When people think of eating disorders, the most common ones that come to mind are probably Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. One that rarely comes to mind, however, is Avoidant/Restrictive Food Intake Disorder, or ARFID for short.
Far too often this diagnosis is missed, or labeled “just picky eating,” but it can have a real impact on someone’s health, nervous system regulation, and sense of autonomy. ARFID often involves sensory sensitivities, anxiety and a full body response that can make eating a difficult experience. So rather than expecting someone to “grow out of it,” what actually helps?
How ARFID feels
Living with ARFID can feel different depending on the sensitivity. People are often drawn to specific textures, tastes or smells, and have a list of “safe foods.” Certain foods can trigger gagging, nausea or even panic. For some, there’s a fear of choking or vomiting. For others, the difficulty is less about fear or sensory sensitivity and more about having very little appetite or interest in eating. Although these experiences can look different, each makes eating feel difficult or unimportant. In many cases, the nervous system responds to certain sensory cues or feared consequences as potentially unsafe. Weak or inconsistent hunger cues are common. These responses are not choices or signs of stubbornness, however.
Living with a limited list of safe foods can make everyday activities exhausting or anxiety provoking. Social situations, holidays, school cafeterias, and lunch at the office can cause panic and shame, overshadowing the normally healthy connection we have with our food and with each other when we share meals. The benefits of treatment extend beyond food because working with a therapist specialized in ARFID can help those living with it feel more liberated as they move through life.
ARFID can occur in anyone, although it commonly overlaps with neurodivergence. For some autistic people and people with ADHD, sensory processing differences, executive-functioning challenges, or difficulty recognizing hunger cues may shape their experience with food.
Starting with the Nervous System
Sometimes, jumping right into exposure with new foods is far too daunting for people with ARFID. This makes sense: asking a nervous system to try something new before it can regulate is overwhelming! Often, this makes starting with validation a good first step. What stands out to me about ARFID treatment is how important it is for a person to feel understood before they are asked to make a change.
ARFID is real, and not the fault of the individual struggling with it. Many people with ARFID have developed shame around eating behaviors and sensitivities. If you’re living with ARFID, please know that ARFID is your nervous system trying to protect you, and there is nothing “broken” about you.
ARFID treatment should start with sensory attunement. If the nervous system can’t settle, no new food will feel safe. So, before food is addressed, it can be helpful to start with nervous system regulation techniques. A predictable environment with calming tools like weighted blankets, fidgets or breathing cues can help make the space safer for addressing ARFID sensitivities.
Following that, it’s essential that autonomy is emphasized so those with ARFID know they have the choice to begin experimenting with new foods without pressure. I believe autonomy should remain central throughout ARFID treatment. Expanding someone’s choices around food should not come at the cost of making them feel pressured or powerless.
Starting with a texture or color that feels safe is a great first step in recovery work. The key here is consent-based care, which also honors that fear is protective. Some people with ARFID have a history of choking, vomiting, or feeling pressure around food. It is crucial that care honors those past experiences, and endeavors to make the therapy room a safer environment.
Building Towards Recovery
For many people with ARFID, taking a structured approach to trying new foods can, over time, reduce the stress around unfamiliar food. For example, one structured approach begins with starting a list of “always,” “sometimes,” and “not yet” foods. Starting with an easier “sometimes” food to determine whether it’s enjoyable can increase a sense of autonomy and motivation. Over time, more foods may move into the “always” category, creating more freedom around food choices.
Because ARFID can be driven by different experiences, treatment and recovery can look very different from one person to another. If a traumatic event provoked restricted food intake, taking a trauma-informed approach can be transformative. If low appetite is an issue, somatic approaches that help with interoception are helpful. Regardless of the cause, ARFID is not a choice, not a phase, and is no one’s fault. It deserves recognition, compassion, and flexibility around defining recovery. Recovery may not mean eating every food, but it can mean less anxiety, more freedom and more reliable nourishment.
Want to learn more? Check out Dr. Marianne Miller’s podcast episode on a more attuned approach to treatment.
