Understanding ARFID
A clear, evidence-based guide for adults
Prepared by
Dr Melissa Bujtor
HCPC Registered Dietitian · AfN Registered Nutritionist (RNutr)
Paediatric Feeding Specialist
If you have ARFID, have recently been diagnosed, or think ARFID may describe your experience of food and eating, understanding what is happening can be an important first step.
Perhaps food has always been difficult. Perhaps your eating changed following illness, choking, vomiting, pain or another experience. Or perhaps you have spent years finding ways to manage eating without ever having a name for why it feels different for you.
This guide explains what ARFID is, the different ways it can present, what it can mean for your health and everyday life, and what appropriate support can look like.
It provides general information, not a diagnosis. If you are wondering whether you have ARFID, an appropriate clinical assessment can help establish what is happening.
What ARFID means
ARFID stands for Avoidant/Restrictive Food Intake Disorder.
It is a recognised feeding and eating disorder in which someone avoids or restricts the amount or range of food they eat to the extent that there is a significant impact on their nutrition, physical health or everyday life.1,2
This might include:
- losing weight or difficulty maintaining weight;
- nutritional deficiency;
- relying on nutritional supplements or enteral feeding to meet nutritional needs;
- significant interference with everyday life, such as eating with other people, working, travelling, attending social occasions or eating away from home.1,2
Importantly, ARFID is not defined by how many foods you eat.
Someone can eat a relatively small range of foods without having ARFID. Equally, someone may eat a wider range but struggle to eat enough or experience significant nutritional or everyday consequences. It is the overall impact, considered alongside the nature of the restriction and your wider health and circumstances, that matters.
ARFID was introduced as a diagnosis in DSM-5 in 2013 and is also recognised within ICD-11.1,2 Although awareness is increasing, many adults have lived with restricted eating for years without recognising it as something for which they could seek support.
Understanding your experience of eating
ARFID does not look the same in everyone. Three commonly recognised presentations help us understand what may contribute to restricted intake.3 You may recognise one or a combination of these.
i
Sensory differences around food
Particular textures, tastes, smells, temperatures, appearances or combinations of foods may be uncomfortable, overwhelming or difficult to manage.
You might rely on particular foods, brands, textures, preparation methods or ways of presenting food because they make eating more predictable or accessible.
These sensory needs are not simply a matter of being unwilling to try something different. Understanding what makes a food accessible or inaccessible to you can be more useful than labelling foods as things you like or dislike.
ii
Low interest in eating or food
You may experience little appetite or interest in food.
Eating might feel like something you have to remember to do rather than something your body readily prompts you towards. You may become full quickly, find eating effortful, or experience hunger cues that are less noticeable.
For some people, the difficulty is not which foods they can eat but eating enough of them, often enough.
iii
Concern about what might happen when eating
You may avoid or restrict food because you are concerned about something happening when you eat — such as choking, vomiting, pain or another frightening or uncomfortable consequence.
Sometimes there is a clear starting point, such as a choking episode, illness or period of gastrointestinal symptoms. For others, there is no single identifiable event.
Avoidance can become a way of trying to prevent that experience from happening.
These presentations are useful ways of understanding ARFID, but you do not need to fit neatly into one category. A good assessment should look beyond the diagnostic label to understand what eating is actually like for you.
Is restricted eating always ARFID?
No.
People eat differently for many reasons. Having a limited food range, strong preferences, sensory differences, little interest in food or needing foods prepared in particular ways does not automatically mean you have an eating disorder.
ARFID is diagnosed when avoidant or restrictive eating meets particular diagnostic criteria and has a significant nutritional, physical or psychosocial impact.1,2
That is why the important question is not simply “How many foods do I eat?” — it is also:
“What impact is eating having on my health and my life?”
What about body image?
ARFID differs diagnostically from eating disorders in which restriction is driven by concerns about weight or body shape.1,2
Having ARFID does not mean that you cannot have thoughts or feelings about your body. People with ARFID live in the same world as everyone else and can experience body dissatisfaction or concerns about weight and appearance.
