When does picky eating become something more serious? Here, we take a closer look at avoidant/restrictive food intake disorder
Have you ever had a particular food that you absolutely detest? Something that the more you think of, or smell, would turn your stomach. It’s not unusual to have preferences for certain meals or food items, or things that don’t appeal to your taste buds, whether temporarily or long-term, but for some people this aversion goes far deeper. Selective eating can mean a person avoids certain foods and even entire food groups, along with potentially limiting what they consume overall.
After experiencing my own eating disorder in my teens, I’ve always had a vested interest in the topic, which led me to volunteer with Beat, the UK’s eating disorder charity. In recent months, I’ve noticed avoidant/restrictive food intake disorder (ARFID) being discussed more and more – in fact, Beat reported an increase in people seeking support for ARFID from 2% of its calls in 2018 to 10% in 2023.
I must admit, when I first heard the term, I had to do a quick Google search as it wasn’t something I was familiar with. But awareness of this condition is slowly increasing, which feels desperately necessary as those with ARFID often feel misunderstood, undermined, or dismissed as simply ‘fussy’.
What is ARFID?
The term ARFID was previously known as ‘feeding disorder’, ‘selective eating disorder’, or even just ‘picky eater’. Now it’s better understood, the title of avoidant restrictive food intake disorder is apt, as the condition centres around the person restricting or avoiding food in some way.
Unlike other restrictive eating disorders (such as anorexia), ARFID rarely has a body image component. This means someone with the condition is unlikely to be restricting their food to change their weight and may not be worried about their appearance. Therefore, it's important not to make assumptions that a person has to look a certain way (or be a particular weight) in order to have AFRID – it can occur in people of any size, gender, or age, from childhood to adulthood.
The reasons someone may restrict or avoid food with this disorder are varied, including:
- Sensory issues and struggling with certain textures, appearances or smells
- A negative experience with food in the past, such as choking or vomiting
- Generalised anxiety around food and eating
- Worries about the consequences of eating
In some cases, those with ARFID can’t put their finger on the root cause impacting them. It can start at a very early age, but can also come up later in life. It can also present alongside other conditions that cause sensory issues like autism and attention deficit hyperactivity disorder (ADHD).
Happiful writer Bonnie Evie Gifford explains that it wasn’t until she was diagnosed as autistic that she came across the term ARFID. “I started to realise that a lot of my experiences around sensory issues and food anxiety weren’t just me being awkward or stubborn. Once I knew that there was a name for what I was experiencing, it meant I could start to look into how others coped with it, helping me to find new ways I could try to decrease my food-related anxiety and work through some sensory-related issues,” Bonnie says.
In the video below, counsellor Maggie Learoyd explains more about ARFID.
Signs of ARFID
As there are various reasons a person might have ARFID, the signs and symptoms can differ between people as well. Someone won’t necessarily display all of these, but some to watch for include:
• Struggling to recognise hunger cues
• Sensitivity to foods due to their texture, smell, or temperature
• Requiring supplements to support basic nutritional needs
• Experiencing nutritional deficiencies
• Developing anxiety around mealtimes
• Having a preference towards always eating the same meals
• Only wanting foods that are the same colour
• Feeling full quickly, after only a few mouthfuls
• Viewing eating as a ‘chore’
• Skipping meals entirely
• Avoiding social events that involve or revolve around food
What can help if you have ARFID?
As Bonnie mentions, knowing there is a name for what you’re going through can be helpful in terms of finding the right support. Like other eating disorders, those with ARFID often benefit from working with a professional and being open about what’s going on.
“Talking through things in online safe autistic spaces, with my partner, and also with a qualified nutritionist, each helped me to identify the different challenges I wasn’t even necessarily aware I had been struggling with,” Bonnie explains.
Speaking to a medical professional is an important first step, but learning more about the condition and sharing this knowledge with loved ones, can be really beneficial and empowering, too. You might also want the support of a nutritional professional, who has experience in this area, as they can work with you to help identify any potential deficiencies you have, making a plan to ensure you get the nutrients you need, and slowly expanding your intake.
As a reasonably new diagnosis, the best treatment options are still being explored. However, a few key ones that are referenced by ARFID Awareness UK include:
• Cognitive behavioural therapy (CBT)
Talking therapies can support you in getting to the root cause of disordered eating. Known for being a valuable treatment for anxiety and depression, CBT allows you to work with a professional to identify and, in turn, change any unhelpful behaviour patterns.
• Eye movement and desensitisation and reprocessing therapy (EMDR)
This is an interactive therapy technique, often used to help people with post-traumatic stress disorder (PTSD). As it can be effective in addressing psychological stress and trauma, which may form underlying factors in ARFID, studies, such as 2017 research in European Psychiatry, noted “significant improvements” in subjects using EMDR as a treatment option.
• Exposure therapy
Best done under the supervision of professionals, exposure therapy is all about overcoming fears and anxieties by confronting them in a safe, controlled environment. This can be a way to show yourself they aren’t as dangerous, or scary, as you believe. With ARFID, this might begin with thinking about or listing the foods you avoid, gradually moving on to looking at images of them, being in the same room as them, touching or smelling them, until finally, being able to taste them.
• Desensitisation therapy
This technique has a similar approach to exposure therapy, in gradually exposing you to the thing that triggers your fear or anxiety, however, it combines relaxation techniques so that you replace those challenging feelings with a more comforting alternative. ARFID Awareness UK notes that this can be particularly helpful for autistic people or those who might be very young, for example, using ‘play’ methods around eating.
While there’s no set path to take on your journey with ARFID, know that if you’re experiencing this, you’re not alone. There are various routes to try, and professional support is available, whenever you’re ready.
