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Avoidant/restrictive food intake disorder

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Avoidant/restrictive food intake disorder

There are children and adults who, without worrying at all about their physical appearance or weight, eat very little. They are very selective and touchy children, which affects their physical health. In this article we explain what the diagnosis leads to.

Last update: June 09, 2023

Do you have a child who eats very little or prefers only a specific type of product? Avoidant/Restrictive Food Intake Disorder (ARFID) is a recent clinical condition of which not everything is yet known. It describes very capricious and selective children and adults who, due to their obsession, do not cover all their nutritional needs.

These are behaviors that “turn families upside down” and continue to put the health of the affected person at risk. From a psychological point of view, it also represents a real challenge. These patients limit their food intake due to factors such as an aversion to the appearance of the food, due to its taste, color or texture. Likewise, they are afraid of suffocating.

It is a complex and delicate reality that well deserves to be analyzed, to take account of this new category of Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

ARFID is diagnosed only if there are serious physical consequences on the patient’s health.

Avoidant/Restrictive Food Intake Disorder: Definition and Symptoms

Avoidant/restrictive eating disorder was formerly called “selective eating disorder.” With the new DSM-V update, a condition that appears significantly in the child and adolescent population has been described in greater detail. This is what emerges from a research published in the Journal of Eating Disorders.

In a sample of 173 children aged 7 to 17, 22.5% of patients met ARFID (disorder abbreviation) criteria. We are facing a clinical condition far from normal food problems. In these cases, patients do not show an obsession with appearance or with losing weight. There’s no body dysmorphia either.

What you see they are people who limit their intake for arbitrary reasons, to the point of not satisfying their nutritional and energy needs. Studies such as those conducted at the Johns Hopkins School of Medicine also indicate that there is no adequate awareness or knowledge of TERIA among healthcare professionals.

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This puts a part of the population at risk and, therefore, it is necessary to make it much more visible. Let’s do it!

What are the symptoms of avoidant/restrictive food intake disorder?

It’s possible that many moms and dads right now are worried about that child who eats little or is very picky. The truth is, sometimes we don’t know when an eating behavior goes from being capricious or difficult to problematic. This explains why in 2013 it was decided to accurately specify and describe this condition in the DSM-V.

What is the picture of having avoidant/restrictive food intake disorder? The following list reveals it:

  • Anemia.
  • Gastric reflux.
  • Weakened immune system.
  • Cramps, dizziness and fainting.
  • Having a cold body temperature most of the time.
  • There is often stomach pain.
  • Intestinal disorders such as constipation.
  • Dry skin, muscle weakness, hair loss.
  • I don’t like to eat for fear of choking.


  • Considerable weight loss, due to poor diet.
  • I reject many products because of their texture, color or taste.
  • Teenage girls or adult women stop menstruating.
  • Psychosocial deterioration and great risk to the person’s life.
  • The child has a lower growth percentile than expected.
  • Many of these people suffer from anxiety disorders.
  • This selectivity or whim in food gets worse over time.
  • The adult shows a very pronounced thinness of which he is unaware.
  • Patients eat only a very small number of foods.
  • In many cases, these patients end up being tube fed.

ARFID is often associated with anxiety disorders.

Avoidant/restrictive food intake disorder is common in what types of people?

Most research on ARFID focuses on the child and adolescent population. We know that it is more frequent in children, but it can also appear in the adult population. Therefore, works such as those shared by the University of Pennsylvania, highlight that adults with “picky” eating patterns are more likely to develop this condition.

On the other hand, it is also common that people who are on the autism spectrum (ASD) are more likely to develop ARFID.

How is avoidant/restrictive food intake disorder diagnosed?

The correct diagnosis of ARFID requires a multidisciplinary intervention. Medical professionals and psychologists specialized in eating behavior are needed. Next, the keys to each area are detailed.

