ARFID Diagnosis in Adults: Understanding and Identifying Avoidant/Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder (ARFID) is recognized as a serious eating disorder that can affect individuals of any age. While often associated with childhood and adolescence, Arfid Diagnosis In Adults is increasingly important as awareness grows and understanding of this condition deepens. This article provides a comprehensive overview of ARFID in adults, drawing on the latest research and clinical insights to help identify, understand, and seek appropriate support for this complex disorder.

Prevalence of ARFID in Adults

Eating disorders are not limited by age, and ARFID is no exception. While data specifically focusing on ARFID diagnosis in adults is still developing, studies indicate that ARFID is present across the lifespan. It’s estimated that over 1.1 million Australians experience an eating disorder, highlighting the significant scale of these conditions (1).

Recent reports indicate that ARFID prevalence was around 0.13% in 2023, but this figure is likely an underestimation due to the relatively recent inclusion of ARFID in diagnostic manuals (DSM-5 in 2013) and the ongoing research in this area (1). Notably, an Australian study reported a 0.3% frequency of ARFID among adults aged 15 and older (4). This suggests that ARFID diagnosis in adults is not uncommon and warrants greater attention.

It’s crucial to understand that eating disorders, including ARFID, are serious mental illnesses, not lifestyle choices. They can profoundly impact physical, emotional, and social well-being. Early ARFID diagnosis in adults is paramount, as timely intervention significantly improves the potential for recovery and enhances quality of life.

Figure 1. Breakdown of eating disorder prevalence by diagnosis, highlighting the relevance of ARFID diagnosis and awareness among adults.

Understanding ARFID in Adults: Beyond “Picky Eating”

ARFID in adults is characterized by the avoidance or restriction of food intake, but crucially, this is not driven by concerns about body shape or weight. This distinction is vital in differentiating ARFID from other eating disorders like anorexia nervosa.

Adults with ARFID may severely limit the amount or variety of food they consume due to:

Sensory Sensitivities: Heightened sensitivity to the texture, taste, smell, or appearance of certain foods. This can lead to the avoidance of entire food groups or textures.
Fear of Aversive Consequences: Anxiety or phobia related to eating, such as fear of choking, vomiting, allergic reactions, or gastrointestinal distress.
Lack of Interest in Eating: Genuine low appetite or a lack of interest in food, which is not linked to a desire to lose weight or body image concerns.

It’s essential to distinguish ARFID from typical “picky eating” in adults. While some adults may have food preferences, ARFID involves a much more extreme and impactful level of avoidance or restriction. ARFID diagnosis in adults is considered when these eating patterns lead to significant nutritional deficiencies, weight loss, or impaired psychosocial functioning. The avoidance becomes clinically significant when it compromises their ability to meet energy and nutritional needs.

Key Characteristics of ARFID in Adults

Recognizing the characteristics of ARFID is crucial for timely ARFID diagnosis in adults. The core features revolve around eating disturbances and their related complications:

Eating Disturbance Patterns

Adults experiencing ARFID will exhibit food avoidance and/or restriction stemming from one or more of these factors:

Restriction: Demonstrating limited interest in food or eating, often eating very small portions or skipping meals without compensatory eating later.
Avoidance: Steering clear of specific foods based on their sensory attributes. For example, avoiding all soft foods, crunchy foods, or foods of a particular color.
Aversion: Experiencing fear or phobia related to negative outcomes from eating. This could manifest as refusing to eat in public due to fear of vomiting or avoiding certain textures due to choking anxieties.

Complications Arising from ARFID

The restricted eating patterns in ARFID can lead to a range of serious complications, impacting physical and psychological health:

Weight Loss and Nutritional Deficiencies: Significant unintentional weight loss or, in younger adults still developing, failure to gain weight as expected. However, it’s important to note that ARFID can occur in adults at any weight, and not all individuals with ARFID are underweight. Nutritional deficiencies are common due to limited food variety, affecting essential vitamin and mineral intake.
Dependence on Enteral Feeding: In severe cases, individuals may require feeding tubes (enteral feeding) to ensure adequate nutrition intake, delivered through the nose, stomach, or intestines.
Psychosocial Impairment: ARFID can severely disrupt daily life. Difficulties eating with others, limited food choices when eating out, and prolonged mealtimes can interfere with work, social activities, and relationships. This psychosocial impact is a significant indicator for ARFID diagnosis in adults.

ARFID Diagnosis in Adults: Differentiation from Other Disorders

When considering ARFID diagnosis in adults, it’s vital to differentiate it from other eating disorders and medical or mental health conditions.

