When we think about eating disorders, conditions like anorexia nervosa and bulimia often come to mind. However, there’s another lesser-known but equally serious eating disorder: Avoidant/Restrictive Food Intake Disorder (ARFID). ARFID is characterized by an extreme avoidance of certain foods, often due to sensory sensitivities, fear of negative consequences like choking, or a general lack of interest in eating. While ARFID can affect anyone, research suggests it is particularly prevalent among autistic individuals.
What is ARFID?
ARFID is an eating disorder recognized in the DSM-5, distinct from other eating disorders in that it is not driven by body image concerns. Instead, people with ARFID may experience:
- Sensory sensitivities (e.g., extreme aversions to textures, smells, or flavors)
- Fear-based food avoidance (e.g., due to past experiences of choking, vomiting, or gastrointestinal distress)
- Low interest in eating (e.g., lack of appetite or difficulty recognizing hunger cues)
Unlike picky eating, which is common in children and often outgrown, ARFID can persist into adulthood and lead to nutritional deficiencies, weight loss, and reliance on supplements or specialized diets.
Why is ARFID Common in Autistic People?
Autism and ARFID are closely linked due to several overlapping traits:
1. Sensory Sensitivities
Many autistic individuals experience heightened sensory processing, which makes them more sensitive to food textures, smells, and tastes. Certain foods might feel unbearable in the mouth, making eating an overwhelming experience. For example, some autistic people might only eat foods that are crunchy or soft while avoiding mixed textures like casseroles or soups.
2. Rigid Routines and Preferences
Autistic individuals often rely on routines to navigate the world. This can extend to food, where they might feel safest eating the same limited set of meals repeatedly. Sudden changes in food options—such as a different brand or packaging—can be distressing and lead to avoidance.
3. Anxiety and Past Trauma
Many autistic individuals have heightened anxiety, which can exacerbate food-related fears. A past choking incident or a severe stomachache might cause someone to avoid entire food groups. This fear-based restriction can become deeply ingrained over time.
4. Interoception Difficulties
Interoception refers to the ability to sense internal body signals, such as hunger and fullness. Many autistic individuals struggle with recognizing these cues, which can contribute to disordered eating patterns, including eating too little or too much at irregular intervals.
The Consequences of ARFID
Without intervention, ARFID can lead to:
- Nutritional deficiencies, such as anemia, calcium deficiency, or inadequate protein intake
- Weight loss or poor growth, especially in children and adolescents
- Social challenges, as food is often central to gatherings, leading to isolation or stress
- Increased anxiety, as individuals may feel overwhelmed by food-related expectations
How to Support an Autistic Person with ARFID
1. Respect Their Sensory Needs
Forcing someone to eat foods they find overwhelming can worsen anxiety and aversion. Instead, work with their sensory preferences by offering foods with acceptable textures and flavors while slowly introducing new options in a non-threatening way.
2. Offer Safe and Predictable Food Options
Having reliable, preferred foods available reduces stress around eating. Autistic individuals often thrive with predictability, so maintaining some consistency while gently expanding food choices can be beneficial.
3. Use Gradual Exposure Techniques
Introducing new foods slowly and in a non-pressuring manner can help expand dietary variety. For example, if someone dislikes mashed potatoes but enjoys fries, a step-by-step approach can bridge the gap by trying different potato preparations over time.
4. Address Nutritional Gaps Without Pressure
If ARFID leads to deficiencies, consider supplements or fortified foods to ensure proper nutrition. A dietitian familiar with autism can provide guidance on safe, non-stressful ways to increase nutrient intake.
5. Support Emotional Well-being
Since anxiety often plays a role in ARFID, therapy can help manage food-related fears. Dialectical Behavioural Therapy (DBT) or autism-informed therapy approaches can help individuals navigate food anxiety in a way that feels safe and empowering.
Final Thoughts
ARFID is a serious eating disorder that disproportionately affects autistic individuals due to sensory sensitivities, routines, anxiety, and interoception difficulties. Recognizing ARFID as a legitimate condition, rather than just “picky eating,” is crucial for ensuring proper support and care. By respecting individual needs, offering gradual exposure to new foods, and addressing nutritional concerns with compassion, we can help autistic individuals develop a healthier, less stressful relationship with food.
If you or someone you love struggles with ARFID, consider seeking support from a professional experienced in autism and eating disorders. With the right approach, it’s possible to improve food experiences and overall well-being.
Plymouth Online Therapy 