What is ARFID?: Understanding the Misunderstood Eating Disorder

Julia Actis, Assistant Clinical Manager, LMSW, CSW-I • October 16, 2024

What is ARFID?: Understanding the Often Misunderstood Eating Disorder

Amongst eating disorders, Avoidant/Restrictive Food Intake Disorder (ARFID) is lesser known and often misunderstood. Unlike disorders like anorexia or bulimia, ARFID isn't motivated by body image or weight. Instead, it's characterized by a persistent avoidance or restriction of certain foods due to various reasons, leading to nutritional deficiencies and serious health issues. As ARFID gains more awareness, it's essential we explore what this condition entails to provide understanding and reach those in need of support.

Avoidant/Restrictive Food Intake Disorder (ARFID)

What is Avoidant/Restrictive Food Intake Disorder (ARFID)?

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder marked by extreme food restriction or avoidance. Unlike other eating disorders driven by body image concerns, ARFID emerges from sensory sensitivities, fear of adverse effects from eating, or negative experiences related to food. These behaviors can significantly impact nutritional intake, leading to weight loss, negative effects on health, and in children, inhibited growth. Many people with ARFID struggle with meeting basic dietary needs, impacting healthy development and functioning. Although often initially diagnosed in children, ARFID can last into adulthood.

The causes and severity of ARFID can vary from person to person. Understanding these factors is critical for diagnosis and treatment:

Sensory Sensitivities: Aversions to specific textures, smells, or colors of food.

Fear of Negative Effects: Anxiety about choking, vomiting, or allergic reactions.

Traumatic Food Experiences: Past incidents that induce fear or avoidance.

Recognizing ARFID's unique triggers can facilitate accurate diagnosis and effective therapies.

Is Avoidant/Restrictive Food Intake Disorder (ARFID) the Same As Picky Eating?

A common misconception about ARFID is that it is "just picky eating". However, the two are different in their severity and impact. Picky eating is often a harmless phase in childhood that people typically outgrow without serious health implications. In contrast, ARFID involves intense aversions, leading to a restrictive eating pattern that can impact nutrition and development. Those with ARFID may avoid certain food groups all together and often experience severe anxiety around mealtimes.

The distinction between picky eating and ARFID lies in the degree and consequences of food avoidance. Unlike picky eaters, those with ARFID face significant obstacles that affect their social lives and overall well-being. The psychological component is real, causing complications that extend beyond mere preference in foods.

How Common is Avoidant/Restrictive Food Intake Disorder (ARFID)?

Though ARFID is a relatively new classification (first added to the DSM-5 in 2013), its recognition is steadily increasing in various clinical settings. This condition is more prevalent in younger populations, with up to 15.5% of children and adolescents being affected by ARFID (NIH). While seemingly rare amongst adults, increased awareness has led to more frequent diagnoses.

Although it is not as commonly known as other eating disorders, ARFID’s growing rate of diagnoses underscores the importance of awareness and education. With increased understanding, healthcare professionals are more frequently recognizing and diagnosing ARFID, a crucial step in providing necessary interventions.

Symptoms and Causes

What are the Signs and Symptoms of Avoidant/Restrictive Food Intake Disorder (ARFID)?

Lack of appetite, disinterest in food, notable weight loss, and a failure to gain weight mark the disorder’s physical symptoms, affecting overall health and development. ARFID can affect people in a variety of ways, but understanding common signs is the first step towards effective treatment. These signs can include:

Limited Food Range: Preference for certain foods, often based on sensory features like taste, smell and texture. These specific foods are termed as "safe foods."

Psychosocial Difficulties: Anxiety at social events involving food, impacting daily interactions. People with ARFID may feel uncomfortable eating or trusting food that they did not source from their home, like at restaurants or school.

Recognizing these symptoms can facilitate early diagnosis and treatment, promoting better health outcomes for someone living with ARFID.

What are the Risk Factors for Avoidant/Restrictive Food Intake Disorder (ARFID)?

Several risk factors contribute to the development of ARFID, originating from both biological predispositions and lived experiences. Understanding these risks aids in early identification and potential prevention strategies, tailored to those predisposed to the disorder:

Genetic Predisposition: Someone with a family history of anxiety or other mental health conditions may be more susceptible to developing ARFID.

