By Kayla Costello and Ava Silverman (CEED Summer Research Fellows)

Selectivity around food is typical among young children and is often short-term, but what happens if your child never “grows out of it?” What happens if an individual suddenly “grows into it” following a traumatic event or the development of a new health condition?¹

If you’ve watched Abbott Elementary on ABC, you may have noticed that Gregory unwillingly admits to his co-workers that he only likes four foods! If you haven’t caught the scene, take a look here. Though we don’t know what’s going on for Gregory, for other people this can be an example of extreme food selectivity among adults.

Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by extreme selectivity around food, leading to significant distress and/or impairment of one’s life and social activities.² The difference between ARFID and anorexia nervosa is that the ARFID eating behaviors aren’t driven by a desire to control shape or weight. Although ARFID is commonly associated with children, people of any age can be affected. For some people, ARFID can be a carryover from childhood difficulties around food, whereas others may experience onset following a traumatic event, like choking or even seeing someone else choke.¹

Something that is common among people with ARFID is having “safe” foods that they are able to eat with minimal distress. When someone with ARFID is presented with a food that is not tolerable to them, they may become upset, uncomfortable, and avoidant of eating until their “safe” foods become available to them.

Some people with ARFID may avoid entire food groups (e.g., proteins), which can lead to serious physical consequences. Nutritional deficiencies, severe stomach pain, gastrointestinal disorders, and difficulty maintaining expected weight can occur in ARFID.³ Importantly low weight is not necessarily part of ARFID, people with ARFID come in all shapes and sizes. Sometimes it is hard to understand why your child or friend won’t “just try” a different food, or why you, as an adult, can’t seem to expand the list of foods that you can tolerate eating. For people with ARFID, these new or different experiences may be extremely overwhelming. Many require specialist help to meet their nutritional needs.

Sometimes it is hard to understand why your child or friend won’t “just try” a different food, or why you, as an adult, can’t seem to expand the list of foods that you can tolerate eating. For people with ARFID, these new or different experiences may be extremely overwhelming. Many require specialist help to meet their nutritional needs.

Researchers have identified three common ARFID profiles: sensory sensitivity, lack of interest in eating, and fear of aversive consequences.⁴ Many people have elements of more than one profile.

• Sensory sensitivity: People with the sensory sensitivity presentation of ARFID may avoid foods based on intense disgust with or aversion to certain tastes, textures, smells, sounds, or appearances.
• Lack of interest in eating: People with a lack of interest in eating tend to not feel hunger at mealtimes or can feel full more quickly than others. People in this category often forget to eat during the day, especially if they are busy.
• Fear of aversive consequences*: This presentation can include intense fears of choking, vomiting, stomach aches, or other negative consequences as a result of eating. People who have a fear of aversive consequences may have had a traumatic event, like choking on a food or sensitivities to certain foods.

*For people with gastrointestinal disorders and food allergies, who are at risk of severe reactions, fear of aversive consequences alone is often not enough to diagnose ARFID.⁵

ARFID research is relatively limited compared to research on other types of eating disorders. Researchers, clinicians, and advocates are hoping that with more research we can develop a better understanding of ARFID and better ways to help people address the symptoms.

We are working to understand both genetic and environmental causes of ARFID. If either you or your child deal with selective eating to extreme picky eating, you might be eligible to participate. No official ARFID diagnosis is required. Please visit arfidgen.org for more details and resources.