‘I Would Call This the Silent Eating Disorder’: What Experts Want You to Know About ARFID

‘I Would Call This the Silent Eating Disorder’: What Experts Want You to Know About ARFID

‘I Would Call This the Silent Eating Disorder’: What Experts Want You to Know About ARFID

In the realm of eating disorders, certain conditions receive significant attention and awareness, such as anorexia nervosa and bulimia nervosa. However, a less known but equally impactful disorder exists, often escaping the public’s eye: Avoidant/Restrictive Food Intake Disorder (ARFID). This condition is shrouded in silence, making it challenging to diagnose and understand. Experts frequently refer to it as a “silent eating disorder” due to its subtle but profound impact on individuals’ lives. I would call this the silent eating disorder’: What experts want you to know about ARFID is crucial in shedding light on this underrecognized and misunderstood condition.

Understanding ARFID

Definition and Diagnostic Criteria

Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by an avoidance of certain foods or a restrictive food intake that leads to nutritional deficiencies, significant weight loss, or an inability to meet appropriate nutritional and energy needs. Unlike other eating disorders, ARFID is not driven by body image concerns or a desire to lose weight. Instead, it stems from a variety of other factors, including sensory sensitivities, fear of choking or vomiting, and a lack of interest in eating.

The diagnostic criteria for ARFID, as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), include:

  1. Avoidance or restriction of food intake leading to significant weight loss, nutritional deficiency, dependence on enteral feeding or oral nutritional supplements, or marked interference with psychosocial functioning.
  2. The behavior is not better explained by a lack of available food or by an associated culturally sanctioned practice.
  3. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way one’s body weight or shape is experienced.
  4. The eating disturbance is not attributable to a concurrent medical condition or better explained by another mental disorder.

Differentiating ARFID from Other Eating Disorders

One of the most significant challenges in diagnosing ARFID is differentiating it from other eating disorders. Unlike anorexia or bulimia, individuals with ARFID do not have a distorted body image or an intense fear of gaining weight. Instead, their food avoidance is often rooted in genuine fears or aversions related to the sensory aspects of food or negative experiences associated with eating.

Prevalence and Demographics

ARFID can affect individuals of all ages, but it is most commonly diagnosed in children and adolescents. It is estimated that ARFID affects approximately 3-5% of the general population, making it more common than some might realize. However, due to its subtle presentation, many cases go undiagnosed or are mistaken for other conditions such as picky eating or anxiety disorders.

Causes and Risk Factors

Sensory Sensitivities

One of the primary causes of ARFID is sensory sensitivities. Many individuals with ARFID have heightened sensitivity to the taste, texture, smell, or appearance of certain foods. This can lead to an aversion to specific food groups or a preference for foods with particular sensory characteristics, such as crunchy or bland foods.

Traumatic Experiences

Traumatic experiences related to eating, such as choking, vomiting, or severe gastrointestinal distress, can also trigger ARFID. Individuals who have experienced such events may develop a fear of eating or certain foods, leading to avoidance and restrictive eating behaviors.

Lack of Interest in Food

Some individuals with ARFID simply lack interest in food or eating. This lack of interest may stem from a variety of factors, including genetic predisposition, developmental delays, or underlying medical conditions.

Psychological Factors

Psychological factors, such as anxiety or obsessive-compulsive tendencies, can contribute to the development of ARFID. For some individuals, eating can become a source of significant anxiety, leading to avoidance and restriction of food intake.

Signs and Symptoms

Physical Symptoms

  • Significant weight loss or failure to gain weight in children and adolescents.
  • Nutritional deficiencies leading to symptoms such as anemia, fatigue, and weakened immune function.
  • Dependence on nutritional supplements or enteral feeding to meet caloric and nutritional needs.
  • Gastrointestinal issues such as constipation, bloating, and abdominal pain due to limited dietary variety.

Behavioral Symptoms

  • Avoidance of certain foods or food groups based on sensory characteristics or past negative experiences.
  • Reluctance or refusal to eat in social settings or with others, leading to social isolation.
  • Limited dietary variety, often consuming the same foods repeatedly.
  • Prolonged mealtimes or rituals around eating, such as cutting food into small pieces or arranging it in a specific way.

Psychological Symptoms

  • Intense anxiety or distress around mealtimes or eating certain foods.
  • Obsessive thoughts or behaviors related to food and eating.
  • Lack of interest in food or eating, often described as “not feeling hungry” or “forgetting to eat.”

Impact on Individuals and Families

Physical Health Consequences

The physical health consequences of ARFID can be severe. Nutritional deficiencies can lead to a range of health issues, including anemia, weakened immune function, and poor growth and development in children. In extreme cases, individuals with ARFID may require hospitalization and enteral feeding to address severe malnutrition and weight loss.

Emotional and Psychological Impact

The emotional and psychological impact of ARFID can be profound. Individuals with ARFID often experience significant anxiety and distress related to food and eating. This can lead to social isolation, as they may avoid eating in social settings or with others. The constant worry and preoccupation with food can also interfere with daily functioning and overall quality of life.

Impact on Families

Families of individuals with ARFID often face significant challenges. Parents may feel frustrated and helpless as they struggle to get their child to eat a balanced diet. Mealtimes can become a source of conflict and stress, impacting family dynamics and relationships. The need for specialized medical and psychological care can also place a financial burden on families.

