When eating feels difficult, stressful or extremely limited
For someone living with Avoidant/Restrictive Food Intake Disorder (ARFID), eating can feel much more complicated than simply trying a new food or being a “picky eater”.
Certain textures, tastes, smells or appearances may feel overwhelming. A frightening experience such as choking or vomiting can create intense anxiety around eating. Some people rarely feel hungry, become full very quickly, or find eating takes an enormous amount of effort.
Over time, the range or amount of food someone feels able to eat can become increasingly limited. This can affect nutrition, growth, energy, health, relationships, school, work and everyday life.
At Myrtle Oak Clinic, our eating disorder Dietitians and Psychologists support children, adolescents and adults experiencing ARFID. We provide individualised, evidence-informed treatment from our Central Coast and Newcastle clinics, as well as via telehealth.
What is ARFID?
Avoidant/Restrictive Food Intake Disorder, commonly known as ARFID, is an eating disorder characterised by avoiding or restricting food to the extent that a person’s nutritional needs, physical health or everyday functioning are affected.
ARFID can occur in children, teenagers and adults.
A person with ARFID may experience one or more of the following:
- difficulty eating enough food to meet their energy and nutritional needs
- a very limited range of accepted or “safe” foods
- nutritional deficiencies
- weight loss or difficulty gaining weight
- faltering growth in children and adolescents
- reliance on nutritional supplements or enteral feeding
- significant anxiety or distress around food and eating
- difficulty eating away from home or with other people
- impacts on school, work, relationships, travel and social activities.
ARFID experiences can look very different from one person to another. Understanding what is driving the food avoidance is an important part of assessment and treatment.
What causes someone with ARFID to avoid food?
ARFID is commonly understood through three main presentations. Many people experience a combination of these.
Sensory sensitivity
Taste, smell, texture, temperature or appearance can make certain foods extremely difficult to tolerate.
Someone may have a relatively small group of foods that consistently feel safe and predictable. Changes in brand, preparation, packaging or presentation may sometimes make an otherwise familiar food difficult to eat.
Fear of something bad happening when eating
Food restriction can develop following a distressing experience such as:
- choking
- vomiting
- an allergic reaction
- abdominal pain
- nausea
- another frightening experience involving food.
The person may begin avoiding particular foods or situations because eating feels unsafe.
Low interest in food or eating
Some people experience very little hunger or interest in food.
They may forget to eat, become full very quickly, find eating tiring or describe eating as a chore. Consuming enough food consistently can therefore become extremely difficult.
ARFID and picky eating. When should I be concerned?
Selective eating is common, particularly during childhood.
ARFID becomes a concern when restricted eating begins affecting nutrition, growth, physical health or someone’s ability to participate comfortably in everyday life.
Signs that further assessment may be helpful include:
- the number of accepted foods becoming increasingly limited
- strong distress when unfamiliar foods are presented
- avoiding entire food groups or particular textures
- difficulty eating enough throughout the day
- weight loss or difficulty gaining weight as expected
- concerns about growth
- nutritional deficiencies
- relying heavily on nutritional supplements
- meals taking a very long time
- avoiding school camps, restaurants, parties or eating with friends
- anxiety about choking, vomiting or becoming unwell
- family life becoming increasingly centred around managing food
- wanting to eat differently but feeling unable to do so.
You don’t need to wait until eating difficulties become severe before seeking help.
ARFID, autism and ADHD
ARFID frequently occurs alongside other conditions, particularly autism, ADHD and anxiety.
For neurodivergent people, sensory processing differences, interoception, executive functioning, predictability, routine and previous experiences with food may all influence eating.
Understanding these factors allows treatment to be adapted to the individual rather than applying a one-size-fits-all approach.
At Myrtle Oak Clinic, we aim to provide neuro-affirming ARFID care that considers the whole person and works collaboratively towards meaningful nutrition and eating goals.
Can adults have ARFID?
Yes. ARFID can affect people at any age.
Some adults recognise that they have experienced extremely selective eating for most of their lives. Others develop significant food restriction following illness, gastrointestinal symptoms, choking, vomiting or another distressing experience.
Adults with ARFID may have developed many strategies for managing eating difficulties, such as avoiding restaurants, eating before social events, taking their own food when travelling or relying on a small number of predictable foods.
ARFID treatment can help adults understand the factors maintaining their eating difficulties and gradually work towards improved nutritional adequacy, flexibility and confidence around food.
ARFID Treatment
Treatment starts with understanding your individual experience of ARFID.
There is rarely value in simply telling someone with ARFID to “eat more” or “try new foods”. Effective treatment considers why eating has become difficult and develops strategies that respond to those specific drivers.
Depending on the person’s needs, ARFID treatment may focus on:
- improving overall nutritional adequacy
- supporting growth or nutritional restoration where required
- establishing more consistent eating
- addressing nutritional deficiencies
- reducing anxiety and fear around eating
- gradually increasing food variety
- building tolerance and confidence around challenging foods
- developing awareness of hunger, fullness and other body cues
- reducing reliance on nutritional supplements where clinically appropriate
- increasing confidence eating outside the home
- supporting parents and carers around mealtimes
- improving participation in school, work and social activities.
