ARFID in Adults: What It's Like to Have an Eating Disorder

What is ARFID in adults like?

Have you ever wondered if your highly specific eating habits were more than just “picky eating”? 

Often mislabeled, avoidant/restrictive food intake disorder (ARFID) is a condition where individuals experience nutritional deficiencies because they are avoiding specific foods or limiting the amount of food they eat. 

Adults with ARFID often have very rigid, inflexible eating patterns^[1]. Many have a co-occurring mental health or neurodevelopmental diagnosis.

In this resource, we explore ARFID symptoms in adults, including food aversion. We also share insights from our eating disorder experts on how to get an adult ARFID diagnosis or start treatment.

The 3 types of ARFID in adults

Not all ARFID experiences are alike. This selective eating disorder commonly presents in one of the following types.

Type 1: Sensory sensitivity/avoidant

Individuals with this type of ARFID avoid certain foods due to the sensory features of the food, which can cause a disgust or overstimulation reaction. Food texture sensitivity issues are common in these adults.

Negative reactions may be related to the food's:

• Smell
• Taste
• Texture
• Temperature 
• General appearance (e.g., color)

Some adults become so concerned about a possible reaction of disgust that they refuse to eat.

Restricting food due to sensory issues means that ARFID can overlap with autism spectrum disorder. Adults with autism often have strong sensory sensitivity and may have food texture sensitivity/aversion.

Type 2: Fear of aversive consequences

This type of ARFID is based on experiencing anxiety, fear or worries while eating, such as having a fear of:

• Choking
• Nausea
• Vomiting
• Pain
• Swallowing

The fear of having a negative reaction reinforces the individual to avoid certain foods altogether.

This type of ARFID can co-occur with certain mental health conditions like anxiety and obsessive-compulsive disorder (OCD). OCD is also tied with other eating disorders. For these individuals, exposure therapy can be helpful.

People with this aversive type of ARFID may have had a traumatic event or a perceived trauma related to vomiting, choking, exposure to an allergen, or another uncomfortable and negative response to a food they ate. This can lead to the development of anxiety and fear around certain foods.

Type 3: Lack of interest

This type of ARFID can co-occur with attention-deficit/hyperactivity disorder (ADHD). Adults with this type of ARFID may show little to no interest in food. They might:

• Not feel hunger
• Forget to eat
• Have a generally low appetite
• Get extremely distracted during mealtimes
• Lack motivation to eat foods they do not strongly prefer or foods that are not convenient

This can result in limited intake of food for these adults. 

ADHD and ARFID

We asked clinical psychologist Michelle Jones, PhD, clinical manager at Eating Recovery Center (ERC), about the relationship between ADHD and ARFID on a recent ARFID podcast.

Dr. Jones has studied ARFID since it first became a diagnosis over a decade ago. She explains:

"If you have ADHD, your attention is not focused in a way that allows you to pay attention to food and hunger in quite the same way as someone with a neurotypical brain. 

Eating takes a lot of work, organization and coordination to prepare food. It can end up feeling like a chore."

What are ARFID symptoms in adults?

Common ARFID symptoms in adults include:

• Food texture sensitivity 
• Food aversion
• Refusing to try different foods or new types of food
• Requiring extremely specific preparations of foods
• Restricting foods based on their feel, color, smell or texture (chewy, sticky, crunchy, etc.)
• Choosing not to eat when preferred foods are unavailable, even when hungry
• Avoiding meals or delaying them as long as possible
• Lack of interest in shopping for food, cooking, choosing or going to restaurants
• Frequent lack of hunger
• Forgetting to eat
• Going for long periods without eating
• Having an emotional or physical reaction to food related to fears of having an allergic reaction, choking or vomiting
• Strong preference for quick, easy-to-prepare foods
• Anxiety around food
• Low body weight
• Nutritional deficits
• Being underweight without trying to lose weight

The symptoms of ARFID in adults may look different from the symptoms of ARFID in children and ARFID in teens. 

Note: If an adult lacks interest in eating and eats a very limited selection of foods, but they're functioning relatively well, and not losing weight, they may not fit the criteria for ARFID.

ARFID causes

The various causes of ARFID are generally related to the following factors:

• Genetic
• Biological
• Psychological
• Sociocultural

There is no single cause of ARFID, but every human being is born with a genetic code, which may exhibit patterns of certain mental and physical health conditions^[2] such as ARFID.

Research on the eating disorder ARFID

New research including members of our ERC team^[3] shows the following for adults with ARFID at ERC.