Diagnosis and Assessment

Clinical Evaluation

Diagnosing ARFID requires a thorough clinical evaluation by a healthcare professional with expertise in eating disorders. This evaluation typically includes a detailed medical history, assessment of eating behaviors and patterns, and a physical examination to identify any nutritional deficiencies or health issues.

Diagnostic Tools

Several diagnostic tools can aid in the assessment of ARFID. These may include:

  • Food diaries or logs to track eating patterns and identify specific food aversions or avoidance behaviors.
  • Nutritional assessments to evaluate dietary intake and identify any nutritional deficiencies.
  • Psychological assessments to identify underlying anxiety, obsessive-compulsive tendencies, or other psychological factors contributing to the eating disorder.

Differential Diagnosis

Differentiating ARFID from other eating disorders and medical conditions is crucial for accurate diagnosis and treatment. Healthcare professionals must consider other potential causes of restrictive eating behaviors, such as gastrointestinal disorders, food allergies, and other mental health conditions.

Treatment and Management

Multidisciplinary Approach

Effective treatment of ARFID requires a multidisciplinary approach, involving healthcare professionals from various fields, including medicine, psychology, nutrition, and occupational therapy. This collaborative approach ensures that all aspects of the disorder are addressed, from physical health and nutrition to psychological well-being and sensory sensitivities.

Nutritional Rehabilitation

Nutritional rehabilitation is a critical component of ARFID treatment. This involves developing a structured and individualized meal plan to ensure that the individual’s nutritional needs are met. Registered dietitians with expertise in eating disorders play a vital role in this process, providing education and support to help individuals expand their dietary variety and overcome food aversions.

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) is an evidence-based treatment approach commonly used for ARFID. CBT helps individuals identify and challenge negative thoughts and behaviors related to food and eating. It also involves exposure therapy, gradually introducing feared or avoided foods in a controlled and supportive environment to reduce anxiety and build confidence.

Sensory Integration Therapy

For individuals with significant sensory sensitivities, sensory integration therapy can be beneficial. Occupational therapists use this approach to help individuals become more comfortable with different sensory experiences related to food, such as textures, smells, and tastes. This therapy often involves structured activities and exercises to desensitize sensory reactions and improve tolerance for a wider variety of foods.

Family-Based Therapy

Family-based therapy is particularly important for children and adolescents with ARFID. This approach involves working closely with the family to support the individual’s recovery and create a positive and supportive mealtime environment. Parents are empowered with strategies to encourage healthy eating behaviors and manage food-related anxiety.


In some cases, medications may be prescribed to address underlying anxiety or obsessive-compulsive tendencies contributing to ARFID. Selective serotonin reuptake inhibitors (SSRIs) and other anti-anxiety medications can be effective in reducing anxiety and improving overall well-being.

Real-Life Stories and Experiences

Case Study: Overcoming ARFID

Emma, a 10-year-old girl, had struggled with ARFID since early childhood. Her diet was limited to a few bland and crunchy foods, and she avoided anything with a different texture or strong flavor. Mealtimes were a source of anxiety and conflict for her family. After being diagnosed with ARFID, Emma began a comprehensive treatment program involving nutritional rehabilitation, CBT, and sensory integration therapy.

Over several months, Emma made significant progress. With the support of her family and healthcare team, she gradually introduced new foods into her diet and developed coping strategies to manage her anxiety. Emma’s story highlights the importance of a multidisciplinary approach and the potential for recovery with the right support.

The Impact on Families

John and Sarah, parents of a teenager with ARFID, shared their experience of navigating their son’s eating disorder. They described the frustration and helplessness they felt as they tried to get their

son to eat a balanced diet. Family-based therapy played a crucial role in their journey, helping them understand their son’s condition and providing them with practical strategies to support his recovery.

Their story underscores the importance of involving families in the treatment process and the positive impact it can have on the individual’s recovery and overall family dynamics.

Expert Insights and Recommendations

Early Detection and Intervention

Experts emphasize the importance of early detection and intervention for ARFID. Recognizing the signs and symptoms early can prevent the disorder from becoming more severe and reduce the risk of long-term health consequences. Healthcare professionals, educators, and parents should be aware of the warning signs of ARFID and seek appropriate evaluation and treatment if concerns arise.

Educating Healthcare Providers

There is a need for increased education and awareness about ARFID among healthcare providers. Many healthcare professionals may not be familiar with the disorder, leading to misdiagnosis or delayed diagnosis. Training programs and continuing education opportunities can help bridge this knowledge gap and ensure that healthcare providers are equipped to identify and treat ARFID effectively.

Supporting Research and Advocacy

Continued research is essential to advancing our understanding of ARFID and developing more effective treatments. Advocacy efforts can help raise awareness about the disorder, promote early detection, and support individuals and families affected by ARFID. Organizations dedicated to eating disorders play a crucial role in these efforts, providing resources, education, and support to the community.


ARFID is a complex and often misunderstood eating disorder that can have significant physical, emotional, and psychological impacts on individuals and their families. ‘I would call this the silent eating disorder’: What experts want you to know about ARFID emphasizes the importance of raising awareness and understanding of this condition.

With a comprehensive and multidisciplinary approach to treatment, individuals with ARFID can overcome their challenges and achieve a balanced and healthy relationship with food. Early detection, education, and ongoing support are key to improving outcomes and enhancing the quality of life for those affected by ARFID. By shedding light on this silent eating disorder, we can foster greater empathy, understanding, and effective interventions for all who are impacted.