ARFID vs. Anorexia Nervosa: While both ARFID and anorexia nervosa can involve severe food restriction and similar medical consequences, the underlying motivation differs drastically. Individuals with anorexia nervosa restrict food intake due to an intense fear of weight gain and body image distortion. In contrast, adults with ARFID restrict food for reasons unrelated to weight or shape concerns, such as sensory sensitivities or fear of adverse consequences. This distinction is fundamental in ARFID diagnosis in adults.

Excluding Other Conditions: A thorough assessment for ARFID diagnosis in adults must rule out other potential causes for eating disturbances. This includes:

Medical Conditions: Ensuring that the eating issues are not better explained by gastrointestinal disorders, allergies, or other medical conditions that could impact appetite or food tolerance.
Other Mental Disorders: Confirming that the eating disturbance is not primarily a symptom of another mental health condition, although ARFID can co-occur with other conditions like anxiety or autism.

ARFID and Co-occurring Conditions in Adults

ARFID in adults can exist independently or alongside other conditions. It is increasingly recognized that ARFID frequently co-occurs with:

Autism Spectrum Disorder (ASD): Sensory sensitivities are common in autism, which can significantly contribute to ARFID. Studies suggest that a substantial proportion of individuals with autism also meet criteria for ARFID (7).
Attention-Deficit/Hyperactivity Disorder (ADHD): Research indicates a notable overlap between ADHD and ARFID (8). Impulsivity, sensory sensitivities, and difficulties with planning and organization related to ADHD may contribute to ARFID behaviors.
Anxiety Disorders: Anxiety, particularly related to food or eating, is a significant factor in ARFID. Fear of choking, vomiting, or experiencing adverse reactions to food can drive avoidance and restriction.

Understanding these co-occurring conditions is crucial for comprehensive ARFID diagnosis in adults and for tailoring effective treatment approaches.

Risk Factors for ARFID in Adults

The development of ARFID in adults is complex and multifactorial, involving a combination of biological, psychological, and sociocultural factors. It’s important to remember that anyone, at any age, can be vulnerable to developing an eating disorder like ARFID. It is not a matter of choice but a serious mental health condition.

While specific risk factors for ARFID in adults are still being researched, potential contributing factors may include:

Pre-existing Anxiety or Phobias: Individuals with a history of anxiety disorders, particularly phobias related to food or eating, may be at increased risk.
Sensory Processing Sensitivities: Adults with heightened sensory sensitivities, which may be related to conditions like autism or ADHD, can be more susceptible to ARFID.
Negative Experiences with Food: Past experiences like choking, vomiting, or allergic reactions can trigger food aversions and contribute to ARFID development.
Gastrointestinal Issues: While ARFID is not caused by gastrointestinal problems, experiencing GI distress or conditions that impact appetite can sometimes be a contributing factor.

Recognizing Warning Signs of ARFID in Adults

Early detection of ARFID is crucial for effective intervention. Recognizing the warning signs across physical, psychological, and behavioral domains is essential for seeking timely ARFID diagnosis in adults.

Physical Warning Signs

Unexplained weight loss or difficulty maintaining a healthy weight.
Reduced appetite or complaints of feeling full quickly.
Signs of nutritional deficiencies, such as brittle nails, dry hair, hair loss, fatigue, or weakness.
Delayed growth (in younger adults still developing) or failure to gain weight as expected.
Gastrointestinal issues or complaints related to digestion.

Psychological Warning Signs

Increased anxiety or distress related to food and mealtimes.
Avoidance of social situations involving food.
Difficulty concentrating or reduced cognitive function, potentially due to nutritional deficiencies.
Expressed fears about choking, vomiting, or eating certain foods.

Behavioral Warning Signs

Decreased interest in food and eating.
Refusal to eat certain foods or food groups, or a significant reduction in dietary variety.
Eating very slowly or taking an unusually long time to finish meals.
Cutting food into very small pieces or engaging in unusual eating rituals.
Difficulty eating meals with others or avoiding eating in social settings.
Consistently eating only a very limited range of “safe” foods.

It is crucial to act promptly if you or someone you know exhibits these warning signs. “Watch and wait” is never advised when an eating disorder is suspected. Seeking professional support is the first and most important step.

Impacts and Complications of Untreated ARFID in Adults

If left undiagnosed and untreated, ARFID in adults can lead to serious medical and psychological consequences.

Medical Complications

Nutritional deficiencies and inadequate calorie intake can severely impact bodily functions, leading to:

Cardiovascular Problems: Heart irregularities, weakened heart muscle, and other cardiac issues.
Osteoporosis: Reduced bone density due to nutritional deficiencies, increasing the risk of fractures.
Severe Nutritional Deficiencies: Including anemia (iron deficiency), vitamin deficiencies (e.g., vitamin A, vitamin C), and electrolyte imbalances.
Malnutrition: Characterized by fatigue, muscle weakness, brittle nails, hair loss, impaired immune function, and cognitive difficulties.
Growth Failure and Stunted Growth: Particularly concerning in adolescents and young adults whose bodies are still developing.
Kidney and Liver Damage: Due to metabolic stress and nutritional imbalances.
Gastrointestinal Problems: Disrupted digestive function and motility issues.
Low Blood Sugar (Hypoglycemia).

