Eating disorders are conditions marked by persistent and disturbed eating patterns. These disorders are often linked to underlying mental health conditions like anxiety and depression. One of the various types of eating disorders is avoidant restrictive food intake disorder (ARFID). Previously known as selective eating disorder, avoidant restrictive food intake disorder symptoms can be difficult to identify as the condition is often brushed off as simply “picky eating.” Below is a guide on ARFID symptoms in adults and children to help you identify if someone’s picky eating is a sign of a more serious problem.

What Is ARFID?

Avoidant restrictive food intake disorder (ARFID), previously known as selective eating disorder, was recently added to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, also known as DSM-5. ARFID is an eating disorder that’s similar to anorexia nervosa in that both disorders involve limiting the amount of food and/or the kinds of food one eats. However, unlike anorexia, ARFID does not involve distress about body shape or size nor any fear of gaining weight.

Although picky or selective eating is common among children, a person with ARFID doesn’t eat enough calories to grow and develop properly, and in adults, this means that basic bodily functions may suffer. Additionally, children with ARFID may experience stalled weight gain and vertical growth, and adults with this disorder may experience weight loss.

Due to a lack of proper development and growth, children with ARFID may struggle to perform well in school, and adults may struggle in their job or school performance. People with ARFID also struggle to eat with others and require extended periods to eat.

Avoidant Restrictive Food Intake Disorder (ARFID) Symptoms

ARFID eating symptoms may vary widely from person to person and tend to evolve. The bulk of symptoms fall under the umbrellas of things like sensory avoidance triggers, restrictive eating habits, and fear-based eating experiences.

• Dressing in layers to hide weight loss or stay warm
• Cold intolerance
• Lethargy and/or excess energy
• Difficulties concentrating
• Reporting gastrointestinal issues such as upset stomach and feeling full around mealtime that have no cause (usually to avoid eating)
• Only eating certain textured foods
• Fear of choking or vomiting
• Lack of appetite or interest in food
• No evident body image disturbance or fear of gaining weight
• A limited list of preferred foods that become shorter over time
• Dramatic restriction in certain amounts of types of foods

• Constipation
• Abdominal pain
• Stomach cramps
• Non-specific gastrointestinal problems (constipation, acid reflux, upset stomach, etc.)
• Menstrual irregularities (missing periods or having periods on hormonal contraceptives)
• Dizziness
• Fainting spells
• Always feeling cold
• Dry skin
• Dramatic or sudden weight loss
• Fine hair on the body (lanugo)
• Thinning of hair on the body and head
• Brittle hair and nails
• Muscle weakness
• Cold, mottled hands and feet
• Swelling of the feet
• Impaired immune functioning

In people with ARFID, the body is denied basic nutrients needed for normal function. Thus, it’s forced to slow down all it’s processes to conserve energy, leading to various medical consequences. With that said, the body is generally resilient at coping with the stress of an eating disorder, which is why someone with ARFID may come out with perfect laboratory test results even if they’re at high risk of death.

ARFID DSM-5 Criteria

An ARFID diagnosis is determined by the DSM-5, which is a guide doctors use to diagnose patients with mental health disorders. If a person shows signs of an avoidant eating disorder like the ones mentioned above, they would be taken to a health care professional who would use the DSM-5 to confirm their condition and provide a diagnosis.

• An eating or feeding disturbance (such as an apparent lack of interest in eating or food, sensory food aversion, or concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
  • Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
  • Significant nutritional deficiency.
  • Dependence on enteral feeding (feeding tube) or oral nutritional supplements.
  • Marked interference with psychosocial functioning.
• The eating disturbance cannot be explained by lack of available food or by an associated culturally sanctioned practice.
• The eating disturbance does not occur solely during anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way the person perceives their body weight or shape.
• The eating disturbance is not linked to a medical condition or is not better explained by another mental health disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

People with autism spectrum conditions are more likely to develop ARFID, as well as people with attention-deficit hyperactivity disorder (ADHD) and intellectual disabilities. Sensory food aversion is also linked to ARFID and occurs when a person overreacts to certain types of food based on the taste, smell, color, or texture.

Children who don’t outgrow normal picky eating or who show severe picky eating habits are also more likely to develop ARFID. Many people with ARFID also have anxiety disorders and are also more likely to develop other co-occurring mental health disorders.

ARFID Treatment

People with eating disorders like ARFID can die suddenly due to electrolyte imbalance or cardiac arrest. Therefore, knowing avoidant restrictive food intake disorder symptoms and signs can equip you to catch ARFID as early as possible and find eating disorder support for the individual.

If you or someone you know is showing signs of ARFID or has developed this condition but doesn’t know where to get help, our center for eating disorders in Philadelphia is here for you. In addition to ARFID treatment, we offer various levels of care for conditions like anorexia nervosa, bulimia nervosa, and more.

With the help of a highly-qualified, experienced, and trained team of dietitians and therapists, our Philadelphia, PA, drug rehab and mental health center can aid in your healing from eating disorders. For more information about our eating disorder programs, call Banyan Treatment Center today at 888-280-4763.

1. NCBI - DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet].