What is ARFID?
Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by an eating or feeding disturbance leading to persistent failure to meet appropriate nutritional and/or energy needs, associated with one or more of: significant weight loss or faltering growth, significant nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, and marked interference with psychosocial functioning. Unlike anorexia nervosa or bulimia nervosa, ARFID is not driven by body weight/shape concerns.
- A 7-year-old child with extreme texture sensitivities eats only five foods: chicken nuggets, plain pasta, white bread, applesauce, and crackers. Any attempt to introduce new foods results in gagging, crying, and refusal. Growth has faltered, and labs show iron and vitamin D deficiencies. The pediatrician refers to a feeding clinic where an SLP evaluates oral-motor skills (normal) and an OT assesses sensory processing. The family begins CBT-AR with graded exposure: tiny tastes of new foods paired with preferred items, using a reward system. After 12 weeks, the child tolerates 10 additional foods, labs normalize, and mealtime stress decreases significantly.
- A 14-year-old develops intense fear of vomiting after a stomach virus and stops eating at school entirely. She loses 15 pounds over 2 months and becomes socially isolated, eating only plain crackers and broth at home. Her parents bring her to a therapist who diagnoses ARFID (fear-of-aversive-consequences subtype). Treatment includes CBT-AR with graded exposure to feared foods, interoceptive exercises, and mirtazapine to reduce nausea anxiety and stimulate appetite. Her pediatrician monitors weight and nutrition. After 4 months, she returns to eating with peers, regains weight, and participates in sports again.
- A 22-year-old college student with low appetite and early satiety frequently forgets to eat, relying on meal-replacement shakes to maintain weight. She has no body image concerns but feels full after a few bites and lacks hunger cues. Academic stress worsens the pattern, and she loses 10 pounds. Her doctor diagnoses ARFID (apparent lack of interest subtype) and refers her to a dietitian who creates a structured meal schedule with phone reminders. A therapist teaches her mindfulness and interoceptive awareness to reconnect with hunger signals. ACT-based strategies help her eat for values (energy, social connection) rather than appetite. Over 3 months, her intake and weight stabilize, and she begins enjoying meals with friends.
- A 5-year-old with autism eats only beige, crunchy foods (goldfish crackers, french fries, plain chicken) and refuses everything else. He gets upset if foods touch each other or if brands change. His weight is stable, but he is found to have low iron (iron-deficiency anemia) and constipation. The family works with an occupational therapist trained in feeding therapy, using play-based ways to get used to new foods (touching, smelling, licking them) and rewards for trying. Cyproheptadine (an antihistamine) is added to increase appetite. After 6 months, he accepts 8 new foods, his anemia clears with iron supplements, and family mealtimes become less stressful.
- A 19-year-old man with a history of severe acid reflux avoids most solid foods because he fears pain and choking. He eats only soft, bland foods (oatmeal, yogurt, mashed potatoes) and has lost 20 pounds. Tests show his reflux is well controlled, but the avoidance continues. He starts CBT-AR focused on fear of what might happen when eating. Therapy includes learning about reflux, gradual practice with foods he has avoided, and anxiety management skills. His stomach doctor fine-tunes his reflux treatment. After 5 months, he is eating solid foods again, gains weight, and eats out with friends for the first time in years.