Types of ARFID and their treatment

What is ARFID?

ARFID is an eating disorder that causes a person to severely limit their overall intake of food, to avoid specific foods, or both.

Unlike other eating disorders, ARFID is not a product of concerns about weight or body image, though. Instead, it occurs due to discomfort, fear, or lack of interest in food.

Doctors diagnose ARFID when a person’s food intake is limited to the degree that it consistently does not meet the person’s needs, which may manifest as:

• weight loss
• nutritional deficiencies
• reliance on supplements or tube feeding
• difficulty with mental or social functioning

The condition occurs most often in children, but it can affect people at any age, according to the National Eating Disorders Association.

ARFID often coexists with neurodivergence, such as autism or attention deficit hyperactivity disorder (ADHD), or mental health conditions, such as depression or anxiety disorders.

Are there different types of ARFID?

Officially, there are no distinct, medically recognized types of ARFID.

Doctors use manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5th revised edition (DSM-5-TR) to diagnose ARFID. The DSM-5-TR only includes one definition of the condition.

However, experts do recognize that there are differences in the motivations that drive ARFID. A 2024 study of children and adolescents with ARFID identified four presentations, or subtypes:

• fear subtype
• sensory subtype
• lack of interest subtype
• combined subtype

The following sections explore these in more detail.

Fear subtype of ARFID

The fear subtype of ARFID involves a fear of the consequences of eating food. For example, the person may have a fear of choking or vomiting.

These fears overlap with several phobias, such as emetophobia. However, while a person with emetophobia might be especially careful to avoid being sick, they will not necessarily do this by significantly limiting their diet in the way a person with ARFID does.

A person with the fear subtype of ARFID may:

• avoid specific foods that seem dangerous or risky
• only eat “safe” foods
• be afraid of eating in general, resulting in meal avoidance or eating much less than they need

The 2024 study found that people with the fear subtype of ARFID had the lowest body weight out of all subtypes, and nearly 80% of them were girls. The reasons for the higher number of girls than boys are unclear.

This subtype also had the shortest duration of symptoms.

Sensory subtype of ARFID

People with the sensory subtype of ARFID avoid foods mainly because of how it feels to eat them. They may be hypersensitive to the:

• texture
• temperature
• flavor
• smell

People with the sensory subtype may have more rigid eating patterns, limiting or excluding foods with a similar texture or smell, or requiring foods to be a specific temperature.

The authors of the 2024 study on ARFID found that the sensory subtype of ARFID was the second most common, affecting 29.5% of the participants.

Those who avoid foods based only on sensory qualities tend to have more varied body weights and may not always experience significant weight loss.

While autistic children can have any subtype of ARFID, previous research suggests they have greater sensory sensitivity than children who are not autistic.

Lack of interest subtype

A person with this ARFID subtype may avoid or limit food due to a lack of interest in eating. They may:

• not notice hunger cues
• not find food appetizing
• feel that eating is a chore
• only have interest in eating certain foods

The 2024 study found that children with the lack of interest subtype of ARFID had lower standard deviation scores for body weight. This means people with this subtype were more likely to have a lower-than-average body mass for their age.

In comparison to the fear subtype, people with this presentation of ARFID tend to have less anxiety and distress around food, and they are often older at the age of their diagnosis.

Combined subtype

The combined subtype of ARFID involves features from more than one of the above subtypes, or from all three. According to the 2024 study, it is the most common presentation of ARFID.

In that study of 319 children, 38.2% had the combined type. In comparison to the other forms, children with the combined type were more likely to:

• exclude more food groups
• have nutritional deficiencies
• rely on dietary supplements

Because many autistic children with ARFID have both sensory sensitivities and a lack of interest in food, many have the combined subtype.

Treatment for ARFID

ARFID is still a fairly new diagnosis in the DSM-5-TR, and research into treatments is still ongoing.

However, as with other eating disorders, treating ARFID often involves support from a variety of medical professionals, including primary care doctors, pediatricians, psychologists or psychiatrists, and dietitians. This helps to address both the physical and mental effects of the condition.

The main treatment currently is talk therapy. Some types of therapy that doctors may recommend include:

• Cognitive behavioral therapy for ARFID: This therapy focuses on identifying beliefs or thinking patterns that are contributing to ARFID, and then beginning to change them. It also teaches coping skills and relapse prevention.
• Family-based therapy for ARFID: This approach involves family or chosen family, who learn how to help loved ones reduce symptoms and establish balanced eating patterns.
• Supportive parenting for anxious childhood emotions for ARFID: This therapy focuses on helping parents or caregivers learn how to respond to children with ARFID, supporting them in becoming more flexible with food.

As research progresses, there may be different approaches for the different subtypes.

For example, while the fear subtype of ARFID may respond well to treatments for anxiety, researchers believe the underlying emotion for the sensory subtype is disgust, which may require a different approach.

For those with a lack of interest in food, certain medications may help increase appetite. Those with the combined type may benefit from several of the above therapies or support for coexisting conditions, if applicable.

When to seek help

ARFID is treatable, and people do not need to experience it alone. People who notice feelings of anxiety, distress, disgust, or a lack of appetite when they try to eat should speak with a doctor, particularly if these feelings result in:

• unintentional weight loss
• nutritional deficiencies, which may cause a wide range of symptoms
• difficulty at school, work, or in social situations
• problems with child growth or development

ARFID is not the only reason a person might experience these symptoms, so it is vital to get a diagnosis from a doctor. If a parent or caregiver is concerned about their child, they should also speak with a doctor or pediatrician as soon as possible.

Support for parents and caregivers

Looking after someone with ARFID can be distressing, as caregivers may worry their loved one is not getting enough to eat, or that they are to blame for this.

However, it is important to remember that ARFID is a medical condition that requires the help of professionals. Caregivers cannot treat it themselves, and they may need help, too.

If a parent or caregiver begins experiencing anxiety, anger, or has trouble coping, they should reach out for support.

Summary

Though there are no official, distinct types of ARFID, researchers have identified several factors that can drive the condition: lack of interest in food, fear of eating, and sensory sensitivities. People sometimes refer to these as subtypes.

People may have just one of these subtypes, or several. Some research suggests a combined subtype is the most common form.

Knowing the reasons behind ARFID may help people identify symptoms, get a diagnosis, or find the most helpful treatments. If a person has concerns that they or a child has ARFID, they should speak with a knowledgeable doctor.