ARFID Treatment Guide: Understanding and Addressing the Disorder

This blog was developed with insights from Amy Braverman, MS, LCMHC, Clinical Manager of The Emily Program’s Triangle Outpatient Center in Durham, NC; Kayla Warechowski, Registered Dietitian at our Douglas Residential Treatment Center in Durham, NC; and Sydney Brodeur-Johnson, PhD, LCP, CEDS, Senior Director of The Emily Program’s Clinical Services and Equity, Diversity, and Inclusion.

Most of us have specific food preferences. We might shy away from certain flavors, stick to familiar dishes, or avoid ingredients due to allergies. For many parents, navigating a child’s picky eating feels like a developmental rite of passage.

But what happens when your food preferences become so rigid or limited that they affect your physical or mental health? It might signal the presence of Avoidant/Restrictive Food Intake Disorder, commonly known as ARFID.

ARFID involves intense anxiety or aversion to food that can lead to serious health consequences. Unlike typical picky eating, ARFID can persist into adolescence and adulthood and requires specialized care.

The good news? ARFID is fully treatable, and recovery is possible. By understanding ARFID, you can debunk common myths, foster understanding, and find hope for recovery.

What is ARFID?

ARFID, or Avoidant/Restrictive Food Intake Disorder, is an eating disorder that leads someone to restrict the amount or variety of food they eat, or both. Unlike eating disorders such as anorexia or bulimia, people with ARFID don’t restrict their food intake because of concerns about their weight or body shape. Instead, ARFID stems from:

1. Sensory Sensitivities: Some individuals with ARFID are highly sensitive to how food looks, smells, tastes, or feels in their mouth. Even small changes in texture, temperature, or appearance can make eating feel impossible.
2. Fear of Adverse Consequences: Others avoid food due to intense fear of choking, vomiting, stomach pain, or allergic reactions.
3. Low Appetite or Interest: Some people with ARFID experience a lack of hunger or interest in food. Eating may feel like a chore, and they might even forget to eat.

“While some people identify with just one of these subtypes, others might experience a combination of all three,” explains Emily Program Dietitian Kayla Warechowski. Understanding these presentations helps providers develop targeted, individualized treatment plans.

What are the symptoms of ARFID?

ARFID symptoms vary widely but generally impact physical health, daily functioning, and emotional well-being. Here are some key signs to watch for:

Physical Symptoms

• Failure to grow or gain weight as expected (in children)
• Difficulty maintaining a healthy weight
• Frequent tiredness or weakness
• Nutritional deficiencies
• Gastrointestinal issues without a known medical cause
• Feeling full after eating small amounts

Behavioral Symptoms

• Reliance on a very limited range of “safe” foods
• Taking an unusually long time to finish meals
• Avoiding meals or “forgetting” to eat, especially when busy
• Following strict eating rituals (e.g., cutting food into tiny pieces)
• Avoiding social eating situations

Psychological Symptoms

• Intense anxiety around food and mealtimes
• Strong emotional reactions to changes in familiar foods
• Sensitivity to sensory aspects of food
• Fear of negative consequences like choking or stomach aches
• Distress when eating routines are disrupted

What sets ARFID apart from picky eating is the severity of these symptoms and their associated challenges. ARFID significantly disrupts overall well-being, relationships, and quality of life.

What causes ARFID, and who can have it?

Like all eating disorders, ARFID develops from a complex mix of biological, psychological, and social factors. While commonly associated with children, ARFID can affect people of all ages.

“ARFID can absolutely affect people all across the age spectrum,” says Warechowski. “It is a misconception that ARFID exclusively impacts children or that it’s something someone ‘will just grow out of.'”

Factors such as sensory processing challenges, trauma (like choking incidents), and high stress can trigger or worsen ARFID. Understanding ARFID as a mental health condition, not a choice or phase, underscores the need for a multidisciplinary team approach, which can address the condition’s biological, psychological, and social dimensions.

How is ARFID treatment different from other eating disorder treatment?

While treatments for conditions like anorexia or bulimia often include work on body acceptance and challenging diet culture beliefs, ARFID treatment focuses primarily on helping people feel more comfortable with food itself and building practical eating skills.

