Avoidant Restrictive Food Intake Disorder (ARFID) is an eating disorder that, despite increasing recognition in recent years, remains underdiagnosed and frequently misunderstood.

Typically emerging in children, ARFID involves persistent food avoidance or restriction. ARFID presents significant challenges not only for the individuals affected by the condition, but also for their families, schools, and the wider community. Although there is growing awareness within clinical settings, many misconceptions persist. In this article, we will explore what ARFID is, discuss key symptoms in children, and address some common myths and misunderstandings surrounding the disorder.

What is ARFID?

ARFID is a type of eating disorder that differs fundamentally from eating disorders like anorexia or bulimia. Unlike these conditions, ARFID is not driven by concerns about body image or a desire to lose weight. Instead, it is characterised by a limited or selective intake of food, which can result in significant nutritional deficiencies, weight loss, and impaired growth or development, particularly in children.

ARFID was officially recognised in 2013 with the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, defines ARFID as an eating or feeding disturbance e.g.: apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; 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;
• Dependency on oral nutritional supplements or feeding tubes;
• Marked interference with social functioning (e.g., eating at social gatherings).

It’s important to note that ARFID is not simply “picky eating”. Many children go through phases of selective eating, but ARFID involves a more persistent and impairing condition with potential medical or psychological consequences.

Symptoms of ARFID

While the specific symptoms can vary from child to child, common indicators of ARFID include:

• Extreme selectivity in food choices: Children with ARFID may restrict their diet to only a few specific foods or food groups, often excluding entire food groups such as vegetables, fruits, or proteins.
• Sensory sensitivities: Many children with ARFID have heightened sensitivities to the texture, smell, taste, or appearance of food. This sensory discomfort can make it challenging for them to eat a variety of foods.
• Fear of negative consequences: Some children with ARFID may avoid certain foods due to a fear of choking, vomiting, or experiencing physical discomfort. This can lead to the avoidance of foods with unfamiliar textures or unfamiliar preparation methods.
• Severe weight loss or failure to gain weight: In children, ARFID may result in stunted growth or developmental delays.
• Avoidance of social situations: Because food is often central to social interactions, children with ARFID may struggle in l settings that involve social interactions such as throughout the school day, family meals, birthday parties, or eating out, due to their limited food intake.

The Emotional and Psychological Impact of ARFID

ARFID can have a profound effect on a child’s emotional and psychological well-being. The persistent avoidance of food can lead to feelings of isolation, frustration, and anxiety. Additionally, the pressure to eat or try new foods can lead to emotional distress and further avoidance behaviours. For children with additional sensory processing difficulties, the impact of ARFID can therefore be significant.

For children, ARFID can affect not only their physical health but also their social and emotional development. These children may struggle with issues such as social isolation or bullying related to their eating behaviours. Over time, these challenges can result in low self-esteem and issues with body image. Where a child has ARFID comorbid with other special educational needs, delays in their social and emotional development can be exacerbated.

Common Misconceptions About ARFID

Despite increasing awareness, many myths and misconceptions about ARFID persist. These misconceptions can hinder proper diagnosis and treatment, and they often lead to unnecessary stigma for those with the disorder. Below are some of the most common myths surrounding the disorder:

1. ARFID is just “picky eating”

One of the most common misconceptions about ARFID is that it is simply an extreme version of being a picky eater. While it is true that children with ARFID may have highly selective food preferences, particularly if the child also has additional special educational needs such as autism and/or sensory processing difficulties, the key distinction is that their behaviour is not temporary, and there is a misconception that the child will simply ‘outgrow’ it. For those children with ARFID, restrictive eating habits persist and can result in serious health consequences, such as malnutrition, vitamin deficiencies, and impaired growth or development.

Additionally, picky eaters usually do not experience the level of distress and dysfunction seen in children with ARFID. For those with ARFID, the avoidance of certain foods is often accompanied by anxiety, discomfort, or even fear, which further complicates the disorder and can exacerbate the presentation of other special educational needs.

2. ARFID is just a problem for children

While ARFID is often diagnosed in childhood, it can affect individuals of any age. In fact, it is not uncommon for ARFID to persist into adolescence or adulthood. ARFID is often underdiagnosed in adults, as its symptoms can be mistaken for other issues, such as gastrointestinal disorders, or even dismissed as unhealthy eating habits.

3. People with ARFID are just trying to lose weight

Unlike anorexia or bulimia, children with ARFID do not typically have a desire to lose weight. In fact, the avoidance of food in ARFID can lead to malnutrition and weight loss, but this is not driven by a desire to control their weight. Thus, weight loss in ARFID should not be confused with intentional dieting or an obsession with body image.

4. ARFID is a result of ‘lazy parenting’ that can be overcome by “just forcing the child to eat”

Another misconception is that ARFID can be easily cured by simply forcing a child to eat a wider variety of foods. This approach is not only ineffective but can also be harmful. ARFID is a complex disorder that often involves both psychological and sensory components. Forcing a child to eat foods they fear or avoid can lead to increased anxiety and further food avoidance. Treatment for ARFID for younger children and those on the Autism Spectrum can involve therapeutic approaches, such as: desensitisation therapy, and exposure therapy, where children gradually work to expand their food choices in a safe and supportive environment. For older children with language, which may or may not be suitable for those of the Autism Spectrum therapeutic approaches, include: cognitive behavioural therapy (CBT), dialectical behaviour therapy and hypnotherapy[1].

