- Avoid/Restrictive Food Intake Disorder (ARFID) is a feeding and eating disorder marked by an inability to eat enough to meet your energy or nutrient needs.
- This is a common point of confusion, as many young children go through phases of selective eating.
- The scientific literature has validated three primary types of ARFID, although in reality, many people may identify with more than one subtype.
- According to the DSM-5 diagnostic criteria, body image and ARFID are not supposed to co-occur, but in practice they often do.
- A diagnosis can feel like the disappointing news they’ve been waiting for, or it can be a freeing explanation for what they’ve been experiencing.
What is ARFID?
Avoid/Restrictive Food Intake Disorder (ARFID) is a feeding and eating disorder marked by an inability to eat enough to meet your energy or nutrient needs. It may show up as significant interference with daily functioning (e.g., not being able to go to school or work), weight loss without trying, not growing properly (for children/teens), nutrient deficiencies, or reliance on oral supplements (such as Ensure, Boost, or Sperri). It can affect children, teens, and adults.
What sets ARFID apart from many other eating disorders is the why behind the restriction. ARFID isn’t caused by dissatisfaction or obsession surrounding body image; it may stem from sensory sensitivities, low interest in food/eating, anxieties surrounding food, or a combination of these.
While not included in the diagnostic criteria, many people with ARFID still experience body image issues; the investigation of this overlap is ongoing in research. ARFID also shows up disproportionately in neurodivergent populations, and can shape how the ARFID subtypes present.
The overlap between ARFID and autism is well documented: one recent meta-analysis suggested that 11-16% of people with ARFID may also be autistic. The relationship between ARFID and other types of neurodivergence has received less attention, but ADHDers may also be more likely to have eating disorders including ARFID.
The “why” behind someone’s feeding disorder is more than a technicality; it is the foundation of effective treatment. This post explores how clinicians categorize the different types of ARFID, what treatment options exist, and why matching the approach to the subtype is important for successfully managing the types of ARFID.
What is the Difference Between Types of ARFID and Picky Eating?
This is a common point of confusion, as many young children go through phases of selective eating. The table below outlines some key differences between picky/selective eating and ARFID. We go even further into this distinction in much more depth in THIS blog, worth a read if you’re trying to figure out where you or a loved one’s eating falls on this spectrum.
An individual with ARFID might accept only a handful of foods and may avoid entire food groups or have strong restrictions around texture, smell, brand, temperature or appearance. These restrictions can make it difficult to meet nutritional needs or participate in everyday activities such as school lunches, birthday parties, eating at restaurants, or family meals.
Importantly, while ARFID includes impairments to daily functioning, it does not always result in a lower body weight. Someone with ARFID can have a “normal” or higher body weight, particularly when their limited diet relies heavily on energy-dense, processed foods. Weight alone therefore cannot rule ARFID in or out.
The key distinction isn’t simply how narrow someone’s food range is, but whether the restriction causes clinically significant nutritional, physical, or psychosocial consequences. This distinction gets harder to draw for neurodivergent kids and adults, whose selective eating is often dismissed as “just picky” for far longer, even when it meets the threshold for clinical impact.
What are the Types of ARFID?
The scientific literature has validated three primary types of ARFID, although in reality, many people may identify with more than one subtype.
| Types of ARFID – ARFID Subtype | What drives restriction? | What can this look like? |
| Sensory sensitivities | Avoidance is driven by sensitivity or overstimulation from a food’s texture, smell, taste, or appearance. These reactions are involuntary and are not simply a matter of preference or willfulness. | A child or adult may be unable to tolerate slimy, soft, or smooth textures, but readily accept crunchy or chewy textures. They may also avoid foods because of strong smells, specific colors, or the way foods look. |
| Lack of interest in eating | There is little to no interest in food or eating, which may involve low appetite, limited hunger cues, or difficulty recognizing the need to eat. An individual may also have hunger cues, but ignore them because eating feels like a chore. | A child may not ask for food even when mealtimes have passed, become extremely distracted during meals, or need reminders to eat. An adult might realize they have gone most of the day without eating and still have little desire for food. |
| Fear of adverse consequences | Restriction is driven by fear of choking, vomiting, pain, nausea, or an allergic reaction. This may develop after a frightening experience with food, although a specific incident is not always present. | After experiencing a choking episode, a child or adult may become afraid of eating hard or solid foods and begin avoiding them. Someone with severe food allergies may also restrict their diet because of fear of allergens or cross-contamination. |
An analysis of 319 children and adolescents diagnosed with ARFID examined the participants’ symptoms rather than assigning them automatically to one of the three DSM-5 subtypes.
