Going out for dinner with friends is meant to be fun – but for some people, it means walking a tightrope of fear. No matter how big the menu is, or how varied choices are, these people could scour through for hours and still be left with nothing to eat. Textures that could be too slimy, tastes that are too putrid, smells that are too pungent, leaves them going hungry.
It would be easy to dismiss people seemingly turning their noses up at a variety of foods as picky eaters, but in reality, their limited diets could be a symptom of a little-known eating disorder.
Avoidant/Restrictive Food Intake Disorder, known as ARFID, is a recent eating disorder diagnosis that only officially entered diagnostic manuals in 2013. Because it is such a new diagnosis, not a lot is really known about it – but it can have a severe impact on sufferers’ lives.
Here’s everything you need to know about ARFID, the symptoms to look out for and the treatment available.
What is ARFID?
In its simplest terms, ARFID is an eating disorder where sufferers avoid certain foods or types of food.
However, unlike other eating disorders, like anorexia or bulimia nervosa, ARFID is not necessarily driven by body image.
“ARFID can be driven by sensitivity,” explains Martha Williams, the Senior Clinical Advice Coordinator for eating disorder charity, Beat.
Getty Images
“Sufferers can be sensitive to things like the texture or taste of certain foods, or fears about eating food due to previous experiences choking. In some cases, it may just be driven by disinterest in food.”
ARFID can also be a concurrent symptom of a wider disorder, and is commonly found in people who fall on the autistic spectrum. One study found that in a group of 536 children, the 58.3% who had an ARFID diagnosis also had autism.
What are the symptoms of ARFID?
Taking a long time to eat at meal times, struggling to eat a variety of foods, becoming distressed or mentioning a sensitivity to certain meals are the stereotypical signs of ARFID, which can be spotted over time. We could also see sufferers only eating ‘beige’ meals or having the same food every time they do eat.
Williams explains that, like a lot of eating disorders, ARFID can present differently in different people.
“It means ARFID is often difficult to diagnose,” she continues. “It doesn’t present like other eating disorders, where we can see people rapidly drop weight quickly, for example.
“Because of the restrictive nature of ARFID, we can see those with the disorder losing weight, but they may still be in the normal parameters of weight.”
It’s also something that can be dismissed as ‘fussy eating’, particularly in children, with many parents assuming their child’s aversion to food will be something they grow out of.
“It’s important to highlight that ARFID is not just the way the patient is around food,” William adds. “It’s also psychological. It’s about tackling the dominant thoughts and feelings around food.
“It’s crossing that bridge from picky eating to a serious health concern. Are they limiting their intake to the point they’re deficient in nutrients? There’s no clear way of diagnosing it, it’s about having a look at those more subtle symptoms over a long period of time.”
How is ARFID treated?
As the disorder is still relatively new, there is no set way to treat ARFID, but numerous methods and treatments can be employed to ease symptoms.
It tends to begin with the patient having goals set around their eating habits, which build up over time.
These goals could include:
Trying and eating a larger range of foodsBecoming comfortable eating around othersReducing anxiety around eatingBecoming less afraid of choking or vomiting
Psychological interventions may also be employed to help ease fears around food, including cognitive behavioural therapy, exposure therapy and further nutritional support.
However, the sort of treatment patients may receive for an ARFID diagnosis can be varied.
“It can be a postcode lottery,” Williams says. “Because ARFID is so new, there’s no one set pathway to treatment.
“There’s still very limited research into the field, and so it’s up to each care provider in how they treat the disorder. Someone suffering from ARFID in London may see a totally different treatment path than someone diagnosed in Northumbria. There may also be long waiting times for treatment – some doctors may find themselves reluctant to implement anything as it’s so specialist.”
And if you’re in a position where you’re concerned about a loved one who may have ARFID? Williams says the best thing to do is to educate yourself.
Maskot//Getty Images
“It’s important to do your research,” she explains. “It can really help if you can learn a little bit about food yourself.
“The problem is that there’s just not too much awareness around it. Cases get missed, or children don’t get diagnosed, because people don’t know what to look out for.
“If it’s a child you’re concerned about, you’re going to be the one that has to advocate for them. In the first instance, you should always speak to a GP, who will be the ones to make the referral to the correct specialist.”
What is it like to have ARFID?
