Avoidant/Restrictive Food Intake Disorder (ARFID)

ByEvelyn Attia, MD, Columbia University Medical Center;
B. Timothy Walsh, MD, College of Physicians and Surgeons, Columbia University
Reviewed/Revised Modified Aug 2025
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Avoidant/restrictive food intake disorder is a feeding/eating disorder characterized by eating very little food and/or avoiding eating certain foods. It does not include having a distorted body image (as occurs in anorexia nervosa) or being preoccupied with body image (as occurs in bulimia nervosa).

  • Avoidant/restrictive food intake disorder can cause substantial weight loss, slower-than-expected growth in children, difficulty participating in normal social activities, and sometimes dangerous nutritional deficiencies.

  • Doctors base the diagnosis on the nature of the restricted food intake and its effects after they have ruled out other causes of eating very little.

  • Cognitive behavioral therapy can help people learn to eat normally and help them feel less anxious about what they eat.

The exact cause of avoidant/restrictive food intake is unknown, but there may be genetic, psychological, and social factors involved (for example, trauma, anxiety, autism, and developmental disorders).

Avoidant/restrictive food intake disorder typically begins during childhood, usually between the ages of 11 and 13, and may initially resemble the picky eating that is common during this phase of life. For example, children may refuse to eat certain foods or foods of a certain color, consistency, or odor. However, picky eating typically involves only a few foods, and children who are picky eaters, unlike those with this disorder, have a normal appetite, eat enough food overall, and grow and develop normally.

People with avoidant/restrictive food intake may not eat because they lose interest in eating or because they think eating has harmful consequences.

Symptoms of ARFID

People with avoidant/restrictive food intake disorder eat very little and/or avoid eating certain foods. They may eat so little that they lose a substantial amount of weight. Children with the disorder may not grow as expected.

Nutritional deficiencies are common and may become life threatening.

Because of their problems with eating, people with this disorder may have difficulty participating in normal social activities, such as eating with other people and maintaining relationships with others.

Diagnosis of ARFID

  • A doctor's evaluation, based on standard psychiatric criteria (including evaluation for other mental illnesses)

  • Tests to check for general medical disorders

Doctors suspect avoidant/restrictive food intake disorder in people who avoid food or eat very little and have 1 or more of the following:

  • Significant weight loss or, in children, not growing as expected

  • A severe nutritional deficiency

  • The need for tube feeding or for nutritional supplements taken by mouth

  • Great difficulty participating in normal social activities and interacting with others

  • No evidence of a distorted body image

When people eat so little that they lose weight and develop nutritional deficiencies, doctors typically do tests for general medical disorders that can cause such problems. Such general medical disorders include food allergies, digestive tract disorders that impair food absorption (malabsorption), and cancer.

Doctors also consider other mental illnesses that sometimes lead to weight loss, such as other feeding and eating disorders (particularly anorexia nervosa), depression, and schizophrenia. Doctors do not diagnose avoidant/restrictive food intake disorder if people restrict their food intake because food is unavailable or is part of a cultural tradition (such as religious fasting).

Usually, doctors also do not diagnose avoidant/restrictive food intake disorder if they identify another disorder or a medical treatment (such as radiation therapy or chemotherapy) as the cause.

Treatment of ARFID

  • Cognitive behavioral therapy or family-based treatment

Cognitive behavioral therapy or family-based treatment may be used to help people with avoidant/restrictive food intake disorder learn to eat normally. Both can help them feel less anxious about what they eat.

More Information

The following is an English-language resource that may be useful. Please note that The Manual is not responsible for the content of this resource.

  1. National Eating Disorders Association (NEDA)

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