It turned out that most participants identified with symptoms of more than one ARFID subtype. The authors called this a “combined presentation”and it was noted in 38.2% of the study participants. It was more common than any single-mechanism subtype on its own. The sensory sensitivity subtype was the next most common at 29.5% of participants, followed by lack of interest at 25.1%, and fear of aversive consequences at 7.2%.
The 2024 study has been supported by other studies which report mixed presentations of the types of ARFID in more than half of individuals with ARFID.
Another cross-sectional study of 261 patients found that symptoms from all three drivers commonly co-occur rather than sorting cleanly into one category, with eating problems spanning a wide range of BMIs.
As the 2024 analysis showed, many people with ARFID show behaviors in more than one category at once, meaning that the most common type of ARFID may actually be a combined/mixed presentation.
Some predictors are worth naming: the fear subtype skewed heavily female (nearly ~80%) and had the lowest body weight and shortest symptom duration of any class, whereas the lack of interest subtype tended toward older age at diagnosis and lower distress around eating compared to the fear group.
Autistic children showed more sensory sensitivities and greater lack of interest in eating than neurotypical kids, which is a large part of why the sensory and combined classes are where autism co-occurrences tend to concentrate.
The overlap between ARFID and autism can be substantial; eating and feeding disorders affect roughly a quarter of children generally but occur more than three times as often in neurodivergent children. Sensory sensitivities and mealtime-specific anxiety help explain why ARFID and autism co-occur so frequently, and why the sensory and fear subtypes in particular often look different in neurodivergent individuals.
Check out our blog post about the link between autism and ARFID.
At Jackie Silver Nutrition, we are a team of registered dietitian nutritionists who are equipped to support children and adults with autism and ARFID. We can support you, or your child, in managing nutritional deficiencies, gaining or maintaining weight, trying new foods, and finding ways to feed yourself that work for you. Book a FREE 15 minute discovery call today to see if we would be a good fit to support you.
What About ARFID Without Malnutrition?
Most descriptions of ARFID implicitly center the underweight, undernourished presentation. But that’s not the whole picture, based on what we see often in practice: individuals who land on the higher end of the weight spectrum can be due to their “safe foods” being higher in carbohydrates, fat, and sugar and lower in fruit, vegetables, or protein.
Dietary intake studies of children and adolescents with ARFID have found that their most commonly reported foods notably exclude fruits and vegetables altogether, with significantly higher intake of added sugars and total carbohydrates compared to healthy controls, alongside measurable gaps in micronutrients like vitamin K and B12.
In adults, research on ARFID across the weight spectrum has found people in larger bodies represent roughly a third to two-fifths of people studied (that’s 33% – 40%). Adults with ARFID and higher weight also reported higher symptoms of other types of eating disorders, and were more likely to have other health conditions (including depression, anxiety, mood disorders, gastrointestinal conditions, and metabolic conditions.
This matters clinically and diagnostically. The DSM-5 criteria for ARFID doesn’t require only underweight status, as psychosocial impairment or nutritional deficiency are each sufficient on their own to make an ARFID diagnosis. However, in practice, the field’s attention still skews toward whoever looks visibly malnourished.
This is an unfortunate reality in eating disorder care, where severity too often gets assigned based on body size rather than actual functional impairment or nutritional status.
Someone eating a narrow, processed-food-heavy diet can be nutrient-deficient, distressed around food, and functionally impaired, while their weight remains stable or increases.
Does Body Image Have a Place in ARFID Diagnosis/Treatment?
