What Causes ARFID?Understanding Avoidant/Restrictive Food Intake Disorder (ARFID): Myths, Facts, Diagnosis, and Treatment

If your child has been labeled “extremely picky” or struggles to eat enough variety or volume, you may have come across the term ARFID — Avoidant/Restrictive Food Intake Disorder. Families often feel confused, worried, or even blamed when they hear this diagnosis. Let’s break down what ARFID really is, what doesn’t cause it, and how it can be recognized and supported

What is ARFID?

ARFID looks different for every child but has similar properties that can be recognized

ARFID is an eating disorder first formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‑5) in 2013. Unlike anorexia or bulimia, ARFID is not related to body image concerns or a fear of weight gain. Instead, it involves:

• A persistent failure to meet nutritional or energy needs

• Significant weight loss (or failure to gain expected weight)

• Nutritional deficiency

• Dependence on supplements, enteral feeding, or limited variety

• Interference with psychosocial functioning (e.g., anxiety, avoiding social meals)

What Causes ARFID?

ARFID is multi‑factorial — meaning there isn’t a single cause. Instead, it often develops through a combination of:

• Sensory sensitivities: Hypersensitivity to food textures, smells, appearance, or temperature.

• Fear‑based avoidance: After choking, vomiting, or a traumatic medical event related to eating.

• Lack of interest in food: Low appetite, fatigue, or reduced interoceptive awareness (difficulty recognizing hunger/fullness cues).

• Medical and developmental conditions: Prematurity, GI issues, food allergies, or autism spectrum disorder may increase risk.

These drivers can overlap; a child may have both sensory sensitivities and fear following a medical event

Myths vs. Facts about ARFID

Myth	Fact
ARFID is just extreme picky eating	ARFID is a recognized eating disorder that significantly impacts health, growth, and daily life
Children choose to “be difficult” about food	ARFID is driven by real fear, sensory distress, or medical trauma
ARFID always starts in teenage years	ARFID often starts in early childhood and can persist without treatment
Kids will “grow out of it”	Without support, ARFID can worsen over time and lead to medical complications or social isolation

At What Age is ARFID First Recognized?

• ARFID can emerge as early as toddlerhood or preschool (ages 2–5), especially when mealtime struggles are severe and persistent.

• Many children show restrictive eating earlier, but it becomes diagnosable when the behavior:

  • Leads to nutritional compromise

  • Impacts growth or weight gain

  • Interferes with participation in daily life (school, social activities)

Adolescents and adults can also receive a first‑time diagnosis, often when lifelong eating challenges are finally understood.

How is ARFID Diagnosed?

Diagnosis is typically made by:

• A qualified medical or mental health professional (pediatrician, psychologist, psychiatrist, or specialized feeding/eating disorder team)

• A thorough clinical history and interview, sometimes including standardized tools (e.g., PARDI-AR-Q)

• Assessments of growth, nutrition, medical history, and feeding behavior

Importantly, ARFID is diagnosed when food restriction is not explained by body image concerns, cultural practices, or other medical conditions alone.

What Are the Best Ways to Treat ARFID?

Evidence‑based treatment for ARFID is multi‑disciplinary, meaning several types of specialists may help:

• Feeding therapy (occupational therapist or speech‑language pathologist) to build oral motor skills, tolerance, and positive food exposure

• Cognitive‑behavioral therapy (CBT‑AR) to help reduce fear and anxiety around eating

• Dietitian support to address nutrient deficiencies and create realistic meal plans

• Medical care to monitor growth and manage underlying GI or allergy concerns

The overall goals are:

• Increasing nutritional adequacy and food variety

• Reducing fear, anxiety, or distress around food

• Supporting positive mealtime participation and social engagement

Children in the same family can have very different eating patterns

Bottom Line

ARFID isn’t caused by “bad parenting” or a child being stubborn. It’s a real, diagnosable eating disorder rooted in sensory, medical, or psychological factors — often several combined. With early recognition and the right team approach, children and families can see meaningful progress.