5. ARFID is a rare condition

While ARFID may not be as widely known as other eating disorders, it is not a rare condition. Research indicates that ARFID affects a significant number of individuals, particularly children. Studies suggest that 5% to 14% of children may be affected by the disorder[2], though the true prevalence is difficult to determine due to underreporting and misdiagnosis.

Studies on ARFID and Individuals with Special Educational Needs (SEN)

Recent studies have begun to highlight the prevalence and unique challenges of ARFID in individuals with Special Educational Needs (SEN), recognising that the condition is not only underdiagnosed but also may present differently in individuals with SEN. Many children with SEN, such as those with autism spectrum disorder (ASD) may experience sensory sensitivities that overlap with the characteristics of ARFID. These sensory issues, such as aversions to the textures, smells, or tastes of food, are a significant factor in food restriction.

Research indicates that ARFID is more common in children with autism and other neurodevelopmental disorders compared to the general population. A study published in Developmental Medicine & Child Neurology found that 49.1% of children in a clinical sample met the diagnostic criteria for ARFID, with comorbid autism spectrum disorder (ASD) emerging as a significant predictor of ARFID diagnosis[3]. Similarly, a UK-based survey conducted by the University of Hertfordshire reported that 56% of children diagnosed with ARFID also had a formal autism diagnosis, while 65.6% of autistic children in the sample met criteria for ARFID[4]. The survey noted that these results demonstrate the importance of screening for ARFID in children diagnosed with Autism, “…as early identification and intervention can lead to improved outcomes and tailored treatment strategies for affected individuals”.

Collectively, these findings reinforce the strong association between ARFID and neurodevelopmental conditions such as ASD.

Is ARFID classified as a special educational need or disability?

Special educational need (SEN) is defined in the Children and Families Act 2014 as a learning difficulty or disability that calls for special educational provision. While ARFID isn’t explicitly listed as a SEN under the Children and Families Act 2014, it can fall under the broader umbrella of SEN or disability when it significantly impacts a child’s ability to access education or participate in school life. If ARFID leads to nutritional deficiencies, fatigue, anxiety, or social withdrawal, it can interfere with concentration, attendance, or participation in school activities. In such cases, schools may need to make adjustments, like providing a quiet space for eating, flexible mealtimes, or support from a teaching assistant.

Under the Equality Act 2010, a disability is a physical or mental impairment that has a substantial and long-term adverse effect on day-to-day activities. ARFID, especially when linked to autism, anxiety, or sensory processing issues, can meet this threshold, particularly if it affects eating, social interaction, or emotional regulation over time.

Children with ARFID may be eligible for an Education, Health and Care (EHC) plan if their needs are complex and require coordinated support across education, health, and care. Support may also come through CAMHS, dietitians, occupational therapists, or speech and language therapists, depending on the child’s profile.

So, while ARFID isn’t always classified as a SEN or disability by default, its impact can certainly justify that classification, especially when it disrupts learning or wellbeing. For those seeking support, it’s helpful to document how ARFID affects the child’s functioning in school and daily life.

Conclusion

Avoidant/Restrictive Food Intake Disorder (ARFID) is a serious and complex eating disorder that goes beyond typical picky eating. It is marked by a persistent avoidance of food due to sensory sensitivities, fear of negative consequences, or lack of interest in food, which can lead to significant health consequences. Unfortunately, misconceptions about ARFID continue to hinder understanding and treatment of the disorder.

For those struggling with ARFID, particularly children, proper diagnosis and a comprehensive treatment plan are essential for recovery. Special educational or healthcare provision may also be obtained through CAMHS or via an Education, Health and Care (EHC) plan for children with ARFID and additional special educational needs. EHC plans are legal documents that outline a child’s educational, health, and social care needs, and they can ensure access to tailored support across school and healthcare settings.

As awareness grows and education about ARFID improves, it is crucial for society to move beyond the myths and stereotypes to ensure that children with ARFID receive the support and care they need.

[1] https://www.arfidawarenessuk.org/treatment

[2] Norris, M. L., Robinson, A., Obeid, N., Henderson, K., Spettigue, W., & Henderson, L. (2016). Exploring avoidant/restrictive food intake disorder in eating disordered patients: A descriptive study. International Journal of Eating Disorders, 49(6), 540-548.

[3] Farag, F., Sims, A., Strudwick, K., Carrasco, J., Waters, A., Ford, V., Hopkins, J., Whitlingum, G., Absoud, M. and Kelly, V.B. (2022), Avoidant/restrictive food intake disorder and autism spectrum disorder: clinical implications for assessment and management. Dev Med Child Neurol, 64: 176-182. https://doi.org/10.1111/dmcn.14977

[4] ARFID Awareness UK. (2024). ARFID and autism survey results. https://www.cntw.nhs.uk/wp-content/uploads/2025/01/ARFID-SIG-Slides-Quant-Findings-9102024-6.pdf