According to the DSM-5 diagnostic criteria, body image and ARFID are not supposed to co-occur, but in practice they often do. One of the ARFID diagnostic criteria states that it cannot be diagnosed if the eating disturbance is better explained by body image disturbance or a different restrictive eating disorder, like anorexia nervosa or bulimia nervosa. Yet, a growing body of research tells a different story.
A study in 2025 surveying over 5,700 adults who screened positive for ARFID found that adults with mixed ARFID and weight/shape-motivated restriction actually showed more severe ARFID symptoms than those without body image concerns. This research suggests that the current exclusion criteria may be keeping some of the most symptomatic patients from getting an accurate diagnosis and appropriate care.
What Can ARFID Treatment Look Like?
A diagnosis can feel like the disappointing news they’ve been waiting for, or it can be a freeing explanation for what they’ve been experiencing. Whichever camp you fall into, know that there is hope; there are many treatment options for the different types of ARFID, just like many other feeding and eating disorders.
Treatment can span the full range of eating disorder care, depending on your “why” and the severity you may be experiencing.
Across settings, the core goals stay consistent: restoring adequate nutrition, restoring weight if needed, and expanding the range of foods a person can eat without distress.
There are two main approaches to ARFID treatment:
1. Cognitive Behavioural Therapy for ARFID (CBT-AR)
- Developed specifically to target the three core motivations behind restriction and incorporate an individual-specific approach.
- The goal of the treatment is to move through 4 stages:
- Psychoeducation and early change: this stage involves a thorough assessment of eating patterns, habits, and nutritional status. The main goal of this stage is to develop an understanding of what keeps your ARFID going and how to establish regular eating even during the recovery process. This usually takes 1-4 sessions with the therapist or dietitian. At this stage, the focus will be on eating enough and eating consistently during the day, rather than trying new foods.
- Treatment planning: Based on the assessment, you identify which modules to focus on and create a personalized treatment plan. This is decided through sharing priorities and determining which mechanisms are most active in impacting your functioning and nutrition. This usually can be done in one to two sessions.
- Maintaining mechanism: This is the core phase of treatment where specific modules are delivered depending on your WHY behind ARFID. This stage will take up the main amount of treatment sessions. It will depend on the subtype(s) of ARFID you are experiencing, and may include practicing exposures to new foods; gaining awareness of appetite/hunger and fullness cues; working through distress related to eating; and more.
- Relapse prevention: focuses on maintaining gains, preparing for challenges, and developing a long-term plan to continue eating independently.
- Psychoeducation and early change: this stage involves a thorough assessment of eating patterns, habits, and nutritional status. The main goal of this stage is to develop an understanding of what keeps your ARFID going and how to establish regular eating even during the recovery process. This usually takes 1-4 sessions with the therapist or dietitian. At this stage, the focus will be on eating enough and eating consistently during the day, rather than trying new foods.
2. Family-Based Treatment for ARFID (FBT-ARFID)
- Adapts the family-based model long used in child/adolescent anorexia nervosa treatment
- It can be especially helpful for younger children as it empowers parents/caregivers to take an active role in re-establishing regular, adequate eating
- Parents and caregivers are instructed and mentored by the clinician on how to best support the individual with ARFID and move gradually towards adequate nutrition and eventual food exposures
A psychologist or other mental health professional can help someone with ARFID address the fear and anxiety surrounding eating. This may involve:
- Exposures to foods or scenarios in a controlled therapeutic environment (e.g., eating a meal or feared food in session)
- Coming up with helpful tolerance strategies and coping mechanisms, such as deep breathing, physical relief for gastrointestinal symptoms (heating pads, antacids)
- Challenging thoughts and beliefs related to food/eating (What did you think would happen when you ate this food? What actually happened?)
A doctor or psychiatrist can also assist with medications that can be supportive during ARFID treatment, such as anti-anxiety medications.
In addition to CBT-AR and FBT-ARFID, SOS and responsive feeding therapies are techniques which can be used to combat sensory or combined presentations of ARFID. These strategies focus more on sensory exploration of food and repeated exposures to support accepting new foods.
Conclusion: Types of ARFID
ARFID is not a one-size-fits-all disorder; it ranges across subtypes and if you add in the fact that body image can be a real concern, then it becomes clear why individualized assessment matters so much before treatment even begins.
