You probably know someone who is a “picky eater,” likely a child. However, adults can be picky eaters too. Picky eating is not usually a concern if you are healthy and capable of meeting your responsibilities at home, work, school, and socially. However, for some, picky eating becomes extreme and eventually creates daily challenges.

You may wonder at which point picky eating turns into something more serious.

Think of picky eating as being on a spectrum. On one end, a person may have mild symptoms. On the other, they may have severe symptoms. When your symptoms become severe enough to start interfering with your daily function, you have likely gone beyond picky eating and developed an eating disorder known as avoidant restrictive food intake disorder (ARFID). 1

What Is ARFID in Adults?

Avoidant Restrictive Food Intake Disorder in adults is one of the newer eating disorders.2 Since 2013, it has been in the fifth edition of the diagnostic and statistical manual of mental disorders (DSM5). Unlike other eating disorders, weight loss and body image are not typically issues for adults with ARFID.

The DSM5 lists the criteria used to diagnose someone with ARFID, including:2

  • Lacking interest in food
  • Refusing to eat
  • Avoiding certain foods
  • Fearing the consequences of eating

Additionally, someone is experiencing nutritional and energy deficiencies due to their symptoms. According to the DSM5, they must have one or more of the following:2

  • Deficiencies in essential nutrients
  • Dependence on a feeding tube or supplements
  • Impaired social and psychological skills

Significant weight loss not due to another psychological or physical condition, including another eating disorder, must not be present.2

ARFID in Adults Quick Facts

Research is lacking on ARFID, especially among adults. Currently, the limited studies available reveal the following key points:3

  • 9.2% of adults with eating disorders have ARFID.
  • Being sensitive to food traits is the most common reason for ARFID.
  • Lack of interest in food is the second most common reason for ARFID.
  • ARFID affects women more than men, which is the opposite for children and adolescents.

Who Gets Adult ARFID?

The reasons adults develop avoidant restrictive food intake disorder have yet to be fully discovered by researchers since the disorder is relatively new. However, there are some commonalities worth noting.

Someone with autism, attention deficit hyperactivity disorder, intellectual disabilities, and pre-existing psychological disorders, such as anxiety or obsessive-compulsive disorder, have a higher rate of developing ARFID. Someone who has had a negative experience with food, such as choking, may avoid that food if it triggers memories of the experience. If food is followed by pain, like acid reflux, a person may avoid those foods or stop eating them altogether.4

Do I Have an Eating Disorder?

If you suspect you might have an eating disorder or are struggling with your body image or eating habits, we’ve created a quiz to help you learn more.

What Are the Symptoms of ARFID in Adults?

Avoiding and restricting behaviors can lead to severe physical and mental health complications. You must be able to recognize the symptoms of ARFID in adults, like the ones below:5

  • Eating small amounts of food.
  • Eating foods that have the same texture, smell, taste, or color.
  • Having a fear or phobia about eating certain foods.
  • Lacking interest in food or eating.
  • Showing distress around food or when it is time to eat.
  • Losing weight or failing to gain weight.
  • Lacking nutrients.
  • Experiencing gastrointestinal issues or oral motor delays.

The longer the symptoms persist, the more likely you will experience physical complications, such as delayed puberty, unwanted weight gain, muscle or bone weakness, loss of the menstrual cycle, dehydration, low blood pressure, or a weak pulse.

Self-Assessment: Is It Adult ARFID or Picky Eating?

Only a licensed mental health professional can determine if symptoms are due to picky eating or avoidant restrictive food intake disorder in adults. If you are unsure whether you should seek the advice of a professional, look at the following statements. The more statements that apply to your food intake, the more likely you have a food disturbance and should seek professional guidance.6

  • Other people say you are a picky eater or comment on your eating habits.
  • You eat a lot fewer foods than family or friends.
  • You avoid certain foods because of texture, smell, appearance, temperature, color, or taste.
  • You fear choking or getting sick due to certain foods.
  • Trying new foods makes you highly uncomfortable.
  • You avoid events and activities that provide food.
  • You have health problems due to your eating habits.
  • You aren’t interested in food or eating.
  • The list of foods you will eat is getting shorter.
  • Your eating habits affect other areas of your life, such as relationships, work, social, school, etc.
  • You have nutritional deficiencies due to your eating habits.
  • You have lost weight due to your eating habits.

