What is ARFID in adults? ARFID (Avoidant/Restrictive Food Intake Disorder) in adults is a complex eating disorder characterized by a persistent restriction of food intake due to sensory sensitivities, lack of interest in eating, or fear of aversive consequences like choking, resulting in significant nutritional deficiencies and psychosocial impairment, distinct from body image concerns.
Understanding ARFID: Beyond Picky Eating
Avoidant/Restrictive Food Intake Disorder (ARFID) is often misunderstood, particularly in the adult population. While it was only formally introduced into the DSM-5 in 2013, the condition has existed for decades, often mislabeled as extreme picky eating or stubbornness. Unlike Anorexia Nervosa or Bulimia, ARFID is not driven by a desire to be thin or a distortion of body image. Instead, the restriction is driven by biological and psychological factors related to the food itself or the act of eating.
For adults in New Zealand struggling with this disorder, the journey is often lonely. You may have spent a lifetime masking your eating habits, avoiding dinner parties, or enduring ridicule for a “childish” palate. However, ARFID is a legitimate medical diagnosis that requires professional intervention.
Distinguishing ARFID from Picky Eating
It is crucial to differentiate between a selective eater and someone with ARFID. “Picky eating” is generally considered a normal phase of development in children or a personality quirk in adults that does not significantly impact daily functioning. A picky eater may dislike broccoli but can eat a wide variety of other vegetables and maintain a balanced diet. They can usually tolerate sitting at a table where disliked foods are served.
ARFID, conversely, is a clinical diagnosis. The distinction lies in the severity and the consequences. To meet the criteria for ARFID, the eating disturbance must lead to one or more of the following:
- Significant weight loss (or failure to achieve expected weight gain in children).
- Significant nutritional deficiency requiring supplements or enteral feeding.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
If your eating habits prevent you from accepting a job promotion because it involves travel and client dinners, or if you cannot attend a wedding because you fear the menu, this transcends picky eating. This is a disorder affecting your quality of life.
Adult ARFID Symptoms: Social Isolation and Nutritional Deficiencies
The manifestation of ARFID in adults is often more subtle than in children but can be more psychologically damaging due to the duration of the illness. Many adults with ARFID have developed sophisticated coping mechanisms to hide their disorder, which can delay diagnosis and treatment.
The Three Primary Drivers in Adults
Clinicians generally categorize ARFID presentations into three subtypes, though many patients experience a mix:
- Sensory Sensitivity: An intense aversion to specific textures, smells, tastes, or appearances of food. For an adult, this might mean only eating “beige” foods (bread, chips, crackers) because the texture of fruit or meat triggers a gag reflex.
- Fear of Aversive Consequences: This often stems from a traumatic event, such as a severe choking incident, a bout of norovirus, or a severe allergic reaction. The individual becomes terrified that eating will lead to death, pain, or illness.
- Lack of Interest: Some adults simply do not have a hunger drive. Eating feels like a chore or a bore. They may forget to eat for entire days until they feel physically faint.
Psychosocial and Physical Impact
The social isolation associated with adult ARFID is profound. Food is the centerpiece of most cultures, including the Kiwi culture of BBQs, fish and chips on the beach, and café brunches. Adults with ARFID often withdraw from social circles to avoid the embarrassment of not eating or the anxiety of having to explain their plate. This can lead to depression, anxiety disorders, and strain on romantic relationships.
Physically, the long-term effects of a restricted diet can be severe. Even if an adult maintains a “normal” weight (often through high-calorie, low-nutrient processed foods), they may suffer from:
- Severe Vitamin B12 and D deficiencies.
- Iron-deficiency anemia.
- Osteoporosis or osteopenia due to low calcium intake.
- Chronic fatigue and brain fog.
- Gastrointestinal distress (constipation is common due to low fiber).
Pediatric ARFID: Growth Stunting and Sensory Issues
In children, ARFID presents differently, primarily because children lack the autonomy of adults and are in a critical phase of physical development. While an adult body can sustain itself on a limited diet for some time, a child’s body requires a diverse array of nutrients for neurodevelopment and bone growth.
Failure to Thrive
The most alarming sign of pediatric ARFID is a stalling in growth charts. Parents often report that their child was a “good eater” until a certain age, or perhaps they struggled with feeding from infancy. When a child falls off their growth curve, medical intervention becomes urgent. Unlike adults who can rationalize their fears (even if they can’t overcome them), children often lack the vocabulary to explain why the texture of a banana feels like a physical assault.
