ARFID, The Growing Eating Disorder Affecting Children

Avoidant/Restrictive Food Intake Disorder (ARFID) is far from just picky eating.

And unlike anorexia or bulimia, which are rooted in body dysmorphia, ARFID’s sufferers don’t seem to be motivated by a desire to lose weight or alter their appearance. Rather, they’re averse to the actual food, often due to deep anxiety, sensory issues, or fear of eating-related distress, like choking or vomiting. One mom, Briana, told Scientific American that her daughter, Stella, suddenly stopped eating solid foods at eight years old. “She said she had a fear of choking.” Within weeks, Stella grew so malnourished she required hospitalization and a feeding tube.

Stella’s experience mirrors that of many ARFID patients, who are diagnosed, on average, at age 11. Left untreated, the condition can cause developmental delays, malnutrition,dangerous low weight, as well as muscle and hair loss in youth; adults might also notice low testosterone, irregular menstrual cycles, and other physical complications. Signs that a loved one may be struggling with ARFID include noticeable weight loss, gut issues, low body temperature, and the appearance of lanugo, the soft, fine body hair that typically disappears by infancy. Other symptoms include a lack of appetite, difficulty paying attention, food texture avoidance, extreme selective eating, and a fear of vomiting or choking.

Scientists don’t yet know what causes the disorder, but they suspect it’s down to a combination of genetic, environmental, and neurobiological factors.

It’s only been recognized in the DSM since 2013, and data on the true number of ARFID cases remains sparse. Still, current studies suggest ARFID’s global prevalence may be as high as three percent across all age groups – a figure that is on the rise as more physicians and scientists become aware of the condition. In the US, ARFID represents up to 15% of all new eating disorder cases, with roughly 20 to 30% of cases occurring in boys. 

More research will help us develop a better understanding of ARFID’s causes as well as effective treatments for it –  for now, cognitive-behavioral therapy (CBT) shows the most promise. In one 2020 study, 70 percent of patients no longer met ARFID diagnostic criteria after extended CBT, which involved education around the condition and exposure or practice for patients.

For children, treatments generally rely on parents: After Stella’s month-long hospitalization, her parents followed strict guidance: at home, she had to eat what the family ate, was made to take at least some small bites at restaurants, gradually retraining her mind and body to accept solid food. After months of hard work, her normal eating habits returned.