Latest article: Avoidant/Restrictive Food Intake Disorder (ARFID): An integrative clinical overview

Avoidant/restrictive food intake disorder (ARFID) was formally added to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), in 2013 to better identify individuals with severe eating restrictions unrelated to body image concerns. Diagnostic categories were further revised in the DSM-5-TR in 2022 to improve clinical specificity.^1-3

As detailed below, ARFID is more severe than picky or selective eating as it is associated with significant consequences on medical, developmental and psychosocial function.⁴ ARFID is typically classified into three subtypes or presentations, and while some individuals present with one subtype, others present with mixed symptoms.^1,2 Although the research is inconsistent, it is estimated that approximately half of ARFID patients exhibit symptoms of more than one subtype (Figure 1).⁵

1. Sensory-based avoidance: This is the avoidance of foods based on their sensory characteristics, such as taste, texture, smell, temperature and/or appearance. This can result in limited food intake, a preference for bland or “safe” foods, and the exclusion of entire food groups, such as fruits and vegetables. There is a general anxiety around eating, gagging and food neophobia (the fear of trying new foods). People with this subtype are more likely to co-present with autism spectrum disorder (ASD).

2. Fear of aversive consequences: Food restriction is driven by fear of adverse consequences associated with eating, such as choking, vomiting, or abdominal pain. Often, but not always, this is triggered by a choking episode, severe vomiting, food impaction, or painful gastrointestinal flare. This subtype is characterised by a fear of specific foods that carry aversive consequences. For example, patients may avoid meat due to a fear of choking. This subtype has the highest rate of co-occurring anxiety disorder and a higher preponderance in women.

3. Apparent lack of interest in eating/low appetite: This presentation is characterised by a persistent lack of appetite, early satiety, indifference toward food, or a low drive to eat. Such individuals will be slow eaters, have low hunger cues, have a low caloric intake, experience unintentional weight loss, and have a low hedonic response to food. This ARFID subtype has the lowest median body mass index and has been linked to the highest rates of attention deficit hyperactivity disorder (ADHD).^1-2