Merck Manual

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Avoidant/Restrictive Food Intake Disorder (ARFID)

By

Evelyn Attia

, MD, Columbia University Medical Center;


B. Timothy Walsh

, MD, College of Physicians and Surgeons, Columbia University

Last full review/revision Jul 2022| Content last modified Jul 2022
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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).

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

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.

Diagnosis reference

  • 1. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, DSM-5-TRTM, Feeding and eating disorders.

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

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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