Avoidant/Restrictive Food Intake Disorder (ARFID)

Evelyn Attia

, MD, Columbia University Medical Center;

B. Timothy Walsh

, MD, College of Physicians and Surgeons, Columbia University

Reviewed/Revised Jul 2022 | Modified Sep 2022

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Symptoms and Signs
Diagnosis
Treatment
Key Points

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

Avoidant/restrictive food intake disorder typically begins during childhood but may develop at any age. The exact cause of the disorder is unknown, but it may have genetic and psychosocial components, including trauma Overview of Trauma- and Stressor-Related Disorders Trauma- and stressor-related disorders involve exposure to a traumatic or stressful event. Two of the trauma-related disorders are acute stress disorder and posttraumatic stress disorder (PTSD)... read more , anxiety Overview of Anxiety Disorders Everyone periodically experiences fear and anxiety. Fear is an emotional, physical, and behavioral response to an immediately recognizable external threat (eg, an intruder, a car spinning on... read more , autism Autism Spectrum Disorders Autism spectrum disorders are neurodevelopmental disorders characterized by impaired social interaction and communication, repetitive and stereotyped patterns of behavior, and uneven intellectual... read more , and developmental disabilities. ARFID 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).

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.

Clinical criteria

Criteria for avoidant/restrictive food intake disorder (1 Diagnosis reference Avoidant/restrictive food intake disorder (ARFID) is characterized by restriction of food intake; it does not include having a distorted body image or being preoccupied with body image (in contrast... read more ) 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 Anorexia Nervosa Anorexia nervosa is characterized by a relentless pursuit of thinness, a morbid fear of obesity, a distorted body image, and restriction of intake relative to requirements, leading to a significantly... read more or bulimia nervosa Bulimia Nervosa Bulimia nervosa is characterized by recurrent episodes of binge eating followed by some form of inappropriate compensatory behavior such as purging (self-induced vomiting, laxative or diuretic... read more
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 Introduction to Eating Disorders Eating disorders involve a persistent disturbance of eating or of behavior related to eating that Alters consumption or absorption of food Significantly impairs physical health and/or psychosocial... read more , depression Depressive Disorders Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. Exact cause is unknown... read more , schizophrenia Schizophrenia Schizophrenia is characterized by psychosis (loss of contact with reality), hallucinations (false perceptions), delusions (false beliefs), disorganized speech and behavior, flattened affect... read more , and factitious disorder imposed on another Factitious Disorder Imposed on Another Factitious disorder imposed on another is falsification of manifestations of an illness in another person, typically done by caregivers to someone in their care. (See also Overview of Somatization... read more .