Traumatic Feeding Experiences: Traumatic experiences with food, like choking or vomiting, can instill long-lasting aversions to certain foods.

Neurodivergence: Neurodevelopmental differences like ADHD and autism spectrum disorder can lead to hypersensitivity around food texture, taste, and smell, resulting in co-occurring ARFID.

Diagnosis and Tests

How is Avoidant/Restrictive Food Intake Disorder (ARFID) Diagnosed?

Diagnosing ARFID involves a thorough assessment by healthcare specialists, including evaluating eating habits, medical history, and nutritional intake. Clinicians utilize screening tools and assessments to gather details about patients' eating patterns and associated distress. The diagnostic criteria are detailed in the DSM-5, highlighting nutritional deficiencies or physical health issues as a result of limited food intake. A common screener used for diagnosing ARFID is the Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS).

Proper screening is crucial for distinguishing ARFID from other possible conditions. Diagnosis among healthcare providers often includes:

Questionnaires and Interviews: Collect data on eating behaviors and anxieties.

Nutritional Assessments: Identify any deficiencies or health issues.

Psychological Evaluations: Reveal any contributing mental health issues or fears.

Engaging a multidisciplinary approach ensures correct diagnosis and helps inform an effective treatment plan, paving the way for improvements in symptoms.

Management and Treatment

How is Avoidant/Restrictive Food Intake Disorder (ARFID) Treated?

Treating ARFID requires a comprehensive, multidisciplinary strategy that includes psychological, nutritional, and medical components. In severe cases, medical supervision or residential treatment may be employed to resolve health complications and restore weight. Here are some key strategies in treating ARFID:

Cognitive-behavioral Therapy: Used to tackle the negative associations or fears related to food.

Exposure Response Prevention Therapy: Supervised exposures to new foods can be effective in lowering the anxiety response around feared foods and outcomes.

Nutritional Counseling: Meal plans tailored to address and overcome deficits while expanding the diet.

Family Involvement: Family-based therapy, particularly in children and adolescents, can bolster familial support and improve dynamics around eating.

A targeted and integrated treatment fosters a supportive environment for those living with ARFID, facilitating recovery, restoration of weight and improved health.

Who Treats Avoidant/Restrictive Food Intake Disorder (ARFID)?

ARFID is usually treated by a team of healthcare professionals collaborating to address both its psychological and physical aspects. Each professional plays a vital role:

Psychologists/Therapists: Psychologists or therapists who specialize in treating eating disorders focus on cognitive and behavioral interventions to lessen anxiety around eating.

Dietitians: Design and implement personalized meal plans addressing deficiencies and guiding nutritional changes for patients and their families.

Medical Providers: Physicians or pediatricians monitor broad health impacts and support treatment continuity, ensuring health issues do not worsen.

Occupational Therapists: Assist with sensory processing challenges tied to food

Together, this multidisciplinary team provides comprehensive care that addresses each facet of ARFID.

What if my Child has ARFID?

ARFID can be challenging for both children and their families. If your child has been diagnosed with ARFID, the first step is to seek professional support from a pediatrician, therapist, dietitian, and possibly an occupational therapist. These professionals can work together to create a comprehensive treatment plan tailored to your child's needs. Engaging in family-based therapy can also be beneficial, where parents and siblings learn how to support the child around mealtimes. Incorporating gradual exposures to new foods through exposure response prevention therapy can also be helpful. Additionally, finding online resources and support groups for parents dealing with ARFID can provide further guidance and emotional support. Remember, patience and understanding are key as recovery will take time.

Living with ARFID

Living with ARFID can deeply impact someone's daily life. People's anxiety around eating and mealtimes can negatively affect comfort around social engagements involving food, leading to isolation and depression.

Identifying and addressing the disorder’s psychological and physical aspects can allow those affected to live more functional and full lives. Through intervention and a strong support system, individuals with ARFID can better manage their disorder and overcome anxieties, improving their overall quality of life.

When Should I See a Healthcare Provider?

