Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterised by a persistent disturbance in eating that leads to ongoing failure to meet appropriate nutritional and/or energy needs. This is not due to a fear of gaining weight or a disturbance in the way one's body weight or shape is experienced, as seen in anorexia nervosa or bulimia nervosa.

Instead, the avoidance or restriction in ARFID is driven by one or more of the following:

• Lack of interest in eating or food. The individual may simply not feel hungry or have any desire to eat.
• Sensory characteristics of food. Avoidance may be based on the texture, taste, smell, appearance, or temperature of certain foods.
• Concern about aversive consequences of eating. This can include fears of choking, vomiting, or experiencing pain after eating. This fear is often triggered by a past negative experience.

Key characteristics of ARFID include:

• Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).

• Significant nutritional deficiency.

• Dependence on enteral feeding (tube feeding) or oral nutritional supplements.
• Marked interference with psychosocial functioning. For example, difficulty eating with others, avoiding social events involving food, or challenges at school or work due to eating habits.

It's important to distinguish ARFID from:

• Typical picky eating in childhood: While many children are picky eaters, ARFID is more severe and leads to significant nutritional or psychosocial consequences.
• Anorexia nervosa and bulimia nervosa: In ARFID, the restriction is not driven by concerns about body weight or shape.
• Medical conditions: The eating disturbance is not better explained by a co-occurring medical condition (e.g., gastrointestinal disorder).
• Lack of available food or culturally sanctioned practices.

ARFID can manifest in different ways:

• Extreme "picky eating" based on sensory sensitivities.
• Fear of negative consequences like choking or vomiting.
• General lack of interest in food or low appetite.

Consequences of ARFID can be serious and include:

• Malnutrition and nutritional deficiencies.
• Significant weight loss or failure to grow in children.
• Electrolyte imbalances.
• Cardiac issues.
• Delayed puberty.
• Difficulties concentrating.
• Fatigue and weakness.
• Social isolation.
• Psychological issues like anxiety and depression.

Treatment for ARFID typically involves a multidisciplinary team, including medical professionals, dietitians, and therapists. Approaches may include:

• Nutritional rehabilitation: To restore a healthy weight and address nutritional deficiencies.
• Behavioural therapies (e.g., CBT-AR, exposure therapy): To address anxieties and fears related to food and eating and to increase food variety.
• Family-based therapy (FBT): To support families in helping their child eat a wider variety of foods.²⁴
• Occupational therapy and speech therapy: To address sensory issues or difficulties with chewing and swallowing.
• Medication: May be used in some cases to address co-occurring conditions like anxiety or to stimulate appetite.

Early identification and intervention are crucial for managing ARFID and preventing long-term health complications.