• Symptoms often start during childhood. 
• About one-third of study participants had moderate to severe OCD symptoms. 
• One-third of the sample had a probable post-traumatic stress disorder diagnosis.

ARFID diagnosis in adults

In 2013, ARFID was officially added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a manual that helps providers make mental health diagnoses. Still, many adults who struggle with ARFID are not properly diagnosed.

“If your doctor suspects a case of ARFID, they should make a referral to a therapist and dietitian with the clinical expertise to get a consensus,” explains Ovidio Bermudez, MD, FAAP, CEDS, senior medical director of child and adolescent services and chief clinical education officer at ERC, in a previous ARFID podcast. Only then should treatment begin.

Within an ARFID diagnosis there are different presentations, as listed above, and there is not a “one size fits all” treatment approach for all. 

Making the diagnosis

If you think you or a loved one may have ARFID, the most important step toward getting treatment is having an accurate diagnosis. 

To ensure an accurate diagnosis, you will want to find providers who are experienced and trained in eating disorders, such as the providers at ERC.

Dr. Jones emphasizes an important sign to watch for when diagnosing ARFID in adults. 

"Somebody who's restricting their eating because they're trying to lose weight or because they're worried about their appearance would not meet diagnostic criteria for ARFID."

Below, we discuss the ERC approach to treating ARFID in adults.

ARFID treatment for adults

ARFID treatment for adults includes working with highly experienced multidisciplinary treatment teams (medical, psychosocial, nutritional) who seek to understand and address:

• Developmental history
• Internal and external motivators 
• Goals and values
• Areas in the patient’s life that are negatively impacted by ARFID symptoms (e.g., physical health, social functioning, psychological well-being)
• Family dynamics and family involvement

Depending on the diagnosis and following a comprehensive assessment, treatment may include some or all of the following:

• Medical and psychiatric stabilization
• Nutritional rehabilitation and weight restoration
• Education and practicing of coping skills to manage distress around eating
• Assessment of and treatment for comorbid conditions, if applicable
• Family/caregiver involvement
• Collaboration with referring providers

Jamie Manwaring, PhD, research team member at ERC and lead author of a new study on ARFID in adults alongside ERC’s director of research, Renee Rienecke, PhD, FAED^[3], explains the importance of seeking a provider who is highly experienced in treating eating disorders like ARFID. 

“An adult with ARFID might seek treatment with a medical provider, but if the provider isn’t aware of ARFID, they may be more apt to send them to gastrointestinal specialists or other non-eating disorder providers.”

ARFID eating disorder treatment at ERC

The approach to ARFID treatment at ERC is unique for each individual. Dr. Jones shares, 

"One of the things that I feel passionate about is making sure that we are not forcing anyone with an ARFID diagnosis into our expectations of recovery. 

This is really about their life and their functioning and how we can help them function in a way that is going to better their life and not cause adverse experiences."

She continues,

"For someone with ARFID, their version of recovery is probably not going to look like typical normative eating, especially if their symptoms are more severe. 

We might help them feel comfortable ordering off a restaurant menu so they can go on dates, socialize and not be embarrassed. 

We look at functionality and physical health more than anything else as opposed to putting them in a box of what normative eating looks like to everyone else. 

Once people with ARFID get on this routine of eating regularly, their body starts to feel better and their brains function better.

To learn more about ERC's approach to ARFID treatment in adults, listen to our podcast, "What Is ARFID Anyway?"

You can recover from ARFID

A unique component of ARFID eating disorder treatment here at ERC is continuous education of patients and caregivers alike about:

• Diagnosis
• Treatment interventions
• Treatment expectations 
• Treatment goals

We support all of our patients and their families from assessment to discharge -- and beyond.

If you or a loved one has recently been diagnosed with ARFID as an adult, know that you’re not alone! It might feel like no one understands what you’re going through but your feelings are valid and there are others out there who “get it.”

If you’re looking for additional support, give us a call at 866-740-5491 or fill out this form to discuss treatment options. 

We are here for you.

Learn more about ARFID and find support in our free virtual educational series “Supporting Loved Ones with ARFID”

Related Reading

• What Is ARFID?
• ARFID in Children: Signs to Watch For
• ARFID in Teens: Symptoms & Treatment Options
• How ARFID Affects Your Relationship With Food [Podcast]
• Is It Picky Eating or ARFID? [Podcast]
• OCD and Eating Disorders: The Connection Explained