If your eating patterns are negatively affecting your physical health or social life, it's time to seek professional guidance from a healthcare provider. Notable weight loss and nutritional deficiencies linked to food avoidance and restriction also warrant an evaluation. If anxiety around eating deprives you of a balanced diet, or symptoms influence your ability to complete daily tasks and result in emotional distress, pursue professional intervention. Proactively seeking a diagnosis and care can improve treatment outcomes and increase the odds of recovery from ARFID.

What Questions Should I Ask My Doctor?

When speaking with a healthcare provider about ARFID, it’s important to cover all aspects to ensure there is complete understanding and effective treatment in place. When asking questions about ARFID, make sure to focus on:

- Understanding Symptoms: Confirm how ARFID differs from other eating disorders.

- Exploring Treatment Options: Discuss the best strategies for your case.

- Engaging Support Services: Reach out to local or online resources for additional support.

Asking thorough questions allows you to work together with your healthcare providers to navigate ARFID's challenges. Find more important questions to ask your healthcare provider here.

Moving Forward with ARFID Awareness

The journey of understanding and diagnosing Avoidant/Restrictive Food Intake Disorder (ARFID) can be complex, given its differences from other more well-known eating disorders. By raising awareness and educating people about ARFID, opportunities for accurate diagnosis and effective treatment increase, offering real hope for those affected. A multi-disciplinary treatment approach remains essential in achieving recovery and building a healthy relationship with food. As ARFID becomes more widely recognized, increased awareness and effective treatment approaches will continue to open doors for people to access needed support, find recovery, and live fuller lives.

If you or someone you know is experiencing symptoms of ARFID, don't wait to seek help. You can find specialized treatment for ARFID at Thrive Wellness.

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What to Do if You Think Your Teen Has an Eating Disorder

