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Many people don’t think twice about food. They get hungry, they eat, and they move on. But for someone living with avoidant/restrictive food intake disorder, or ARFID, it’s not that simple. Instead, eating can feel overwhelming, stressful, or even scary, and it has nothing to do with dieting or body image.
“I was always told I was a picky eater, since that’s how ARFID often looks from the outside,” says 29-year-old Cassidy Arvidson. Throughout her life, Arvidson has stuck to a small list of “safe” foods and avoided anything with unfamiliar taste, texture, or mixed ingredients. “For most of my childhood, I went through life believing I was really sensitive to food, very particular, and that I’d grow out of it, but obviously that wasn’t the case,” she says. But for Arvidson, it was always more than simply picky eating. Her condition meant that she’d often skip activities centered around eating, whether that’s passing on ice cream with friends or eating before social events to avoid navigating unfamiliar food.
After over two decades of intense reactions to food, she was finally diagnosed with ARFID in 2022 at 25-years-old. Before her diagnosis, Arvidson had barely heard of the condition. But recently, ARFID has gained growing attention online, with some reports estimating a 305 percent increase in four years.
Experts, however, say ARFID isn’t necessarily becoming more common—just more widely recognized and hopefully, better understood. “What’s changed is that we finally have a name for it,” says Angela Derrick, PhD, a clinical psychologist, member of the Academy for Eating Disorders, and co-founder of SpringSource: Eating, Weight, & Mood Disorders. “Before 2013, when ARFID became an official psychiatric diagnosis, a lot of people were told they were just picky, dramatic, or needed to grow up and ‘just eat.'”
But what can look like pickiness from the outside often reflects something much more complex on the inside. Here’s what experts want you to know about ARFID and how to differentiate between having food preferences and something more.
Meet the experts: Angela Derrick, PhD, is a clinical psychologist, member of the Academy for Eating Disorders, and co-founder of SpringSource: Eating, Weight, & Mood Disorders. Christina Ni, MD, is a psychiatrist and interventional psychiatry medical director at Mindpath Health. Janet Lydecker, PhD, is an associate professor of psychiatry at Yale School of Medicine and director of Teen Program of Weight and Eating Research.
What is ARFID?
“ARFID is an eating disorder where someone significantly limits food intake, not because of body image concerns, but due to sensory sensitivities, fear of consequences such as choking or vomiting, or low interest in eating,” says Christina Ni, MD, a psychiatrist and interventional psychiatry medical director at Mindpath Health. For example, one person might avoid foods with certain textures, like anything mushy; another might stick to a very limited list of foods after a frightening choking experience; and another might simply find eating unappealing.
Because of how it looks on the outside, this condition is often missed and dismissed as childlike picky eating. “For a long time, ARFID was seen as a childhood condition, but we’re now understanding that many adults have had it for years without ever receiving a diagnosis,” Derrick says. Many have spent years quietly adapting to food-related challenges by carefully planning around meals, avoiding certain social situations, and masking their struggles. But now, as awareness of ARFID grows, more adults are recognizing themselves in the condition and seeking support for the first time.
Experts are still working to understand how common ARFID is, but current estimates suggest it affects roughly one to five percent of the general population, with higher rates among children and teens. It also appears more frequently in people who have autism, attention-deficit/hyperactivity disorder (ADHD), anxiety, or obsessive compulsive disorder (OCD), as well as in those who’ve had difficult physical experiences with food, such as an allergic reaction, reflux, vomiting, or choking, Derrick says.
“The connection with OCD is particularly interesting, because some people with ARFID have intrusive fears about contamination or something going wrong when they eat, which looks a lot like OCD thinking,” Derrick says. However, ARFID is its own diagnosis, because the avoidance is driven by sensory sensitivity, fear of physical consequences, or a low drive to eat—not in obsessive thought patterns themselves, she explains.
Signs and Symptoms of ARFID
Many people go through phases of picky eating or have strong food preferences, but ARFID goes far beyond that. “ARFID leads to meaningful impairment, including nutritional deficiencies, medical complications, stress, or disruption in daily functioning,” Dr. Ni says. “The defining feature isn’t simply selectivity, but the degree to which eating challenges interfere with health and quality of life.”
