A snapshot of Avoidant/Restrictive Food Intake Disorder (ARFID)

Avoidant/Restrictive Food Intake Disorder (ARFID) is a complex eating disorder that was added to the Diagnostic and Statistical Manual-5 (DSM-5) in 2013. Because this is such a new diagnosis, there is limited reliable data regarding its prevalence. Research suggests ARFID may affect up to 15.5% of the population (from non-clinical samples), and as many as 1 in 4 adults based on a large general population survey conducted in the United States and United Kingdom. Given the potential for ARFID to impact so many people, it is imperative that dietitians understand what it is and its physical and psychosocial effects. 

Diagnostic criteria for ARFID include a lack of meeting nutritional needs and at least one of the following: 

• Weight loss or stunted growth 
• Nutritional deficiency 
• Dependency on enteral or supplemental nutrition 
• Interference with psychosocial functioning 

ARFID subtypes 

Unlike many other eating disorders, ARFID is not associated with body image concerns. Instead, ARFID is driven by other means, all of which depend on the subtype. ARFID can be broken down into three primary subcategories: sensory aversion, lack of interest, and fear of aversive consequences.  

Sensory aversion: This subtype refers to clients who are highly sensitive to sensory input, such as taste, smell, texture, temperature, and/or appearance. Those with this kind of sensory aversion have a heightened disgust response to food compared to those without ARFID. For example, if lunchmeat appears discolored or smells bad, it may be carrying disease, making it unsafe to eat. It is important to have a disgust response to this so that humans don’t eat spoiled food. Evolutionarily, this kind of reaction is important for survival, but ARFID puts this response in overdrive and perceives a wider range of foods as dangerous.  

Lack of interest: People who are uninterested in food or eating have this subtype. This can look like claiming to be too busy, forgetting to eat, or experiencing a lack of hunger cues. Lack of interest commonly occurs in those who have muted body awareness, also known as interoception. For many people, after a period of not eating, hunger cues kick in, igniting a drive for food. Those with ARFID may not experience the biological signals for fuel, and if they don’t notice any negative impact in their restriction, it may be difficult to see the need to eat.   

Fear of aversive consequences: As the least common subtype, this fits those who are afraid that eating may cause a distressing physical reaction like choking, gagging, stomach pain, and/or an allergic response. This can often stem from personal trauma regarding food. If one has witnessed or personally experienced foodborne illness after eating contaminated salad, they are likely going to be much more cautious about the foods they consume. And that caution can range from avoiding raw salad to cutting out all produce to restricting food altogether.  This is essentially another means for survival that can become maladaptive.  

What are the signs/symptoms of ARFID that a dietitian should be aware of? 

Regardless of the reason that someone is restricting intake, physical impacts are going to be similar across subtypes. Those with ARFID can often experience the same physical signs/symptoms as someone with anorexia nervosa, such as:  

• Bradycardia 
• Lightheadedness/dizziness/fainting 
• Cold intolerance 
• Hair loss or lanugo 
• Amenorrhea 
• Edema 
• Hypotension 
• Weakness/lethargy 
• Gastrointestinal distress 

While people with anorexia often experience a high prevalence of gastrointestinal distress, those with ARFID are even more likely to experience symptoms, including, but not limited to, nausea, reflux, constipation, stomach pain, and gastroparesis. There is a significant overlap between ARFID and disorders of gut/brain interaction (DGBI). Up to 40% of those with DGBI meet the criteria for ARFID. Whether one is more likely to cause the other is unclear, as ARFID can exacerbate DGBI as much as DGBI can spur on ARFID.  

ARFID and other mental health diagnoses 

There is also a significant link between ARFID and other mental health diagnoses. Someone with ARFID can experience any and all of the diagnoses outlined below, regardless of subtype.  

• Anxiety: As one can imagine, anxiety frequently comes up and affects anywhere from 9 to 72% of young people with ARFID. Anxiety can drive the perception that food is a threat, leading to increased food avoidance.   
• Obsessive-compulsive disorder (OCD): This can show up with someone who has ARFID in multiple different ways. Similar to anxiety, when someone is stuck in the thought pattern that they need to avoid or limit a food, that avoidance can intensify, leading to worsening nutrition status. With OCD, ritualistic and compulsive tendencies are more present. This can look like rigidity around mealtimes, consuming only specific brands, not allowing foods to touch, etc.  
• Autism spectrum disorder (ASD): Based on a recent meta-analysis, 16% of those with ARFID also have an autism diagnosis. Conversely, 11% of those with autism have ARFID. Compared to neurotypical people, those with ASD often experience sensory processing differences. This can show up in countless ways, including difficulty accessing internal body cues, being hyperaware of flavor profiles, or difficulty eating in certain environments.  
• Attention-deficit/hyperactivity disorder (ADHD): Much like ASD, those with ADHD experience sensory processing and interoception differences, as well as executive functioning challenges. It can be difficult to make decisions and follow through on eating plans. To add to the challenge, some ADHD medication interferes with hunger cues, which can exacerbate ARFID behaviors.  
• Suicidal ideation (SI): ARFID can be an isolating disorder. Because it is not well known, many people do not know how to treat or respond to someone with ARFID. Some people with ARFID may avoid certain social gatherings in an attempt to protect themselves from judgment, questions, or shame regarding their food choices. Whether SI stems from social isolation, one of the other aforementioned mental health disorders, or something else, it is prevalent, affecting almost 23% of those with ARFID.  

Like all eating disorders, ARFID can impact anyone of any demographic. Understanding these intricacies of ARFID provides dietitians with the foundation they need when treating people with this eating disorder.  

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References:  

D’Adamo L, Smolar L, Balantekin KN, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: a cross-sectional study. J Eat Disord. 2023;11:214. https://doi.org/10.1186/s40337-023-00939-0  

Brownlow G, Flack R, Burton-Murray H, Palsson O, Aziz I. The Prevalence and Burden of Avoidant/Restrictive Food Intake Disorder (ARFID) Symptoms in the Adult General Population of the UK and USA. Int J Eat Disord. 2025;59:362-370. https://doi.org/10.1002/eat.24588  

Weeks I, Abber SR, Thomas JJ, et al. The Intersection of Disorders of Gut-Brain Interaction with Avoidant/Restrictive Food Intake Disorder.  J Clin Gastroenterol. 2024; PMID: 37079861. https://pmc.ncbi.nlm.nih.gov/articles/PMC10623385/#S9  

Sanchez-Cerezo J, Nagularaj L, Gledhill J, Nicholls D. What do we know about the epidemiology of avoidant/restrictive food intake disorder in children and adolescents? A systematic review of the literature. Eur Eat Disorders Rev. 2023;31:226-246. https://doi.org/10.1002/erv.2964  

Sader M, Weston A, Buchan K, et al. The Co‐Occurrence of Autism and Avoidant/Restrictive Food Intake Disorder (ARFID): A Prevalence‐Based Meta‐Analysis. Int J Eat Disord. 2025;58:473-488. https://doi.org/10.1002/eat.24369  

Qi B, Kalantzis MA, Thornton LM, et al. Suicidal ideation and avoidant/restrictive food intake disorder: Findings from the ARFID-GEN study. Psychiatry Res. 2025;348: 116471. https://doi.org/10.1016/j.psychres.2025.116471