By Brianna Villalpando, LMSW, LCSW • March 19, 2025

Teen eating disorders are serious. As a parent or caregiver, one of the most difficult situations you can face is noticing that your teen may be struggling with a basic human need like eating. Adolescence is already a rough period for many teens filled with fluctuating emotions, changing bodies, and social pressures. However, sometimes coping with these challenges can manifest in unhealthy ways, like developing complicated relationships with food, body image, control, or exercise. Many teens face body image issues as their bodies mature, excessive pressure to meet unrealistic expectations fueled by social media and peers, and emotional instability and anxiety during their adolescent years, all of which can combine to create the perfect storm for an eating disorder. These challenges can often make your teen more vulnerable to unhealthy coping mechanisms , such as restricting food intake, excessive exercise, or engaging in disordered eating behaviors . If you’ve started noticing signs that something may not be right, it’s essential to take action to help your teen get the support they need. Recognizing the Signs of an Eating Disorder Eating disorders can vary in appearance, but there are some common signs and symptoms to watch for. If you notice any of the following behaviors or changes in your teen, it may indicate a problem that requires further attention: Preoccupation with body image : Teens with eating disorders often show increased focus on their weight or appearance, frequently expressing dissatisfaction with their body. Excessive discussions about dieting : If your teen frequently talks about dieting, food restriction, “getting skinny,” or often makes weight-related comments, this could be a red flag. Obsession with calorie counts : Teens who are obsessed with tracking every calorie, comparing the caloric content of foods, or controlling their calorie-intake may be struggling with an eating disorder. Skipping meals : Frequently skipping meals or not eating regularly is a common sign that something is wrong. Eating in isolation : Eating alone or avoiding family meals may signal discomfort with eating or shame around food. Excessive exercising : Over-exercising or using exercise as a way to purge calories can also point to an eating disorder. Spending long amounts of time in the bathroom : This could be a sign of emerging or purging behaviors, such as vomiting after meals. Hoarding foods : Hiding food or being secretive about eating may indicate issues with food control and secrecy around eating habits. Irregular periods or thinning hair : In females, a disruption in menstrual cycles or thinning hair can be physical signs of the effects of an eating disorder on the body. How Can I Talk to My Teen About Eating Disorders in a Supportive Way? Approaching a conversation about eating disorders with your child requires sensitivity and care. It's important to emphasize empathy and understanding, conveying that your primary concern is your teen's health and well-being. Initiating this conversation compassionately can create an environment of trust and openness to explore the problem. Selecting a calm, comfortable, and private setting is vital so your teen feels safe discussing a sensitive topic that may cause them to feel anxiety or shame. Effective communication hinges on using open-ended questions and active listening. Encourage your teen to share their thoughts and feelings without fear of judgment. By actively listening, you validate their experience, making them feel heard and understood. Before diving into the conversation, educating yourself about eating disorders can provide a solid foundation for discussing the issue knowledgeably. Some quick preparation with research allows you to dispel myths and provide accurate information when you talk to your teen. Why It's Crucial to Seek Medical Help When you notice warning signs, it’s important not to wait to get help. Eating disorders can be life-threatening, both physically and emotionally. They take a serious toll on a teen’s health, affecting their metabolism, hormonal function, and overall well-being. Beyond the physical impact, eating disorders can often involve deeply ingrained psychological and emotional challenges, such as low self-esteem, anxiety, depression, and trauma. After an initial conversation, the first step is to schedule an appointment with a medical provider. Your teen’s primary care doctor or a pediatrician can help evaluate their physical health and provide guidance for next steps. Be prepared to discuss the specific behaviors or signs you’ve observed, as this will help your provider better understand the situation. The doctor may conduct a physical examination, lab tests, and discuss your teen's emotional and psychological state. Building a Support Team Once you’ve taken the first step to ensure your teen’s immediate medical needs are addressed, it’s time to build a multidisciplinary treatment team . This may include: Therapists : A licensed, specially trained therapist who specializes in eating disorders or adolescent mental health can help your teen address the emotional and psychological root causes of their disorder. Medical doctors : Your teen’s doctor can monitor their physical health during the recovery process, ensuring they are safe while navigating the challenges of nourishing their body. Nutritionists or dietitians : A professional who specializes in eating disorders can create a nutrition plan tailored to your teen’s specific needs and help them rebuild a healthy relationship with food. Psychiatrists : In some cases, medication may be prescribed to address underlying mental health issues contributing to their behavior. Act Quickly and Seek Professional Guidance It’s crucial to act as soon as you recognize signs of an eating disorder in your teen. The longer eating disorders go untreated, the harder they can be to overcome. Recovery from an eating disorder is a complex journey, involving both physical and mental obstacles to tackle. It can be incredibly difficult for both the teen and the family to manage this process at home without professional support. A well coordinated team of medical providers, therapists, and eating disorder specialists is essential in guiding your teen through their recovery. This team can help monitor your teen’s progress, provide emotional support, and ensure that your teen is getting the care they need for both short and long-term recovery. Supporting Your Teen on Their Recovery Journey Eating disorders are serious, but with the right care and support, recovery is possible. If you suspect that your teen may have an eating disorder, don’t hesitate to reach out for help. Seek medical advice first, and build a support team of professionals who can work together to provide comprehensive care. Eating disorders are complex, and it’s not something you or your teen should have to face alone. Taking swift action and offering compassionate support will help your teen regain control of their health and their life so that they can thrive through their adolescence and beyond. At Thrive, we offer specialized treatment for anorexia, bulimia, binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID). Our adolescent intensive outpatient and partial hospitalization programs have not only changed lives, but saved them. If you believe your teen is struggling, don't hesitate to reach out for help, we are ready to conduct a complimentary intake assessment today. To learn more about eating disorders, download our free guide "Recovery is Real" filled with practical insights and strategies to help a loved one navigate the journey toward recovery.