The important distinction is that these concerns are not what is driving the avoidant or restrictive eating that characterises ARFID.
This distinction can sometimes be complex, particularly where different eating difficulties coexist, which is one reason a thorough assessment matters.
What ARFID is not
ARFID is still frequently misunderstood. It is:
- not simply being difficult or awkward about food;
- not evidence that you lack willpower;
- not defined by wanting to lose weight or change your body shape;
- not something that can necessarily be resolved by becoming hungry enough;
- not something that can necessarily be overcome by forcing yourself to “just try” foods;
- not something another person can identify simply by looking at your body size.
You may have developed considerable skill in organising your life around foods that are accessible to you. You may know exactly where you can eat, which brands work, what to take when travelling, how to navigate restaurants, or how to avoid situations involving food.
Those strategies can be genuinely useful adaptations.
At the same time, needing extensive planning — or having fewer and fewer options available — can sometimes place a considerable burden on everyday life. Both things can be true.
Who can experience ARFID?
ARFID can affect people of any age. For some adults, similar eating patterns have been present since early childhood. For others, restriction develops later.
ARFID can also occur across the weight spectrum. You do not need to be underweight to have ARFID or to experience nutritional consequences from restricted eating. It is possible to consume enough energy to maintain a higher or stable body weight while still having inadequate intake of particular nutrients.
ARFID also commonly co-occurs with neurodevelopmental differences, including autism and ADHD. Research examining autism specifically has found substantial co-occurrence between autism and ARFID.4
The relationship is complex and should not be reduced to sensory processing alone. Sensory differences may be relevant, alongside appetite and interoception, attention, predictability, anxiety, executive functioning, previous feeding experiences and other individual factors.
Being autistic or having ADHD does not mean you necessarily have ARFID, and having ARFID does not mean you are necessarily neurodivergent. Where neurodevelopmental differences are part of your experience, support should recognise and accommodate your individual sensory, communication, regulatory and other needs.
Why does ARFID happen?
There is no single cause of ARFID.
Current understanding suggests that ARFID can develop through a complex interaction of biological, psychological, developmental and environmental factors, with a different combination being relevant for different people.3 These may include:
For some people, there is a clear history that helps explain how eating became difficult. For others, there is no single identifiable starting point.
You do not need to find one event that “caused” your ARFID in order for your experience to be valid or for support to be useful.
What can help?
There is no single approach that is right for every adult with ARFID. Good support begins by understanding your health, your experience of food and what matters to you.
It may include:
- A comprehensive assessment of your eating history, nutritional intake, physical health and the factors contributing to restriction.
- Supporting nutrition and physical health by making the most of foods that are already accessible to you, and using supplementation or other nutritional support where appropriate.
- Making eating more manageable, including practical strategies for eating regularly or adequately when appetite or interest is low.
- Understanding and accommodating sensory needs, including the characteristics and environments that make eating more or less accessible.
- Supporting food range or flexibility where this is useful to you, using an approach appropriate to the reasons particular foods are difficult.
- Addressing fear or anxiety where this contributes to restriction.
- Assessing feeding or swallowing skills where there are concerns.
- Making appropriate accommodations rather than assuming every difference needs to be changed.
- Working with a wider team where needed — which might include a dietitian, psychologist or other mental health professional, GP, gastroenterologist, speech and language therapist, occupational therapist or another specialist.
You should understand why something is being recommended, and have a meaningful say in what you are working towards.
Does having ARFID mean I have to change the way I eat?
Not simply because your eating looks different from somebody else’s. Eating differently is not, by itself, something that needs correcting.
The more useful questions are:
For some people, increasing food range will be an important part of support. For another person, the priority might be meeting nutritional needs with existing foods, eating more consistently, reducing fear, finding useful accommodations, managing travel or social situations, or having greater flexibility when a particular food is unavailable.
The aim is not to make your eating look more “normal”.
It is to identify what would make a meaningful difference to your nutrition, health, wellbeing and life.
What might meaningful change look like?