Elena* was diagnosed with ARFID in 2020, after she went to private clinic. She was also diagnosed with autism as an adult.
“I always knew I wasn’t ‘just’ a picky eater,” the 27-year-old explains. “A picky eater will eat the foods they dislike if they’re hungry enough. A child with ARFID, like me, would starve for days if they couldn’t get food their brain perceives as edible.
“My brain doesn’t perceive the foods I dislike as food; it perceives those things the same way other people’s brains perceive human waste, and you wouldn’t eat human waste no matter how much you were starving.”
Elena adds she was not taken seriously when she spoke about her feelings around food, particularly when she was younger, with her parents often forcing food she found physically repulsive.
“Only my friends respected my boundaries around food,” she says. “ARFID as a term is pretty new, so for many years people like me suffered alone.”
Milk, fish and meat are among the foods Elena can’t stomach.
“Milk is so slimy. I have no problems with non-liquid foods made out of milk – I just don’t like milk as a liquid,” she explains. “As a general rule, I don’t like most flavoured liquids. Liquids have to be flavourless. Tea is the only exception.
“I dislike so many meats and types of fish that I just decided to go vegetarian for simplicity’s sake.”
There are some foods in combinations that Elena also avoids.
“I can’t handle desserts, such as cakes, that have fruit on top or inside of them. I eat fruit on its own just fine, and I eat cakes on their own just fine, but I can’t stand the combination of the two,” she says.
“I can’t eat salads because I don’t like meals that have many chunks of different objects mixed together – but usually, I eat every salad ingredient separately, on its own, just fine.
Elena says she manages to get the mix of nutrients she needs by learning what food she can and can’t handle
“I mostly enjoy uncooked foods. I like most fruits and berries. I like seeds and nuts.
“When it comes to home cooking, I love a lot of pasta recipes, such as penne al arrabiata.
“When it comes to processed foods from the grocery store, I can’t help but love potato chips. I used to love breakfast cereals, but nowadays I’m indifferent towards them; same goes for milk chocolate and cookies. I still like ice cream, though. I love buns with spinach filling and garlic bread. I like yogurt, but I have to be careful because many of them contain gelatine, which is not vegetarian. Out of cheeses, I love brie the most, but I like most cheeses.”
Eating in restaurants is a rare occurrence for Elena, but she manages to find some safe options.
“I loved most vegetarian pasta, pizza marinara, pizza margherita, and the four-cheese pizza. Fries are always an option. Most restaurant desserts are fine as long as they don’t contain chunks of fruit.”
Elena now works to try a new food once a week to expand her dietary repertoire.
“I must emphasise that ‘trying’, to me, sometimes is just sniffing the food and touching it without putting it into my mouth,” she says. “I have never had a meal whose smell I found nasty that I suddenly liked when I put it into my mouth. Never ever. So I trust my nose. I respect my body’s boundaries.
“I’m currently working with adopting rice. I have liked rice plenty of times before, at restaurants and made by my friends. But the rice I make is nasty. I’m trying to find a way to make it taste like it wasn’t cooked by me.”
“I did not find new foods by eating anything that disgusted me, though,” Elena continues. “If my sense of smell told me I wouldn’t like it, I didn’t try it. If I touched it and didn’t like the texture under my fingers, I didn’t try it. If I didn’t like it after the first bite, I spat it out and didn’t force myself to eat further. I would try something new once a week, but only when I was alone.
“With my current discoveries, I eat the recommended amount of protein and fibre, as well as most vitamins and minerals. I take a daily multivitamin just in case.”
Now balancing what she perceives safe foods, Elena feels she has her ARFID under control – but doesn’t think it’s something she’ll ever be without.
“I now consider it another part of my life,” she explains. “It’s impossible to rewire my brain to perceive food differently.”
* Name has been changed
If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity, 365 days a year on 0808 801 0677 or beateatingdisorders.org.uk.
This article is not intended to be a substitute for professional medical advice or diagnosis. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Related StoryRelated StoryRelated Story
Kimberley Bond is a Multiplatform Writer for Harper’s Bazaar, focusing on the arts, culture, careers and lifestyle. She previously worked as a Features Writer for Cosmopolitan UK, and has bylines at The Telegraph, The Independent and British Vogue among countless others.
