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How Do You Know You Have Avoidant Restrictive Food Intake Disorder?

Here's what you need to know about this eating disorder (that's actually a sensory disorder).

A woman pushes a plate of food away as her hand covers her mouth.

Published: October 22, 2023

Key Points

Avoidant restrictive food intake disorder is misleadingly named.
ARFID is actually a sensory disorder rather than an eating disorder like anorexia or bulimia.
People with ARFID have an aversion to textures in certain foods or may have had a negative experience with a food in the past that causes them to refrain from eating that specific food.

Avoidant restrictive food intake disorder (ARFID) is different from other eating disorders. ARFID is a newly researched disorder with different signs and symptoms than the more commonly known eating disorders.

Let's look at what avoidant restrictive food intake disorder is, what signs you should be aware of, and how it's diagnosed and treated.

What is ARFID eating disorder?

ARFID is an eating disorder diagnosis recently introduced to the Feeding and Eating Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), according to the National Library of Medicine.

This title does not accurately describe the condition, however, since ARFID is a sensory disorder. ARFID is different from other eating disorders because patients' behavior is not connected to body image, desire to lose weight or fear of weight gain.

While it impacts a person's mental health like other eating disorders, it is different from anorexia, bulimia and binge eating, as those disorders are rooted in a maladaptive relationship with food as a coping mechanism. And it needs to be treated differently than other eating disorders, according to Kim DiRé, L.P.C., a therapist with a doctorate of behavioral health in Scottsdale, Arizona.

In one study, 95 of 1,029 patients (9.2 percent) with feeding and eating disorders met the criteria for ARFID.

ARFID can lead to serious psychosocial and physical impairment due to changes in weight, emotional distress, social anxiety, compromised growth and malnutrition, said Kim Anderson, Ph.D., the executive director of the Pathlight Mood & Anxiety Center locations in Maryland and Ohio.

Sensory sensitivity

Sensory sensitivities are key components of ARFID because people with the condition often have heightened sensitivities to tastes, textures and smells. This causes certain foods to be unappealing or even distressing.

"The avoidance of specific foods stems from genuine discomfort or anxiety rather than mere preference," said Kevin Huffman, D.O., CEO and founder of Ambari Nutrition in Elyria, Ohio.

Lack of interest in food or eating

People with ARFID can seem like picky eaters, but that's typically connected to a lack of interest in eating and food in general because of negative experiences with specific foods. This leads people with ARFID to avoid these foods entirely, said Mrinal Pandit, M.S., R.D., a nutrigenomic counselor at Oliva Skin & Hair Clinic in Pune, Maharashtra, India.

"ARFID individuals want to eat and are often hungry but cannot eat certain foods due to heightened anxiety or fear and somatic triggers such as gagging and/or vomiting," DiRé said.

Fear of aversive consequences

ARFID is not a cognitive disorder, so it can be difficult for someone without an understanding of this disorder to comprehend how intense the fear of eating adverse foods is. There is a heightened adrenal-cortisol overload that signals the body to high alert for danger, DiRé said.

When you keep exposing these foods to people with ARFID, you are repeatedly activating their nervous system to a threat of danger.

Individuals with AFRID may refuse to eat certain foods due to fear of consequences, such as an allergic reaction, choking or vomiting.

"It is important to keep in mind that these factors are not independent of each other and may overlap. For example, someone may avoid foods due to an aversion to texture/taste as well as fear of negative consequences [such as] nausea and vomiting," Anderson said.

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How do I know if I have ARFID?

Since ARFID is so comprehensive, it is diagnosed through a series of questions about past trauma that tend to cause the individual to collapse and/or become extremely fatigued and irritated, DiRé said.

Questions healthcare professionals ask patients to investigate an ARFID diagnosis center around the following topics:

Birth trauma
In utero trauma
A past medical condition, procedure or surgery
Concussions
Choking
Food allergies or sensitivities
The mother's medical history during pregnancy
Feeding history
Bowel movement patterns
Foods the patient will eat
Sensory reaction to certain foods
Sensory issues outside of food
Social issues and reactions around food
Restaurant habits
Eating habits

What are the signs of ARFID in men?

Just as men can have bulimia, men can have ARFID or other eating disorders. The ratio of males to females with possible ARFID was 1:1.7, according to a 2023 study. However, there were more men diagnosed with ARFID than women in a 2014 study.

"ARFID can impact individuals of all genders, and it is important to recognize that there may be unique signs and experiences for men," Huffman said. "Although research on male patients with ARFID is limited, their challenges may parallel…female individuals."

Lack of interest in food

The lack of interest in food for men with ARFID is the same as it is for female ARFID patients.

"ARFID is a sensory disorder that does not discriminate between genders," DiRé said.

Avoiding certain foods

Patients' avoidance of certain foods is connected to ARFID's visceral fear provoked by the "unsafe" food, DiRé said. This can lead to malnutrition and the need for nutritional supplements.

Avoiding certain foods and the other challenges of ARFID, such as a lack of interest in food and the risk of choking or vomiting, are all connected.

"These difficulties can result in nutritional deficiencies and physical health repercussions, underscoring the significance of early intervention and treatment," Huffman said.

Choking or vomiting

People with ARFID might choke or vomit when they try new types of food or even have familiar bites. These reactions come from this disorder's fear of consequences and can further contribute to their avoidance of food and the development of ARFID, Pandit said.

"Not all individuals with ARFID start out as selective eaters. Sometimes, a negative experience with food, such as choking, vomiting, gastrointestinal discomfort or an allergic reaction, creates fear of certain foods or even eating in general, which may lead to the development of ARFID as well," Anderson said.

Can you have ARFID and not be on the autism spectrum?

While there are similarities between ARFID and autism's sensory reactions and rigid routines, there is no link between the two. You can be diagnosed with ARFID and not have autism or be diagnosed with autism and not have ARFID.

"It's crucial to recognize that each condition is unique and should be assessed independently," Huffman said.

ARFID and autism are two separate disorders.

"ARFID is the fear of food or the fear of the bad consequences of food. Autism is a neurodevelopmental condition that someone is born with. An individual can have the two disorders as a comorbidity," DiRé said.

Is ARFID linked to ADHD?

There is no link between ARFID and ADHD. ADHD is a mental health condition that can be due to genetics, exposure to environmental risks or issues at birth.

"While an individual can have both ARFID and ADHD, there is no link between the two," DiRé said. "Malnutrition from ARFID can cause attention deficit behavior, but once the individual is re-fed and receives a nutritional balance in their food intake, focus and attention are restored as well."

Can people with ARFID be overweight?

Individuals with ARFID can experience significant weight loss, weight gain or no change in their weight at all. Weight loss is not part of the diagnostic criteria for ARFID. The diagnosis depends on restrictive or avoidant eating behavior, not body weight.

"This is an important point, given that people at higher weights may be at risk of being underdiagnosed," Anderson said.

Many individuals with ARFID find their "safe" foods are white carb foods such as bread, rice, crackers and sweets. They can consume larger amounts of these foods than the needed calories for their daily intake. This can lead to weight gain, according to DiRé.

"More often than not, ARFID individuals go undetected by the medical community because their body mass index (BMI) is in the normal range, while their nutritional supply is very unbalanced. So while ARFID individuals can be overweight, the majority of individuals coming to my office for my ARFID protocol treatment are normally weighted," DiRé said.