Progress is individual. For some people, an important early goal may simply be eating enough consistently. For another person, it may be reducing fear associated with a particular food. For someone else, it may be gradually expanding the variety of foods they can comfortably eat.
CBT-AR: Cognitive Behavioural Therapy for ARFID
Cognitive Behavioural Therapy for ARFID (CBT-AR) is a structured treatment specifically developed for ARFID.
Treatment generally involves several stages and is tailored according to whether someone’s ARFID is predominantly influenced by sensory sensitivity, fear of aversive consequences, low interest in eating, or a combination of these.
CBT-AR may involve:
- Understanding your ARFID
Identifying the factors contributing to food restriction and establishing regular, adequate eating. - Setting individual treatment goals
These may include nutritional restoration, addressing deficiencies, increasing food variety or reducing reliance on nutritional supplements. - Working with the drivers of ARFID
Treatment may involve carefully planned food exposure, sensory learning, strategies for low appetite and fullness, or gradually reducing fear associated with eating. - Building confidence for the future
Developing strategies that allow progress to continue beyond treatment.
Emerging research supports CBT-AR as a promising treatment approach for ARFID, including growing evidence for the role appropriately trained dietitians can play in delivering CBT-AR within multidisciplinary eating disorder care.
What does an ARFID dietitian do?
Nutrition is an important part of ARFID treatment because restricted eating can affect energy intake, nutrient adequacy, growth and physical wellbeing.
An ARFID dietitian may assess:
- current food and fluid intake
- accepted and avoided foods
- nutritional adequacy
- eating patterns and meal structure
- growth and weight history where clinically appropriate
- nutritional deficiencies
- gastrointestinal symptoms
- sensory preferences
- appetite and fullness
- use of nutritional supplements
- previous experiences with food
- the practical impact of ARFID on everyday life.
From here, your dietitian works collaboratively with you to establish realistic nutrition goals.
Treatment may involve improving adequacy using foods that already feel safe before gradually building flexibility and variety. The pace and priorities are individualised according to nutritional needs, medical considerations and the person’s ARFID presentation.
Do I need a psychologist and dietitian for ARFID?
ARFID can affect both physical and psychological wellbeing, so multidisciplinary care can be valuable.
At Myrtle Oak Clinic, our Dietitians and Psychologists work collaboratively where this is appropriate for the individual.
A GP or other medical practitioner may also form an important part of the treatment team, particularly where there are concerns about growth, weight changes, nutritional deficiencies or medical stability.
Your treatment team will depend on your individual needs. We can help you understand which clinicians may be useful when you first contact us.
ARFID Treatment at Myrtle Oak Clinic
Finding someone who understands ARFID can make an enormous difference.
Our clinicians have experience working with eating disorders and ARFID and undertake additional professional development and training in evidence-informed eating disorder treatment approaches.
We support children, adolescents, adults and families and understand that ARFID can present very differently across different ages and stages of life.
Treatment is collaborative, compassionate and tailored to the individual. Our goal is to help make eating more manageable while improving nutritional wellbeing, confidence and participation in everyday life.
ARFID treatment in Newcastle and the Central Coast
Myrtle Oak Clinic provides ARFID assessment and treatment through our multidisciplinary eating disorder team at:
Central Coast
Tuggerah, NSW
Newcastle
Broadmeadow, NSW
Telehealth
Online appointments are also available, allowing us to support people beyond our clinic locations where telehealth treatment is appropriate.
Do I need an ARFID diagnosis or referral?
You can contact Myrtle Oak Clinic without already having an ARFID diagnosis.
Some people come to us knowing they have ARFID. Others simply know that eating has become extremely restricted, stressful or difficult and want help understanding what is happening.
You can self-refer to Myrtle Oak Clinic or speak with your GP about referral options.
Depending on your circumstances and eligibility, your GP or psychiatrist may also discuss whether an Eating Disorder Treatment and Management Plan is appropriate.
When should I seek help for ARFID?
Earlier support can help prevent restricted eating patterns from becoming increasingly entrenched.
Consider seeking professional advice if eating difficulties are affecting:
- nutrition
- growth or weight
- physical health
- energy
- family life
- school or work
- relationships
- social activities
- confidence around food
- your ability to enjoy everyday life.
You also don’t need to know whether what you’re experiencing “counts” as ARFID before contacting us.
We can start by listening to what has been happening and help you determine the most appropriate next step.
Take the first step towards making eating easier
Living with ARFID can make something that happens several times every day feel exhausting, stressful or overwhelming.
With appropriate support, people with ARFID can develop greater nutritional stability, confidence and flexibility around food.
Our ARFID Dietitians and Psychologists provide treatment for children, teenagers and adults from our Newcastle and Central Coast clinics and via telehealth.
Talk to our team about ARFID assessment and treatment.