One way this can show up is through an extremely limited range of “safe” foods, says Janet Lydecker, PhD, an associate professor of psychiatry at Yale School of Medicine and director of Teen Program of Weight and Eating Research. People with ARFID typically rely on just a handful of foods, often chosen based on specific textures, colors, temperatures, or even particular brands.
For Arvidson, sensory sensitivities play a major role in what she can eat. “I’m really sensitive to taste, so I’m not interested in expanding my diet because I don’t want to eat any strong flavors,” she says. “I know it’s illogical, but it’s like my brain is scared of flavor.” Her safe foods include familiar, mild options like French fries, chicken breast, pizza, potato chips, and Goldfish crackers. She’s also highly sensitive to temperature, which means cold foods and drinks, including ice cream, fruits, vegetables, and ice water, are off the table.
But the effects of ARFID aren’t limited to just food itself. According to Derrick, everyday situations that involve food, like dining out, attending social events, or even having lunch at work, can feel overwhelming or sometimes impossible. This rings especially true for Arvidson, who shares that ARFID affects everything from her relationships and career to her ability to travel. Ultimately, it’s this level of disruption to daily functioning that most clearly distinguishes ARFID from ordinary picky eating.
How is ARFID diagnosed?
Diagnosing ARFID typically involves a comprehensive evaluation by a psychiatrist or therapist. It usually begins with a detailed conversation about a person’s eating habits, including what foods they do and don’t eat, the reasons behind those choices, any experiences that may have triggered or intensified the avoidance, and how their eating patterns affect daily life, Derrick says.
“Context matters a lot because it’s important to make sure the restriction isn’t better explained by something else, like anorexia, a medical condition, or cultural food practices,” Derrick says. Because of these complexities, she emphasizes the importance of a comprehensive evaluation during the diagnostic process.
That includes a medical exam, too. This helps identify nutritional deficiencies, assess overall health, and rule out any underlying physical conditions that could be contributing to the eating difficulties.
How to Cope With—and Treat—ARFID
The best treatment for ARFID depends on what’s driving the food avoidance in the first place. Someone who avoids certain foods because of sensory sensitivities, for example, may need a different approach than someone who fears choking, vomiting, or getting sick from eating, Lydecker says.
Even so, exposure-based cognitive behavioral therapy is considered one of the most effective treatments for ARFID. This approach helps people gradually build comfort and confidence around foods they typically avoid through small, manageable steps—without force or pressure or force, Derrick explains. The process is tailored to each person’s specific fears, experiences, or sensory challenges, and the overall goal is to safely and systematically reintroduce avoided foods, helping people build tolerance, flexibility, and trust over time. For example, a person who fears crunchy foods might start by touching or smelling them, then progress to holding a small bite in their mouth, and eventually eating larger portions over time.
From a neurological standpoint, exposure therapy helps the brain relearn that eating can be safe. “Through repeated low-pressure exposure, you’re essentially retraining the neural pathways involved in fear, sensory processing, and food avoidance,” Dr. Ni says. In some cases, anti-anxiety medication may also be used in combination with therapy, particularly when fear or nervousness is a significant contributing factor, Derrick adds.
Alongside clinical treatment, there are supportive strategies that can help make day-to-day eating feel more manageable. Creating predictable meal routines can reduce some of the anxiety that tends to build around food, Derrick says. It can also be incredibly validating to connect with other people who have ARFID through support groups or online communities. “For many people, it’s a relief to realize they’re not the only ones struggling,” Derrick says.
Still, because ARFID is often deeply-rooted, meaningful change usually requires more than self-help strategies. “If eating is causing you distress, affecting your health, or limiting your life in ways that matter to you, that’s enough to deserve support,” Derrick says. “ARFID is not a failure of will and understanding that there’s a clinical basis for what you’re experiencing can be a real turning point.”
That was certainly true for Arvidson. After years of believing she was simply a picky eater who should have outgrown her habits, a diagnosis finally gave her an explanation for what she had been experiencing all along. Today, while she still manages ARFID, she says understanding the condition and connecting with supportive people has made a significant difference. “Just knowing that what I experience is real, and that I’m not making it up, has been the most supportive thing,” she says.
Andi Breitowich