Signs It’s Time to See a Therapist: How to Know When You Need Support

By Brianna Villalpando • March 12, 2025

It can be difficult to know when it's time to reach out for help. We often try to manage stress, anxiety, sadness, or relationship issues on our own, thinking it’s just a phase or something we can work through to “get over.” But sometimes, these feelings or behaviors persist and can start affecting our overall mental and emotional well-being. The truth is, seeking therapy shouldn't be a last resort. Therapy is a valuable tool for anyone looking to better understand themselves, improve their emotional health, and work through life’s challenges. If you’ve been wondering whether it’s time to seek therapy, there are a few key factors to consider when performing a self-evaluation. Here are five signs that it might be time to reach out for additional support: 1. Is My Mood Affecting My Life or Relationships? One of the most telling signs that you may need support is noticing that your mood is negatively impacting your daily life or interpersonal relationships. Have you noticed an increase in conflict with friends, family, or colleagues? Are you feeling stuck in patterns of negativity that seem hard to shake? If your mood is affecting how you function at work, school, or in your personal life, it may be time to talk to a therapist. Pay attention to your behaviors; are you withdrawing from activities you usually enjoy? Are you reacting more intensely to situations than usual? If your emotional state is beginning to impact your relationships, interactions, or your ability to move through everyday life, a therapist can help you explore underlying causes and develop tools to improve your social wellness. 2. Am I Isolating Myself to Avoid Conflict? There’s a big difference between being introverted and isolating yourself as a way to avoid conflict. If you find yourself consistently pulling away from social situations, not because you need time to recharge, but because you’re avoiding uncomfortable conversations or emotional confrontations, this could be a sign of a deeper issue. It’s natural to want to avoid tension or discomfort, but consistent isolation can worsen feelings of loneliness and make it even harder to work through conflicts. Therapy can help you learn healthy coping mechanisms, problem-solving and communication skills, so you can feel more comfortable facing conflict in a productive way rather than shutting down or avoiding it at the cost of self-isolation. 3. Are My Emotions Out of Control? Do you ever feel like your emotions are so overwhelming that you can't regain control? If you're finding it difficult to calm yourself down, quiet your thoughts, or manage your feelings, this might be a sign that therapy could be helpful. Emotions like anger, disgust, fear, anxiety, or sadness are natural, but if they start taking over your thoughts and actions, it can be exhausting and difficult to complete daily tasks. A therapist can help you understand why your emotions are so intense and teach you strategies to regulate them and regain a sense of balance. 4. Have I Experienced Trauma That’s Affecting My Daily Life? Trauma comes in many forms, it could be from a single incident or from ongoing experiences that have affected your sense of safety, connection, or well-being. Sometimes, trauma is tied to experiences in childhood, but it can also be linked to recent events, like accidents, loss, or abuse. If you've experienced trauma and are struggling to perform basic daily tasks or meet your needs, therapy can be incredibly beneficial. Unresolved trauma can lead to feelings of anxiety, depression, or being stuck in past experiences. A trauma-informed therapist can help you process these experiences, understand their impact on your life, and work toward healing and recovery. 5. Am I Hurting Myself or Others? If your mood or behaviors are causing you to hurt yourself or others, it’s crucial to seek help immediately. Whether it’s through emotional or physical self-harm , or unintentionally inflicting harm on the people around you, this is a serious sign to find support from mental health professionals. A therapist can provide a safe, nonjudgmental space to talk about what you’re going through and help you work toward healthier ways of coping. If you’re in immediate danger or experiencing thoughts of self harm, it’s essential to reach out for help as soon as possible. There’s no shame in seeking support when you're struggling with harmful thoughts or actions. Why is Professional Mental Health Support Necessary? Although there may be barriers to seeking therapy, reaching out for professional mental health support is worth it to address the emotional and psychological issues that you shouldn’t have to deal with alone. Therapists have the knowledge and tools needed to guide you through your struggles, offering insights and solutions that aren’t available outside of the therapeutic setting. Their expertise promises not only a deeper understanding of your challenges, but the application of practical methods and skills to resolve them in your everyday life. Additionally, trained mental health professionals offer personalized strategies and coping mechanisms tailored to your unique situation and needs. These strategies are informed by evidence-based practices and a therapist’s experience working with and healing emotional and mental struggles. Personalized therapy helps clients receive the most relevant and effective guidance for their personal challenges. Embracing the Journey Toward Mental Wellness Recognizing that you might need support is the first step toward feeling better and getting the most out of life. Therapy isn’t just for when things are at their worst; it’s a proactive way to improve your emotional health, work through challenges, and build skills for resilience. If you relate to any of these situations, it might be time to reach out and explore therapy as an option. It’s okay to need help, and you don’t have to navigate this journey alone. If you’re unsure whether therapy is right for you, consider talking to a mental health professional to discuss your concerns and explore specialized support options available to you. You deserve to feel your best, and therapy can be a stepping stone to help you reach your goals. Are you in need of support? At Thrive Wellness, we offer personalized therapy and treatment to support you in whatever you're going through, don't be afraid to reach out for help . We also offer a FREE comprehensive guide to wellness in our “How to Thrive” guide . This guide offers practical, easy-to-follow habits that promote physical, mental, and emotional well-being. Start your journey towards a balanced and fulfilling life today with these simple yet transformative steps.

