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December 2019

Picky Eating … or Eating Disorder?

Picky eating isn’t just a frustrating part of the toddler years. For some teens and adults, restricting food and not eating can become extreme—and even harm their health. Behind it: A recently recognized yet little-known condition called avoidant/restrictive food intake disorder (ARFID).

Young teen at dinner table, looking at forkful of mashed potatoes

Here’s what you need to know about ARFID:

It’s more than “fussy eating”

ARFID was introduced by mental health experts as an eating disorder in 2013. Those with ARFID severely restrict how much food they eat. They may not eat food items with a particular color, aroma, texture, or even brand name. Instead, they may only eat foods with a certain consistency. ARFID red flags include low interest in food, fears of choking or vomiting, feeling full around mealtimes, and reluctance to eat with other people in social settings. Teens and adults with ARFID may also rely on supplements instead of food. 

The health risks are serious

People with ARFID don’t get enough calories and nutrients. This can lead to growth problems as well as nutritional deficiencies of zinc, iron, folate, vitamins B-12 and C. According to eating disorder experts, ARFID can cause:

  • Stomach cramps and other digestive complaints

  • Intolerance to cold

  • Irregular or absent menstrual cycles

  • Trouble concentrating

  • Dizziness and fainting

  • Sleep problems

  • Fatigue

  • Constipation

  • Dry skin

  • Hair loss

  • Low blood pressure

  • Rapid heartbeat

Those with ARFID may lose a lot of weight or have a weight so low their bodies can’t function normally.

ARFID isn’t about weight control or body image issues

ARFID is different from eating disorders such as anorexia and bulimia, which are tied to concerns about weight or appearance. Teens and adults with ARFID may not eat for 3 main reasons:

  1. Fear of unpleasant consequences (choking, stomach pain, etc.) based on a previous food-related trauma

  2. Unusual sensitivity to the taste, mouth feel, smell, or appearance of foods

  3. A lack of interest in eating

People with ARFID may also think that they have food allergies or a food intolerance. All these reasons can lead to growing anxiety about eating.  

ARFID can be treated

There are several ways to help people with ARFID. Treatments may include cognitive behavioral therapy, medicines to boost appetite and reduce anxiety, care in a hospital, and outpatient eating disorder programs. Families of people with ARFID often work with providers, too. Families can learn how to support and encourage their loved one’s healthy eating habits and reduce stress so that mealtime is a “safe space” for enjoying food and family.

Concerned? Talk with your family healthcare provider

He or she can rule out other health problems that may have similar symptoms, then help identify the specialists—including mental health practitioners, nutritionists, and others—who can find a solution. 

Online Medical Reviewer: McDonough, Brian, MD
Date Last Reviewed: 7/1/2019
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