Psychological Impacts

ARFID can also significantly affect mental and emotional well-being:

Anxiety and Depression: Increased risk of developing or exacerbating anxiety and depressive disorders.
Social Anxiety and Withdrawal: Avoiding social events and withdrawing from relationships due to eating difficulties.
Low Self-Esteem and Body Image Issues: While not the primary driver of ARFID, negative self-perception can develop as a consequence of the eating disorder and its impact on daily life.

Treatment Options for ARFID Diagnosis in Adults

ARFID diagnosis in adults is relatively recent, and research on optimal treatment approaches is ongoing. However, evidence-based therapies are available and effective, particularly when treatment is initiated early. The goals of ARFID treatment are tailored to address the specific underlying causes of food avoidance for each individual.

Cognitive Behavioral Therapy (CBT): CBT is currently considered a leading evidence-based treatment for ARFID (2). Therapy may involve gradual exposure to feared foods, relaxation techniques to manage anxiety around eating, and strategies to modify unhelpful eating behaviors.
Responsive Feeding Therapy (RFT) Principles: While initially developed for children, the principles of RFT can be adapted for adolescents and adults (6). This approach focuses on creating positive mealtime environments, addressing sensory sensitivities, and promoting a healthy relationship with food.
Nutritional Counseling and Support: Working with a registered dietitian experienced in eating disorders is crucial to address nutritional deficiencies, develop a balanced eating plan, and gradually expand food variety.
Medical Monitoring: Regular medical check-ups are essential to monitor physical health and address any medical complications arising from ARFID.
Medication: There are no specific medications to treat ARFID directly (2). However, if co-occurring anxiety or depression is present, medication may be helpful in managing these symptoms as part of a comprehensive treatment plan.

In cases of severe medical instability due to ARFID, hospitalization may be necessary to provide nutritional rehabilitation and address acute medical risks. However, most individuals with ARFID can recover with community-based treatment involving a multidisciplinary team. A minimum treatment team typically includes a general practitioner (GP) and a mental health professional.

Recovery from ARFID is Possible

Recovery from ARFID in adults is absolutely achievable, even for those who have struggled with the disorder for many years. The recovery journey can be challenging and require commitment, but with the right support and treatment team, lasting recovery is within reach. Many individuals find that overcoming ARFID leads to personal growth, increased self-understanding, and valuable coping skills.

Seeking Help for ARFID Diagnosis in Adults

If you suspect that you or someone you know may have ARFID, seeking professional help is critical. Early intervention significantly improves the chances of successful recovery. Your first step should be to consult with your General Practitioner (GP), who can provide initial assessment and referral to specialized eating disorder services.

For further support and resources, you can visit NEDC Support and Services to find qualified mental health professionals and dietitians specializing in eating disorders in your area. You can also contact the National Butterfly Helpline for confidential support and guidance.

Download the ARFID fact sheet here.

References

Butterfly Foundation. Paying the Price, Second Edition. The economic and social impact of eating disorders in Australia: Deloitte Access Economics; 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. Current psychiatry reports. 2017;19(8):1-9.
Norris ML, Spettigue WJ, Katzman DK. Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth. Neuropsychiatric disease and treatment. 2016;12:213.
Hay P, Mitchison D, Collado AEL, González-Chica DA, Stocks N, Touyz S. Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population. Journal of eating disorders. 2017;5(1):1-10.
Dovey TM, Kumari V, Blissett J. Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (ARFID), autistic spectrum disorders or picky eating: Same or different? European Psychiatry. 2019;61:56-62.
Wong G, Rowel K. Understanding ARFID Part II: Responsive Feeding and Treatment Approaches National Eating Disorder Information Centre – Bulletin. 2018;33(4).
Koomar T, Thomas TR, Pottschmidt NR, Lutter M, Michaelson JJ. Estimating the Prevalence and Genetic Risk Mechanisms of ARFID in a Large Autism Cohort. Front Psychiatry. 2021 Jun 9;12:668297.
Kambanis PE, Kuhnle MC, Wons OB, Jo JH, Keshishian AC, Hauser K, Becker KR, Franko DL, Misra M, Micali N, Lawson EA, Eddy KT, Thomas JJ. Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder. Int J Eat Disord. 2020 Feb;53(2):256-265.