Understanding ARFID (Avoidant/Restrictive Food Intake Disorder)

Avoidant/Restrictive Food Intake Disorder (ARFID) is a serious eating disorder characterised by extreme food restriction and limited food variety, often leading to nutritional deficiencies, growth issues, and psychosocial difficulties.

First officially recognised in the DSM-5 in 2013, ARFID can affect individuals of all age groups, although it is particularly common in children.

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Diagnostic Criteria for ARFID

According to the DSM-5, ARFID is diagnosed when an eating or feeding disturbance leads to persistent failure to meet appropriate nutritional and/or energy needs, accompanied by one or more of the following:

• Significant weight loss or failure to achieve expected weight gain (or faltering growth in children)

• Significant nutritional deficiencies

• Dependence on enteral feeding or oral nutritional supplements

• Marked interference with psychosocial functioning

ARFID is diagnosed only when the eating disturbance:

• Is not due to food unavailability or culturally sanctioned practices

• Does not occur exclusively during the course of anorexia nervosa or bulimia nervosa

• Is not explained by a disturbance in body image perception

• Is not fully attributable to a concurrent medical condition or another mental disorder without exceeding typical eating issues associated with those conditions

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Management of ARFID

Management strategies for ARFID are multidisciplinary and evolving.
Treatment focuses on addressing nutritional, psychological, sensory-motor, and medical needs:

• Dietary Support: Ensuring that nutritional requirements are met to optimise growth, development, and health.

• Psychological Support: Managing parental and child anxiety, improving coping strategies, and reducing mealtime stress.

• Sensory-Motor Strategies: Developing desensitisation techniques, improving oral-motor skills, and creating supportive feeding environments.

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Warning Signs and Symptoms of ARFID

Behavioural and Psychological Signs:

• Dramatic weight loss or failure to gain weight appropriately

• Consistent gastrointestinal complaints without known medical cause (e.g., constipation, stomach pain, fullness at mealtimes)

• Eating only specific textures or types of food

• Fears related to eating, such as fear of choking or vomiting

• Limited food range that progressively narrows over time

• Lack of appetite or apparent disinterest in food

• Dressing in multiple layers (to hide weight loss or for warmth)

• No body image disturbance or fear of weight gain (unlike anorexia)

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Physical Signs:

Due to the inability to meet nutritional needs, individuals with ARFID may experience:

• Gastrointestinal complaints (constipation, acid reflux)

• Menstrual irregularities or loss of menstruation (in postpubertal females)

• Dizziness, fainting, feeling cold

• Sleep disturbances

• Dry skin, brittle nails, hair thinning

• Development of fine body hair (lanugo)

• Slow wound healing and impaired immune function

• Muscle weakness

• Cold, mottled hands and feet, or swelling of extremities

• Laboratory abnormalities (anemia, electrolyte imbalances, low hormone levels)

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How Our Expert Paediatric Dietitians and Occupational Therapists Can Help

At Nutrition and Co, we provide specialised, compassionate support to children and families managing ARFID.
Our services include:

• ARFID Screening and Diagnosis Support
  Comprehensive assessment of your child's eating patterns, growth, and sensory behaviours.

• Sensory Eating Analysis
  Evaluating sensory sensitivities related to food texture, smell, taste, and appearance.

• Practical Strategies to Increase Food Intake and Variety
  Gentle, stepwise approaches such as food chaining and gradual food desensitisation.

• Oral Nutrition Therapy
  Nutritional supplementation strategies to safely support growth while expanding diet variety.

• Family and Feeding Environment Coaching
  Teaching caregivers how to create a supportive, non-pressured mealtime environment optimised for success.

• Sensory and Proprioceptive Awareness Development
  Supporting children’s sensory integration skills to reduce food aversions and anxiety around eating.

• Coordination with Paediatricians and Healthcare Teams
  Collaborative, multidisciplinary care to ensure seamless support.

• School Support and Reports
  Providing written reports for schools and attending meetings where appropriate to advocate for your child’s needs.