Stella was eight years old when she stopped eating solid foods. She went from being a “foodie” to strictly consuming liquids, says Briana, Stella’s mother. That diet soon became problematic for Stella, too: later, she removed chunks from her soup and struggled to drink smoothies that contained small seeds. She grew so afraid of swallowing that she’d spit out her saliva. “She said she had a fear of choking,” Briana says. (The last names of Stella and Briana have been withheld for privacy.)
In less than a month, Stella became so tired and malnourished that her parents took her to the hospital. Doctors put her on a feeding tube, and they were concerned that the rapid weight loss for her age might cause heart issues. Within 24 hours of being hospitalized, a psychologist diagnosed Stella with avoidant/restrictive food intake disorder, or ARFID, a serious eating disorder that’s become steadily more prevalent globally in recent years. Health care providers and psychologists are now trying to untangle ARFID’s causes, signs and disconcerting rise.
Clinicians emphasize that ARFID is much more than a dislike of certain foods. It’s developmentally normal for many kids to go through a picky eating phase between ages two and six. But ARFID presents as a food avoidance so persistent and pervasive that it can cause adults to drop below the minimum health body mass index, or BMI (a hotly debated measurement that links a person’s weight to their height), or to lose so much weight that they experience symptoms of malnutrition, such as vitamin deficiencies, irregular menstrual cycles, low testosterone, hair loss, muscle loss and a constant feeling of being cold. In kids, drastic weight loss from ARFID can cause children to fall off standard U.S. growth charts for healthy development. Developmental issues linked to the loss in weight and calories often spur doctors to recommend supplemental nutritional intake.
“We’re not just trying to treat kids who don’t like broccoli. It’s the kid who is malnourished as a result of their food choices,” says James Lock, a psychiatry professor and director of the Child and Adolescent Eating Disorder Program at the Stanford University School of Medicine.
ARFID was formally recognized as a feeding and eating disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. That enabled clinicians to put a name to a condition that had been around but had gone undetected for some time.
“Probably there were people who had this syndrome, but they didn’t really talk about it because there’s a stigma around it,” says Jennifer Thomas, co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, who has treated people with ARFID.
Wider recognition of the condition is partly driving the recent increase in cases. Real-world data on ARFID cases are lacking, but some studies have reported a global prevalence ranging from 0.35 to 3 percent across all age groups. Certain countries and regions report much higher numbers: a recent study in the Netherlands, for example, found that among 2,862 children aged 10, 6.4 percent had ARFID. The eating disorder clinic that provided specialized care to Stella after she was hospitalized says it treated more than 1,000 people in the U.S. with ARFID in 2024—a 144 percent jump from 2023.
“I think that’s one of the things that has made ARFID a challenging eating disorder [to diagnose]—because it is a lot of different things,” says Jessie Menzel, a clinical psychologist who treats the condition and other eating disorders.
And the National Alliance for Eating Disorders has found that ARFID now accounts for up to 15 percent of all new eating disorder cases. People can experience ARFID at any age, although recently diagnosed cases have mostly been in children and teens. The average age of diagnosis is 11 years old, and 20 to 30 percent of cases are in boys—a higher percentage than other eating disorders, according to the alliance.
Unlike other eating disorders such as anorexia nervosa and bulimia, ARFID doesn’t appear to be associated with body image. The problem—and seeming cause—is the food itself and the emotional and physiological response toward it.
People with ARFID generally fall into one or several of three categories. According to one study of adults with ARFID, 80 percent of respondents said they were uninterested in eating, 55 percent said they stay away from many foods because of sensory issues, and 31 percent said they avoid food because they are afraid of adverse consequences such as choking or vomiting. About two thirds of the participants were in more than one of these categories.
“I think that’s one of the things that has made ARFID a challenging eating disorder [to diagnose]—because it is a lot of different things,” says Jessie Menzel, a clinical psychologist who treats the condition and other eating disorders.
There are some common signs that signal ARFID, however. In addition to significant weight loss and signs of malnutrition, ARFID’s physical symptoms include gastrointestinal issues, low body temperature and the growth of a type of soft, fine body hair called lanugo that is typically not present after infancy. Behavioral changes include a lack of appetite, difficulty paying attention, food texture avoidance, extreme selective eating and a fear of vomiting or choking.
Although ARFID is classified as an eating disorder, it has a lot of overlap with mental health conditions. A 2022 metastudy found that among people diagnosed with ARFID, up to 72 percent had an anxiety disorder. Studies also suggest the uptick in ARFID cases may be tied to the overall increase in mental health conditions diagnosed in kids. ARFID is particularly pronounced in those who have an anxiety disorder, Thomas says. The research conducted by Thomas and her team has shed light on the connection between Avoidant/Restrictive Food Intake Disorder (ARFID) and anxiety disorders. Their studies have shown that approximately 30 to 40 percent of individuals with ARFID have also experienced an anxiety disorder at some point in their lives. While ARFID and anxiety disorders are distinct conditions, they share key similarities, particularly in the intense anxiety that individuals with ARFID often feel around food.
Identifying ARFID can be challenging, especially when it co-occurs with anxiety. Families may find it difficult to receive an ARFID diagnosis, as the symptoms can be misinterpreted or overlooked. One common indicator of ARFID is when a child deviates from growth curves recommended by the American Academy of Pediatrics, signaling potential growth and developmental issues due to a lack of interest in food.
However, pinpointing signs of ARFID becomes more complex when a child with nutritional deficits maintains an average or higher body weight. In such cases, healthcare providers must rely on parents’ observations of their child’s eating habits and food preferences to make an accurate diagnosis.
The underlying causes of ARFID remain unclear, but researchers believe that genetic, environmental, and neurobiological factors contribute to its development. Thomas and her team are currently investigating the neurological aspects of ARFID, aiming to understand the brain activity associated with different ARFID presentations.
In a recent study published in JAMA Network Open, participants with ARFID exhibited distinct patterns of brain activation when exposed to food images. Those with fear-related ARFID showed hyperactivation of the amygdala, while individuals with sensory-related ARFID displayed increased activity in sensory brain regions. These findings suggest that different neural circuits may be associated with various ARFID subtypes.
While cognitive-behavioral therapy (CBT) has shown some success in treating ARFID, understanding the neurobiological underpinnings of the disorder could lead to more targeted interventions. Thomas and her colleagues have observed positive outcomes with CBT, with 70 percent of treated individuals no longer meeting ARFID criteria post-treatment.
For children with ARFID, family-based interventions that focus on gradually expanding food variety and exposure have proven effective. By involving the entire family in meal planning and encouraging the child to try new foods, parents can help alleviate ARFID symptoms over time.
In conclusion, ARFID is a complex disorder that requires a multidisciplinary approach for effective treatment. By combining psychological interventions with a deeper understanding of the neurobiological mechanisms underlying ARFID, healthcare providers can offer more personalized and targeted care to individuals struggling with this condition. If you or someone you know is dealing with an eating disorder, reaching out to organizations like the National Association of Anorexia Nervosa and Associated Disorders or Crisis Text Line can provide valuable support and guidance. The rise of online shopping has completely revolutionized the way we shop for goods and services. With just a few clicks, consumers can browse through a vast array of products, compare prices, read reviews, and make purchases without ever leaving the comfort of their own homes. This convenience has led to a significant increase in online shopping, with more and more people opting to shop online rather than in traditional brick-and-mortar stores.
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