At The Emily Program, we use several specialized approaches, such as CBT-AR (Cognitive Behavioral Therapy for ARFID), body awareness work, and Food Discovery groups. CBT-AR is a therapy designed to address difficult thoughts and behaviors around food, while body awareness work encourages tapping into body sensations through mindfulness and calming techniques. 

Food Discovery

A cornerstone of ARFID treatment, Food Discovery is a form of exposure therapy that helps clients gradually expand their range of accepted foods. This process includes:

• Creating a personalized hierarchy of challenging foods and eating scenarios
• Learning to identify “safety behaviors” that might interfere with progress
• Using specific tools to track progress
• Setting exploratory, client-driven goals

“Food Discovery groups are the gold standard for increasing dietary variety amongst ARFID patients,” explains Warechowski. These sessions—guided by therapists and dietitians—are voluntary, exploratory, and highly individualized.

Treatment Goals

Clients work toward several key goals in ARFID treatment:

• Weight restoration and medical stabilization, including addressing nutritional deficiencies
• Expanding the variety and nutritional adequacy of accepted foods
• Developing regular, consistent eating patterns
• Reducing fears about eating (like fear of choking or getting sick)
• Building coping strategies for identifying and managing emotions
• Developing practical skills for everyday life

This holistic approach emphasizes practical progress with food, while providing the emotional and psychological support needed for lasting change.

What role do families play in ARFID treatment?

Family support can be a valuable part of ARFID recovery, though involvement varies based on age and personal preferences.

For children and adolescents, “family involvement is key for supporting behavior change and sustaining eating disorder recovery,” explains Emily Program Clinical Manager Amy Braverman. Research shows that clients often achieve better outcomes when families are actively involved. Families reinforce treatment strategies at home, creating a supportive environment for recovery.

At The Emily Program, families are engaged through:

• Practical education about ARFID
• Family therapy sessions
• Skills-building to support food discovery and recovery at home

“We aim to support families and caregivers to acquire the skills and education they need to support their loved one in completing food discoveries outside of program hours,” notes Dr. Sydney Brodeur Johnson, Senior Director of The Emily Program’s Clinical Services and Equity, Diversity, and Inclusion.

How is ARFID treatment adapted for neurodivergent clients?

ARFID frequently overlaps with forms of neurodivergence, including autism and ADHD. The Emily Program tailors treatment to meet neurodivergent clients’ unique needs, creating a safe and supportive environment that fosters healing.

Key adaptations include:

Clear Written Resources

• Detailed handouts for educational groups and therapy sessions
• Written overviews of what to expect in treatment
• Summaries of key topics and session goals to support auditory processing challenges

Flexible Meal Support

• Alternative supplement protocols to address nutritional needs
• Gradual approaches to expanding food variety
• Safe food alternatives to accommodate sensory sensitivities

Sensory Considerations

• Options for noise-canceling headphones, dim lighting, and calming fidgets
• Programming passes for self-regulation, allowing clients to step away as needed
• Flexibility to take breaks during sessions

Executive Function Support

• Practical strategies for meal planning, shopping, and preparation
• Help organizing daily food tasks

Integrating Special Interests

• Encouraging clients to share their interests with staff and peers
• Incorporating interests into mealtime tools and broader support plans

“Special interests and hyper-fixations are common among neurodivergent individuals and play a crucial role in fostering joy, fulfillment, and confidence,” explains Warechowski.

This individualized approach ensures that neurodivergent clients feel understood and supported. As Braverman notes, “Clinicians at The Emily Program do a wonderful job of learning about their patients and the intersection of all diagnoses, thereby better informing their treatment recommendations and interventions.”

Moving forward with hope

ARFID is a complex and often misunderstood eating disorder, but with proper treatment, recovery is possible for people of all ages. By understanding the unique challenges of ARFID and tailoring treatment to individual needs, The Emily Program empowers clients to build healthier relationships with food and reclaim their well-being.

If you, a loved one, or a patient is struggling with ARFID, know that help is available. Reach out to The Emily Program to learn more about how we can support you on the journey to recovery.

While ARFID may be lesser known than other eating disorders, it is equally as serious and worthy of treatment. If you or someone you know is struggling, please reach out to The Emily Program to begin recovery today. You can complete our online form or call us to discuss treatment options at 1-888-364-5977.