When ARFID can be caught early, the individual will spend less time entrenched in avoidant patterns, will likely have a faster medical recovery, and can receive a treatment plan that actually targets their “why” behind restriction.
The consistent finding across research is that early identification and subtype-aware treatment lead to better long-term outcomes.
At Jackie Silver Nutrition, our team of dietitian nutritionists is trained to provide support to autistic and neurodivergent folks, people with ARFID, and more. Book a *FREE 15 minute discovery call today to learn about how we can work together to meet your goals. We provide non-judgemental care to children, teens, and adults and meet you where you are in your nutrition journey.
TL;DR – Types of ARFID
- ARFID is a feeding and eating disorder driven by sensory sensitivities, low interest in eating, and/or a fear of adverse consequences — not primarily driven by body image concerns
- Most people show a mix of these drivers rather than fitting neatly into one category, and ARFID overlaps substantially with autism.
- Unlike other eating disorders, ARFID isn’t defined by low body weight: people at higher weights make up roughly a third to two-fifths of adults studied, and often show more eating-disorder psychopathology and comorbidities, not less.
- Treatment (CBT-AR or FBT-ARFID, depending on age and presentation) works best when it’s matched to the specific “why” behind someone’s restriction.
Frequently Asked Questions (FAQ) – Types of ARFID
No. Picky eating usually involves a broad-but-limited food range that improves with age and doesn’t interfere with daily life. ARFID involves a much narrower range of accepted foods, can cause nutritional deficiencies or unintended weight change, and interferes with school, work, or social functioning.
Yes. ARFID is defined by the impairment it causes, not by body weight. Someone whose “safe foods” are energy-dense and processed can maintain or gain weight while still being nutrient-deficient and significantly distressed around food.
Not by DSM-5 criteria — ARFID is technically excluded if a body image disturbance better explains the eating pattern. In practice, though, body image concerns do show up in some people with ARFID, and emerging research suggests this overlap may be more common, and more clinically significant, than the criteria currently account for.
There’s substantial overlap. Sensory sensitivities and mealtime anxiety are common in autistic children, which is part of why ARFID occurs more than three times as often in neurodivergent kids compared to their neurotypical peers.
The two main evidence-based approaches are CBT-AR (Cognitive Behavioural Therapy for ARFID), used across ages and tailored to the specific driver of restriction, and FBT-ARFID (Family-Based Treatment), which is often used with younger children and involves parents/caregivers directly in the recovery process.
Related Articles:
- Why is ARFID in adults often missed?
- Autism and ARFID
- What is responsive feeding therapy?
- SOS Feeding Therapy
- 17 Food Chaining Examples
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About Maria
Maria is a third-year student in Nutritional Sciences and Human Biology at the University of Toronto. She is passionate about nutrition education and outreach and aims to pursue further education in health care. In her free time Maria enjoys volunteering, reading, and cooking.
About Jackie
Jackie is a Registered Dietitian whose mission is to empower and support the neurodivergent and physically disabled communities through nutrition. Jackie runs a virtual private practice, providing services in Ontario and New York, as well as a blog which has simple recipes and health information tailored to these communities. She loves cooking, exercising, traveling, journaling, and spending time with family and friends.
About Maurya
Maurya is a Registered Dietitian in Ontario who supports neurodivergent children, teens, and adults in meeting their nutrition goals. She brings experience in pediatrics, psychiatry, diabetes, and nephrology, and practices with a compassionate, weight-inclusive, client-centered approach. Alongside her work at Jackie Silver Nutrition, she is completing a Master’s thesis on pediatric nutrition and long-term health outcomes, and is committed to providing personalized, evidence-based care.
Disclaimers and disclosures
Medical Disclaimer: The information in this article is meant for educational purposes only. It is not intended to be personalized medical or nutrition advice. For a plan tailored to your needs, please consult with a Registered Dietitian or qualified healthcare professional.
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“What are the Types of ARFID and Treatment Options Available?” was written by Maria Aroca-Ouellette and edited/reviewed by Maurya Hart, MSc, RD and Jackie Silver MHSc, RD
Jackie Silver, MHSc, RD