.Estimating the prevalence and genetic risk mechanisms of arfid in a large autism cohort.Front Psychiatry. 2021;12:668297. doi:10.3389/fpsyt.2021.668297Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders. Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004Schoen SA, Miller LJ, Flanagan J.A retrospective pre-post treatment study of occupational therapy intervention for children with sensory processing challenges.The Open Journal of Occupational Therapy. 2018;6(1). doi:10.15453/2168-6408.1367

Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed., American Psychiatric Association, 2013. DSM-V,doi-org.db29.linccweb.org/10.1176/

Eddy KT, Thomas JJ, Hastings E, et al.Prevalence of DSM-5 avoidant/restrictive food intake disorder in a pediatric gastroenterology healthcare network: Avoidant/Restrictive Food Intake Disorder.Int J Eat Disord. 2015;48(5):464-470. doi:10.1002/eat.22350

Cerniglia L, Marzilli E, Cimino S.Emotional-behavioral functioning, maternal psychopathologic risk and quality of mother–child feeding interactions in children with avoidant/restrictive food intake disorder.IJERPH. 2020;17(11):3811. doi:10.3390/ijerph17113811

Iwajomo T, Bondy SJ, de Oliveira C, Colton P, Trottier K, Kurdyak P.Excess mortality associated with eating disorders: population-based cohort study.Br J Psychiatry. 2021;219(3):487-493. doi:10.1192/bjp.2020.197

Dovey TM, Kumari V, Blissett J.Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (Arfid), autistic spectrum disorders or picky eating: Same or different?European Psychiatry. 2019;61:56-62. doi:10.1016/j.eurpsy.2019.06.008

Zimmerman J, Fisher M.Avoidant/restrictive food intake disorder(Arfid).Current Problems in Pediatric and Adolescent Health Care. 2017;47(4):95-103. doi:10.1016/j.cppeds.2017.02.005

Kennedy HL, Dinkler L, Kennedy MA, Bulik CM, Jordan J.How genetic analysis may contribute to the understanding of avoidant/restrictive food intake disorder (Arfid).J Eat Disord. 2022;10(1):53. doi:10.1186/s40337-022-00578-x

Koomar T, Thomas TR, Pottschmidt NR, Lutter M, Michaelson JJ.Estimating the prevalence and genetic risk mechanisms of arfid in a large autism cohort.Front Psychiatry. 2021;12:668297. doi:10.3389/fpsyt.2021.668297

Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5

Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders. Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004

Schoen SA, Miller LJ, Flanagan J.A retrospective pre-post treatment study of occupational therapy intervention for children with sensory processing challenges.The Open Journal of Occupational Therapy. 2018;6(1). doi:10.15453/2168-6408.1367

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