Sensory Processing and Autism Overlap
There is a significant comorbidity between ARFID and neurodivergent conditions such as Autism Spectrum Disorder (ASD) and ADHD. For many children, the refusal to eat is not “behavioral” in the sense of acting out; it is a sensory regulation issue. The smell of cooking dinner might be overwhelming, or the complexity of a mixed stew might cause sensory overload. Treating pediatric ARFID often requires a multidisciplinary team including occupational therapists to handle the sensory integration aspect.
Critical Differences: Adults vs. Children
While the diagnostic criteria remain the same, the lived experience and treatment approach for ARFID differ vastly between age groups.
Autonomy and Motivation
Children: Treatment is usually initiated by parents. The child may not see their eating as a problem and may resist change vehemently. The goal is often to ensure growth and reduce family stress.
Adults: Treatment is self-initiated. Adults seek help because they are tired of the limitations the disorder places on their lives. They are often highly motivated but face stronger neural pathways; having avoided vegetables for 30 years makes the habit much harder to break than for a 5-year-old.
Treatment Modalities
For children, Family-Based Treatment (FBT) is often adapted for ARFID, placing the parents in charge of re-nourishment. For adults, Cognitive Behavioral Therapy for ARFID (CBT-AR) is the gold standard. This involves exposure therapy—systematically introducing fear foods in a safe environment—and cognitive restructuring to challenge beliefs about the dangers of food.
Finding Specialized Treatment in New Zealand
Navigating the mental health and dietetic landscape in New Zealand can be challenging, especially for a niche diagnosis like ARFID. Because ARFID is not weight-centric, patients often fall through the cracks of the public health system, which prioritizes low-BMI anorexia cases.
How to Find Help in NZ
If you suspect you or your child has ARFID, the first step is a GP visit to rule out physical causes (like swallowing difficulties or gastrointestinal issues). However, many GPs may still be unfamiliar with ARFID. It is helpful to bring printed information about the DSM-5 criteria.
Private vs. Public Sector:
In New Zealand, public funding for eating disorder services (via Te Whatu Ora) is often reserved for severe cases. Many adults with ARFID will need to seek private care. When looking for a provider, search for:
- NZ Registered Dietitians who specialize in “Non-Diet Approach” or specifically list ARFID. General weight-loss dietitians may do more harm than good.
- Clinical Psychologists trained in CBT-AR.
- Speech Language Therapists (for swallowing phobias or oral-motor issues).
Organizations like EDANZ (Eating Disorders Association of New Zealand) offer invaluable resources and directories for finding support. Telehealth has also opened up access, allowing patients in rural NZ to see specialists in Auckland or Wellington.
People Also Ask
Is ARFID a form of autism?
No, ARFID is not a form of autism, but there is a high comorbidity rate. Many people on the autism spectrum experience ARFID due to sensory processing sensitivities, but you can have ARFID without being autistic, and vice versa.
Can you develop ARFID as an adult?
Yes. While many cases start in childhood, adults can develop ARFID later in life, often triggered by a traumatic event such as choking, severe food poisoning, or an allergic reaction that creates a fear of eating.
How is ARFID treated in adults?
The primary treatment is Cognitive Behavioral Therapy for ARFID (CBT-AR). This involves education, exposure therapy (gradually tasting new foods), and addressing the anxiety maintaining the disorder. Nutritional counseling is also essential.
What foods do ARFID patients eat?
“Safe foods” vary by individual but are typically processed, consistent in texture, and bland. Common examples include white bread, crackers, french fries, plain pasta, and specific brands of chicken nuggets or yogurt.
Is ARFID covered by insurance in New Zealand?
It depends on the policy. Basic policies may not cover it, but comprehensive health insurance that includes specialist consultations and mental health support may cover dietetic and psychological treatment. Check if your policy covers “pre-existing conditions” if the issue is longstanding.
Does ARFID cause weight gain?
It can. While many associate eating disorders with weight loss, ARFID patients who rely heavily on processed, high-calorie “safe foods” (like chips and bread) to meet energy needs may maintain a normal weight or experience weight gain, despite being malnourished.