Treatment of ARFID in Adults

Knowing what to expect when seeking treatment for avoidant restrictive food intake disorder can reduce most people’s anxiety. Treatment begins with a phone call or online chat with a local mental health treatment center. They will take some basic information about why you are calling and then schedule a comprehensive evaluation. The process includes some or all of the following.7

Comprehensive Evaluation

At the initial evaluation, you will meet with a licensed mental health professional who can assess and diagnose your symptoms, if appropriate. The evaluation will cover information about your past and present eating habits, genetics, biology, and family mental health.

Lab tests to check vitamin and nutrient levels, thyroid function, hormones, gastrointestinal function, inflammation, and blood cell counts will also be taken and evaluated to rule out other causes of your symptoms.

The evaluation gives your doctor or therapist the information they need to create a treatment plan.

Stabilization

Depending on how your eating habits have affected your body, where you begin treatment can range from inpatient intensive to outpatient care. The goal is to stabilize so no further damage occurs. For some, medication may be needed, such as medicine for anxiety.

Inpatient stabilization may be necessary if heart-related issues, like bradycardia, exist. Other factors include body temperature, blood pressure, dehydration, medical complications, and orthostasis.

Restoring Weight, Growth, and Nutrition

A mental health professional and physician will analyze your body mass index and the degree of malnutrition and set a healthy goal weight. Specific steps will support each goal to ensure you reach those goals.

Restoring physical health is only one part of treatment. You must also heal psychologically.

Restoring Mental Health

Behavioral interventions are effective for treating ARFID in adults. Examples of therapies that work include family-based treatment, cognitive-behavioral therapies, exposure therapy, dialectical-behavioral therapy, and psychoeducation. Creating an aftercare and relapse prevention plan to follow once you complete the program ensures you have support in your home environment.8

You Can Overcome Adult ARFID

Working with a mental health specialist who specializes in eating disorders can help you overcome ARFID. Not only can you get back to a healthy weight and proper nutrition levels by implementing healthy eating patterns, but you can also learn to enjoy new foods without experiencing fear and anxiety.

If you are ready to learn more about overcoming adult avoidant restrictive food intake disorder, call Virtue Recovery Center. We are here 24/7, so you don’t have to wait to get answers to your questions.

Resources:

  1. Zickgraf, H. F., Franklin, M. E., & Rozin, P. 2016. Adult Picky Eaters with Symptoms of Avoidant/Restrictive Food Intake Disorder: Comparable Distress and Comorbidity but Different Eating Behaviors Compared to Those with Disordered Eating Symptoms. Journal of Eating Disorders, 4, 26.
  2. Substance Abuse and Mental Health Services Administration. 2016. DSM-5 Changes: Implications for Child Serious Emotional Disturbance.
  3. Grajek, M.K., Bialek-Dratwa, A., Szymanska, D., Krupa-Kotara, K.H., & Szczepanska, E. 2022. Epidemiology and Consequences of ARFID.
  4. National Eating Disorder Association. 2022. Avoidant Restrictive Food Intake Disorder.
  5. Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current Psychiatry Reports, 19(8), 54.
  6. Seetharaman, S., & Fields, E. L. 2020. Avoidant/Restrictive Food Intake Disorder. Pediatrics in Review, 41(12), 613–622.
  7. Thomas, J. J., Wons, O. B., & Eddy, K. T. 2018. Cognitive-Behavioral Treatment of Avoidant/Restrictive Food Intake Disorder. Current Opinion in Psychiatry, 31(6), 425–430.
  8. Thomas, J. J., Becker, K. R., Breithaupt, L., Murray, H. B., Jo, J. H., Kuhnle, M. C., Dreier, M. J., Harshman, S., Kahn, D. L., Hauser, K., Slattery, M., Misra, M., Lawson, E. A., & Eddy, K. T. 2021. Cognitive-Behavioral Therapy for Adults With Avoidant/Restrictive Food Intake Disorder. Journal of Behavioral and Cognitive Therapy, 31(1), 47–55.

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