There is no single measure. It could mean:
- meeting your nutritional needs more reliably;
- having enough energy for everyday life;
- being able to eat more consistently;
- reducing anxiety or distress around eating;
- finding foods or supplements that address a nutritional gap;
- managing when a familiar product changes or becomes unavailable;
- making travel easier;
- being able to participate in social situations that matter to you;
- understanding and communicating your needs more confidently;
- finding accommodations that make eating more accessible;
- increasing flexibility or food range where this is useful to you.
You do not need to eat everything. You do not need to enjoy every food.
And you do not need to make your eating indistinguishable from everybody else’s for support to have been worthwhile.
When should I seek advice?
Consider seeking professional advice if your eating is affecting your nutritional intake, physical health or everyday life — or if you simply want to better understand what is happening.
You do not need to be certain that you have ARFID before asking for help.
Seek prompt medical assessment
Some signs require more prompt medical assessment, including:
- a significant or rapid reduction in food or fluid intake;
- unintentional weight loss;
- dehydration;
- fainting;
- unusual weakness or lethargy;
- persistent vomiting;
- significant pain associated with eating;
- coughing or choking when eating or drinking;
- difficulty swallowing;
- other concerns about your physical health.
If you are acutely unwell, seek appropriate urgent medical care.
A word about language
If you have spent years being described as “fussy”, “picky”, “difficult” or “awkward” around food, those words may have shaped how you think about your own eating.
They describe what eating looks like to somebody else. They do not necessarily explain what eating feels like to you.
More useful questions are:
A diagnosis of ARFID is not a judgement about you.
Used appropriately, it can provide a shared way of understanding a significant eating difficulty and help identify what support you may need.
Wondering whether you may have ARFID?
You do not need to work this out before asking for help.
If your food range or intake is restricted, you are concerned about whether you are meeting your nutritional needs, or eating is having a significant impact on your everyday life, an assessment can help establish what is happening.
At Dr Melissa Bujtor Specialist Dietetic Practice, adult ARFID assessment looks beyond the number of foods you eat. We consider nutritional adequacy, physical health, sensory experiences, appetite and interoception, eating history, medical and gastrointestinal factors, feeding skills and the impact eating has on your everyday life.
Whether you already have an ARFID diagnosis or are wondering whether ARFID might explain your experience of eating, support is tailored to you, your needs and what you would like help with.
If you would like to discuss ARFID assessment or support, get in touch.
Enquire about ARFID assessment and support
Written by Dr Melissa Bujtor, HCPC Registered Dietitian, AfN Registered Nutritionist (RNutr) and Feeding Specialist, for Dr Melissa Bujtor Specialist Dietetic Practice. This guide provides general information and is not a substitute for individual clinical assessment or advice.
References
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5-TR. 5th ed, text rev. Washington, DC: American Psychiatric Association Publishing; 2022.
- World Health Organization. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Geneva: World Health Organization; 2024.
- Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment. Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5.
- Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, et al. The co-occurrence of autism and avoidant/restrictive food intake disorder (ARFID): a prevalence-based meta-analysis. Int J Eat Disord. 2025;58(3):473–488. doi:10.1002/eat.24369.
Written by Dr Melissa Bujtor, HCPC Registered Dietitian, AfN Registered Nutritionist (RNutr) and Feeding Specialist, for Dr Melissa Bujtor Specialist Dietetic Practice. This guide provides general information and is not a substitute for individual clinical assessment or advice.
About the author
Dr Melissa Bujtor
A HCPC Registered Dietitian and AfN Registered Nutritionist with specialist expertise in paediatric dietetics, feeding development and eating disorders.
Dr Bujtor also holds a British Psychological Society-accredited Master’s degree in Psychology, bringing an understanding of behaviour, cognition and emotional development to her clinical work with children and young people.
She is a published scientist whose work spans research, policy and advocacy, and serves on the Board of Trustees of The Feeding Trust, helping to connect research, policy and clinical practice to improve outcomes for children, young people and families.
Her clinical practice combines evidence-based dietetics with a developmental understanding of feeding — looking beyond what a child eats to understand the factors that may be contributing to their difficulties.
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