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Avoidant/Restrictive Food Intake Disorder (ARFID)


Evelyn Attia

, MD, Columbia University Medical Center, New York State Psychiatric Institute;

B. Timothy Walsh

, MD, College of Physicians and Surgeons, Columbia University

Last full review/revision Jun 2020| Content last modified Jun 2020

Avoidant/restrictive food intake disorder is characterized by restriction of food intake; it does not include having a distorted body image or being preoccupied with body image (as occurs in anorexia nervosa and bulimia nervosa).

(See also Introduction to Eating Disorders.)

Avoidant/restrictive food intake disorder typically begins during childhood but may develop at any age. This disorder may initially resemble the picky eating that is common during childhood—when children refuse to eat certain foods or foods of a certain color, consistency, or odor. However, such food fussiness, unlike avoidant/restrictive food intake disorder, usually involves only a few food items, and the child's appetite, overall food intake, and growth and development are normal.

Patients with avoidant/restrictive food intake may not eat because they lose interest in eating or because they fear that eating will lead to harmful consequences such as choking or vomiting. They may avoid certain foods because of their sensory characteristics (eg, color, consistency, odor).

Symptoms and Signs of ARFID

Patients with avoidant/restrictive food intake disorder avoid eating food and restrict their food intake to such an extent that they have ≥ 1 of the following:

  • Significant weight loss or, in children, failure to grow as expected
  • Significant nutritional deficiency
  • Dependence on enteral feeding (eg, via a feeding tube) or oral nutritional supplements
  • Markedly disturbed psychosocial functioning

Nutritional deficiencies can be life threatening, and social functioning (eg, participating in family meals, spending time with friends in situations where eating may occur) can be markedly impaired.

Diagnosis of ARFID

  • Clinical criteria

Criteria for avoidant/restrictive food intake disorder include the following:

  • The food restriction leads to significant weight loss, failure to grow as expected in children, significant nutritional deficiency, dependence on nutritional support, and/or marked disturbance of psychosocial functioning
  • The food restriction is not caused by unavailability of food, a cultural practice (eg, religious fasting), physical illness, medical treatment (eg, radiation therapy, chemotherapy), or another eating disorder—particularly anorexia nervosa or bulimia nervosa
  • There is no evidence of a disturbed perception of body weight or shape.

However, patients who have a physical disorder that causes decreased food intake but who maintain the decreased intake for much longer than typically expected and to a degree requiring specific intervention may be considered to have avoidant/restrictive food intake disorder.

When patients first present, clinicians must exclude physical illness as well as other mental disorders that impair appetite and/or intake, including other eating disorders, depression, schizophrenia, and factitious disorder imposed on another.

Treatment of ARFID

  • Cognitive-behavioral therapy

Cognitive-behavioral therapy is commonly used to help patients normalize their eating. It can also help them feel less anxious about what they eat.

Key Points

  • Avoidant/restrictive food intake disorder can cause life-threatening nutritional deficiencies and markedly impair social functioning (eg, participating in family meals).
  • Diagnose based on specific criteria, particularly distinguishing avoidant/restrictive food intake disorder from anorexia nervosa or bulimia nervosa.
  • Treat with cognitive-behavioral therapy, which aims to normalize the patient's eating.

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