Breaking Down Barriers: Debunking the Most Common Eating Disorder Myths

By Sage Tippie • February 14, 2025

This Eating Disorders Awareness Month, we’re focusing on fighting the misinformation and stereotypes surrounding eating disorders that so often create barriers to diagnosis and treatment. Myths about eating disorders can perpetuate harmful stereotypes and keep people from receiving effective and timely treatment when they need it. It’s no secret that the field of eating disorders is riddled with misinformation, leading to confusion, stigma, and shame for those struggling. In this blog post, we'll explore the common myths about eating disorders and fight them with concrete facts in the hopes of building a more informed and educated community when it comes to these serious mental health conditions. Eating Disorder Myths Versus Facts Myth: Only those who are medically underweight have an eating disorder. Fact: Someone can have an eating disorder at any weight. In fact, less than 6% of those diagnosed with an eating disorder are medically underweight. There is even a specific diagnosis for those who are not underweight showing the symptoms of anorexia called atypical anorexia. People of all sizes are at risk for serious complications from an eating disorder, not just those that are underweight. Myth: Only women have eating disorders Fact: Although often associated with teen girls, eating disorders can affect those of any gender and age. While stereotypes and stigma surrounding eating disorders may tell us that men are not commonly affected by them, research has found that nearly 25% of those who present for eating disorder treatment are male. Keeping an open mind around who can be affected by eating disorders allows for more accurate and timely diagnosis and treatment for those who need it. Myth: Eating disorders are just about food. Facts: While eating disorders always involve an unhealthy relationship with food or body image, they also are rooted in biological, psychological and sociocultural aspects. Eating disorders cannot be treated just by changing eating behaviors, but by addressing the mental aspect of the illness as well. This is why integrated treatment involving a team of social workers, primary care specialists, therapists, and in some cases occupational therapists or psychiatrists is so crucial: a holistic approach is needed to treat all aspects of an eating disorder. Myth: Eating disorders aren’t that serious. Fact: Eating disorders are extremely serious and life-threatening mental disorders that require dedicated treatment. In fact, anorexia nervosa has the second highest mortality rate of any psychiatric disorder. By taking eating disorders and their diagnosis and treatment seriously, we can save lives. Myth: Eating disorders are a choice. Fact: Just like any other illness, eating disorders are not a choice or a phase, nor is recovery from an eating disorder just a simple decision to start eating more or less. Recovery is not dependent on willpower, but on ongoing professional treatment and long-term support. The recovery process can be lengthy and challenging, requiring patience and a supportive environment and team on your side. It is a gradual, step-by-step journey, rather than an instantaneous decision made on one person’s part. Myth: Eating disorders always involve negative body image. Fact: Avoidant/restrictive food intake disorder (ARFID) does not have to do with body image. Those with ARFID may avoid many foods because of texture, taste, color, or smell, or feared outcomes of eating like choking or vomiting. Like any other eating disorder, ARFID is serious and requires specialized treatment like exposure-response prevention therapy. Myth: Eating disorders only affect White people. Fact: Although Black, Latina/o/x/e, Indigenous/Native, and Asian people are historically underrepresented in studies of eating disorders, large-scale studies have found that rates of eating disorders are the same or higher in all racial and ethnic groups as compared to white individuals (NEDA). Removing racial stereotypes around eating disorders can help to remove barriers that BIPOC individuals commonly face when seeking treatment. Dispelling the Myths: A Path Towards Understanding By addressing and dispelling these myths, we can create a safe space that promotes understanding and empathy. Eating disorders are not choices or phases, but debilitating mental health issues that can affect anyone. Recognizing the seriousness of these disorders is so important in reducing stigma and ensuring that those who are struggling receive the care and support they require. This month and every month, we encourage you to fight misinformation and stick up for those experiencing eating disorders, because knowledge and education can be one of the greatest assets to recovery for those who need it. If you or someone you know is in need of eating disorder support, don’t be afraid to reach out , our team of healthcare professionals are here for you. To learn more about eating disorders and the journey to recovery, download our free eating disorders guide .