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Avoidant/restrictive food intake disorder (ARFID) is an eating disorder where people have highly selective eating habits. Individuals with ARFID limit their food intake due to negative psychological associations with particular types of food and eating,
Compared to patients with bulimia nervosa, or orthorexia, people with ARFID are more likely to be younger and experience a longer duration of illness before the need for treatment presents. (1)
ARFID has only recently been classified by the DSM and is not as clearly understood as some other eating disorders. That’s why it’s important to be aware of the characteristics of ARFID, so you can recognize both the physical and behavioral signs and symptoms in either yourself or a loved one.
Signs of avoidant/restrictive food intake disorder
Physical signs of avoidant/restrictive food intake disorder
Losing weight
Adults with ARFID may lose weight as they struggle to eat over a period of time. An insufficient calorie intake can result in an inability to maintain basic body function. (2)
No longer gaining weight
Children and young people with ARFID may fail to gain weight as expected, and their growth may be affected, with a slowing of height increase. (3) Along with developmental delays, young people with ARFID may also have stunted puberty. For example, the signs of sexual maturity don’t appear as they should by age twelve in individuals who are assigned female at birth, or age fourteen in those who are assigned male at birth.
Nutritional deficiency and malnourishment
When someone has an inadequate diet because they only eat a narrow range of foods, they may not be getting the essential nutrients needed for development, their general health, and their ability to function on a day-to-day basis. In some people, this may result in nutritional deficiencies (e.g. iron deficiency), which can result in anemia.
In extreme cases, ARFID can lead to malnutrition. Warning signs and symptoms of malnutrition include: (4)
Weight loss
Fatigue and muscle weakness
Dizziness and fainting
Low blood pressure
Late start to periods or missed periods for three months or more
Abdominal pain
Constipation
Dry skin and hair loss
Fine body hair growth (lanugo)
Fast or low heart rate
Cold intolerance
Failure to meet developmental milestones
The persistent failure to meet nutritional needs may lead to a dependence on oral supplements or enteral feeding.
Abnormal laboratory findings
Laboratory tests are likely to exhibit the biomarkers associated with nutrient deficiencies or malnutrition. This includes, but is not limited to anemia, low hormone and thyroid levels, low blood potassium levels, low blood cell counts (indicating a weakened immune system), and an abnormal heart rate.
Emotional and behavioral signs of avoidant/restrictive food intake disorder
Heavily restricting food
ARFID goes way beyond picky eating. Although many children and adults may go through phases of selective eating, someone with ARFID does not eat enough calories to grow and develop, or, in adults, to maintain weight and basic body function.
Change in eating habits
You may notice a sudden or severe restriction of food with no explanation, a decreased appetite or lack of interest in food, eating abnormally slowly, and gagging during meal times. As the condition worsens, the small range of ‘liked’ foods decreases, which can lead to significant weight loss and nutritional deficiencies.
Dressing in layers
Individuals with ARFID may dress in layers of baggy clothes. This hides weight loss and helps them keep warm.
Social isolation
Being limited in what they can eat or a complete lack of interest in food often causes people to experience significant difficulties in social situations. People may struggle at school, work, college, or with friends. They may feel anxious in social situations due to their eating difficulties. (3)
Adults and children may find it difficult to form friendships or establish close relationships, as they fear the inevitable social eating occasions. Traveling away from home may also be difficult, due to concerns that their ‘safe’ foods won’t be available.
Other psychological issues associated with ARFID include low mood, anxiety, irritability, and difficulty concentrating. (1)
No compensating behaviors
In AFRID, there are no compensatory behaviors that are seen with other eating disorders, such as excessive exercise, bingeing, or purging. (1)
Symptoms of avoidant/restrictive food intake disorder
Physical symptoms of avoidant/restrictive food intake disorder
Non-specific gastrointestinal complaints
Common symptoms of ARFID are non-specific gastrointestinal issues that can result from an insufficient diet and can contribute to a lack of appetite. They include:
Acid reflux
Stomach cramps
Constipation
Bloating
Cold intolerance
People with ARFID can be hypersensitive to the cold. This is because they are often underweight and, therefore, don’t have a layer of body fat to insulate the body or enough muscle mass to help the body produce heat through metabolism.
Additionally, hands and feet may also appear to be cold to the touch with a mottled appearance. (1) This is usually a sign of low blood pressure and the resultant poor circulation to the extremities.
Emotional and behavioral symptoms of avoidant/restrictive food intake disorder
Food related phobias
With ARFID, food restriction is motivated by fear of adverse consequences, such as food poisoning or illness, sensory sensitivity, or other food-related phobias, including: (4)
Fear of vomiting or choking
Aversion to food with a certain texture, color, or smell
Avoiding a particular foodstuff or food group
Fear of eating with others
These fears can develop from a traumatic experience with food, like significant abdominal pain, choking, or even embarrassment, causing an individual to develop anxiety around food and eating. Others with ARFID may have more general anxieties about the consequences of eating that they can’t explain and restrict themselves to what they consider to be “safe” foods. (3)
Distress at meal times
Both adults and children with ARFID often report vague gastrointestinal problems at mealtimes, which have no known cause. These complaints can include feeling sick, an upset stomach, abdominal pain, and already feeling full and are designed to avoid eating. (6)
No body weight issues
ARFID is similar to anorexia nervosa in that there is a severe restriction of food intake. However, people with ARFID differ in that they don’t have anxiety or an obsession over their body weight or appearance, or fear of gaining weight. (7)
When to get help for avoidant/restrictive food intake disorder
ARFID can look different in different people. But however it presents, it can have a negative impact on physical and psychological health. If you recognize a combination of the signs and symptoms above in yourself or in a loved one, and there are issues with restricting food that are not improving, it’s time to get help.
If you think you have ARFID, make an appointment with a medical professional who has experience in eating disorders.who will be able to guide you toward the right treatment. If you’re concerned about a loved one, encourage them to seek help.
Treatment options can include family therapy, cognitive behavior therapy, dialectical behavior therapy, nutrition counseling, and behavioral interventions like exposure work. (3)
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
