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Avoidant/Restrictive Food Intake Disorder (ARFID)

What is ARFID and what does it stand for? What is the prevalence of ARFID? What are the risk factors and co-occuring problems? ARFID researchers Katarzyna Brimo and Helena Holmäng provide an overview of this diagnosis.

What is ARFID?

Avoidant/Restrictive Food Intake Disorder (ARFID) is characterised by a persistent limitation in the amount and/or variety of food consumed, resulting in significant physical and/or psychoscial consequences. The diagnosis was introduced in the DSM-5 in 2013 and in the ICD-11 in 2022; however, the condition itself is not new. Prior to the inclusion of ARFID as a distinct diagnosis, individuals with these types of eating difficulties were often classified under other diagnoses or described using non-official terms, including anorexia nervosa, unspecified eating disorder, selective eating, and food refusal. The introduction of ARFID enabled a more unified and age-neutral diagnostic framework, with clearer differentiation from other eating disorders.

To meet diagnostic criteria for ARFID, the restricted food intake must lead to at least one of the following:

Significant weight loss (or, in children, failure to achieve expected weight gain or faltering growth),
Significant nutritional deficiency,
Dependence on enteral feeding or oral nutritional supplements, and/or
Marked interference with psychosocial functioning.

In addition, the eating problem must not be better explained by lack of available food, culturally sanctioned practices, or a concurrent medical or mental condition, and must not occur exclusively in the context of anorexia nervosa or bulimia nervosa. Unlike these eating disorders, ARFID is not characterised by fear of weight gain or body image disturbance. Instead, the condition is typically driven by one or more of the following:

Sensory sensitivity, where specific sensory characteristics such as taste, texture, smell, or appearance evoke strong aversion;
Limited interest in eating or low appetite; or
Fear of aversive consequences of eating, such as vomiting or choking.

These profiles may occur independently or in combination and may change over time. For example, younger children with ARFID often present with both sensory sensitivity and limited interest in eating, which is associated with longstanding difficulties. Fear of aversive consequences of eating more commonly emerges later in childhood, adolescence, or adulthood and is generally associated with a more acute onset.

Authors

Prevalence

Knowledge about the prevalence of ARFID in the general population remains limited. This is partly due to variation in study design, age groups, and samples (clinical versus population-based studies), as well as differences in how ARFID is identified and diagnosed across settings. As a result, reported prevalence rates vary widely, ranging from low to very high estimates in certain clinical populations. However, pooled findings from larger population-based studies and meta-analyses suggest that ARFID affects approximately 1–5% of children and adults.

ARFID can occur at any age, but the condition is most often identified during childhood and appears to affect girls and boys at similar rates. Furthermore, ARFID occurs across the full weight spectrum; individuals with the diagnosis may have low, normal, or high body weight.

Risk factors and co-occurring problems

The development of ARFID is not yet fully understood. Available research suggests that multiple biological, psychological, and medical factors may be associated with the condition, both as potential risk factors and as comorbidities.

Early medical factors may increase the risk of ARFID, including preterm birth, low birth weight, neonatal intensive care, prolonged gastrointestinal problems (e.g., reflux, colic, or constipation), as well as early feeding difficulties and challenges during the introduction of solid foods.

Overlap with other syndrome is common in ARFID and includes both psychiatric and medical conditions. Neurodevelopmental conditions such as autism spectrum disorder and attention-deficit/hyperactivity disorder are more prevalent among individuals with ARFID than in the general population. In these contexts, sensory sensitivity, reduced flexibility, and difficulties with appetite regulation may contribute both to vulnerability and to the maintenance of eating difficulties.

Anxiety disorders, including generalised anxiety disorder and social anxiety disorder, are also common. Obsessive-compulsive disorder has been reported at elevated rates in individuals with ARFID and may manifest as ritualised eating behaviours or rigid rules around food intake, without any association with weight or body image concerns.

In addition to psychiatric associated problems, several medical conditions affecting eating, swallowing, or gastrointestinal functioning are frequently observed. Examples include gastroesophageal reflux disease, functional gastrointestinal disorders such as irritable bowel syndrome, constipation, food allergies, and oral-motor difficulties. In some cases, these conditions may act as precipitating or maintaining factors, while in others they may develop secondary to long-standing restrictive food intake.

Overall, co-existence with other disorders often contributes to a more complex clinical presentation and may influence both severity and treatment course. This highlights the importance of thorough clinical assessment and a multidisciplinary approach to the evaluation and interventions in ARFID.