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Avoidant/Restrictive Food Intake Disorder [ARFID]: It is more than just picky eating

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Avoidant/Restrictive Food Intake Disorder (ARFID) is a complex feeding and eating disorder that was formally recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Unlike other eating disorders such as anorexia nervosa or bulimia nervosa, ARFID is characterized by a limited variety or quantity of food intake that results in nutritional deficiencies and significant distress. This article explores the causes, symptoms, and available treatment approaches for ARFID, highlighting the importance of early diagnosis and intervention. 

Causes of ARFID

The exact causes of ARFID are not yet fully understood. However, several factors have been proposed as potential contributors to the development of this disorder. These factors may include sensory sensitivities, fear of choking or vomiting, traumatic experiences related to food, anxiety, and other underlying mental health conditions such as obsessive-compulsive disorder or autism spectrum disorder. It is worth noting that ARFID can affect individuals of all ages, from children to adults. 

Symptoms of ARFID: 

ARFID is characterized by specific symptoms that differentiate it from other eating disorders, ie: 

  • Highly selective eating: Individuals with ARFID often have a limited range of preferred foods, avoiding certain textures, colours, or tastes. 
  • Restricted food intake: There may be a significant reduction in the overall quantity and variety of food consumed, resulting in nutritional deficiencies. 
  • Fear or avoidance of new foods: Trying new foods may induce intense anxiety, leading to a reluctance or refusal to experiment with unfamiliar foods. 
  • Nutritional deficiencies and impaired growth: Due to inadequate food intake, individuals with ARFID may experience weight loss, stunted growth, and various nutritional deficiencies, such as iron, vitamin D, and calcium. 
  • Psychological distress: ARFID can cause significant psychological distress, impairing social functioning, and quality of life. 

 Treatment approaches for ARFID

Early intervention is crucial for successful treatment of ARFID. A multidisciplinary approach involving healthcare professionals, including dietitians, psychologists, occupational therapists, speech therapists and physicians, is often employed. 

Treatment options may include the following

  • Nutritional rehabilitation aims to restore a healthy relationship with food by gradually increasing the variety and quantity of foods consumed. This is typically done under the guidance of a registered dietitian who specializes in eating disorders. 
  • Cognitive-behavioural therapy (CBT) can help individuals with ARFID address their fears and anxieties related to food. Therapists work with patients to identify and challenge negative thoughts and beliefs about food and gradually expose them to new foods in a controlled manner. 
  • Exposure therapy is a therapeutic approach for example, The SOS approach to feeding, that involves gradually exposing individuals to feared or avoided foods in a safe and supportive environment, helping them develop tolerance and acceptance of a wider range of foods. 
  • Family-based treatment: Especially for children and adolescents with ARFID, involving the family in the treatment process can be beneficial. This approach focuses on gradually expanding the child’s food repertoire and providing parental support. 


In some cases, medication may be prescribed to manage co-existing conditions such as anxiety or obsessive-compulsive disorder, which may contribute to ARFID symptoms. 


ARFID is a distinct feeding and eating disorder characterized by selective eating and restricted food intake. It can significantly impact an individual’s physical and psychological well-being. Early diagnosis and intervention are essential for successful treatment outcomes. A combination of nutritional rehabilitation, cognitive-behavioural therapy, exposure therapy, family-based treatment, and medication can help individuals with ARFID improve their relationship with food and achieve healthier eating patterns. If you or someone you know is struggling with ARFID, seeking professional help from qualified healthcare providers is highly recommended.

Compiled by Registered Dietitians (SA): Lucinda Lourens, Cecile van Niekerk and Samantha Greyvenstein. For individual nutrition advice, please contact us at dietitian@petc.co.za 


  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 
  • Norris, M. L., Spettigue, W. J., & Katzman, D. K. (2016). Update on eating disorders: Current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric Disease and Treatment, 12, 213-218. 
  • Thomas, J. J., & Eddy, K. T. (2019). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: Children, adolescents, and adults. Cambridge University Press. 
  • Zucker, N. L., & Craske, M. G. (2017). Interoceptive exposure for children and adolescents with avoidant/restrictive food intake disorder: A clinical case series. Cognitive and Behavioral Practice, 24(1), 96-108. 

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