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Medical diagnostics

It is important to note that TERIA can only be diagnosed if the behavior has serious physical consequences. Doctors evaluate whether the nutritional deficiency or the need for supplemental or enteral feeding is due to a psychological problem.

psychological diagnosis

Pediatrics in Review alludes to the importance of DSM-V in guiding diagnostic criteria. Although what this condition is has been explained before, now look at the guides to identify it:

  • The patient’s medical history is required.
  • A clear lack of interest in food must appear.
  • Fear of suffocation or secondary physiological effects.
  • This behavior is not associated with other eating disorders such as anorexia.
  • The restriction is not based on cultural reasons or the person’s lack of food.
  • Avoid food or select it based on smell, taste, texture, etc.

What are the treatments for this disorder?

It is common for people with TERIA to go through an entire journey between different specialists, such as nutrition, gastroenterology or psychiatry; always receiving ineffective treatments and misdiagnoses. Addressing eating behavior problems requires a multidimensional approach, through units specializing in eating disorders.

Know the associated causes

Avoidant/restrictive food intake disorder usually has striking comorbidity with other clinical conditions. In general, it is common to find the following realities:

  • Learning Disabilities.
  • Autism Spectrum Disorder (ASD).
  • Obsessive Compulsive Disorder (OCD).
  • Attention Deficit Hyperactivity Disorder (ADHD).
  • Many of these patients show anxiety problems.
  • The research published in the Journal of Eating Disorders, discussed at the outset, highlights the prevalence of pervasive developmental disorder.

Experimental programs are currently being conducted to learn which therapeutic approach is the most appropriate for patients with avoidant/restrictive food intake disorder.

Therapeutic approaches

The therapeutic approaches are always personalized for each patient, starting from the diagnosis. In these cases and by units specialized in eating disorders (eating disorders) apply the strategies listed below:

  • Regular medical assistance.
  • Psychosocial intervention to improve eating habits.
  • Approach with psychotropic drugs according to the needs of the patient.
  • Treat the physical complications resulting from a deficient diet.
  • From Massachusetts General Hospital they carry out a pilot study in which cognitive behavioral therapy is applied and the patient’s family is included. Its effectiveness is currently unknown, but it is a successful model in most eating disorders.
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Progress well under way to address ARFID

Finally, as we pointed out at the beginning, we still don’t know everything about this type of eating disorder. As more scientific literature becomes available, we will better understand its etiology and the most suitable therapies.

For now, progress is positive, with general awareness of this mental health issue being very important.

It may interest you …

All sources cited have been thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography for this article has been deemed reliable and of scholarly or scientific accuracy.

  • Brigham, K. S., Manzo, L. D., Eddy, K. T., & Thomas, J. J. (2018). Evaluation and Treatment of Avoidant/Restrictive Food Intake Disorder (ARFID) in Adolescents. Current pediatrics reports, 6(2), 107–113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534269/
  • Fisher, M. M., Rosen, D. S., Ornstein, R. M., Mammel, K. A., Katzman, D. K., Rome, E. S., Callahan, S. T., Malizio, J., Kearney, S., & Walsh, B. T. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a “new disorder” in DSM-5. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 55(1), 49–52. https://pubmed.ncbi.nlm.nih.gov/24506978/
  • Kauer, J., Pelchat, M. L., Rozin, P., & Zickgraf, H. F. (2015). Adult picky eating. Phenomenology, taste sensitivity, and psychological correlates. Appetite, 90219–228. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477986/
  • Nicely, T. A., Lane-Loney, S., Masciulli, E., Hollenbeak, C. S., & Ornstein, R. M. (2014). Prevalence and characteristics of avoidant/restrictive food intake disorder in a cohort of young patients in day treatment for eating disorders. Journal of Eating Disorders, 2(1), 21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145233/
  • Seetharaman, S. y Fields, EL (2020). Avoidant/restrictive food intake disorder. Pediatrics in review , 41 (12), 613–622. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185640/
  • Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current psychiatry reports, 19(8), 54. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281436/
  • Thomas, J. J., Wons, O. B., & Eddy, K. T. (2018). Cognitive-behavioral treatment of avoidant/restrictive food intake disorder. Current opinion in psychiatry, 31(6), 425–430. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235623/

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