ARFID, or Avoidant/Restrictive Food Intake Disorder, is an eating disorder that goes beyond typical picky eating. People with ARFID have significant difficulty eating enough food, a wide enough variety of foods, or both. It is not about body image or weight loss. It can stem from sensory sensitivities, a fear of adverse reactions to food, or a lack of interest in eating. Left unaddressed, ARFID can affect physical and mental health at any age.
ARFID is a clinically recognized eating disorder. It develops through a mix of environmental and genetic factors, and it is not a choice or a phase. Sessions are available in person and online.
ARFID looks different from person to person. These are common signs, grouped by type.
ARFID can affect growth and health, so a medical evaluation is an important part of care. If someone is fainting, has chest pain, or is refusing all food and fluids, seek medical care right away.
Physical Symptoms
Behavioral Symptoms
Emotional Symptoms
ARFID can lead to physical symptoms when the body does not get enough nutrition. They vary with severity, duration, and which nutrients are lacking.
Weight loss, or not gaining weight and height as expected (falling off the growth curve in children)
Low body weight
Fatigue and low energy
Signs of malnutrition, such as dry skin, brittle nails, hair loss, or pale skin
Slow wound healing and frequent illness
Feeling cold more than usual
Digestive problems, such as constipation, abdominal pain, bloating, or reflux
Nutrient deficiencies, such as anemia, electrolyte imbalances, or vitamin deficiencies
Slow heart rate, low blood pressure, or poor circulation
Muscle weakness and loss of muscle mass
Bone health concerns
Delayed or missing menstrual periods
Difficulty concentrating and trouble sleeping
The behavioral signs of ARFID show up in how a person approaches food and eating. They go beyond ordinary picky eating and tend to intensify over time.
Limited variety: Eating a narrow range of preferred “safe” foods
Sensory-based avoidance: Rejecting foods by color, texture, smell, temperature, or consistency
Fear-based avoidance: Refusing foods after a negative experience, such as choking, vomiting, or an allergic reaction, or because of an expected one
Little interest in eating: Low appetite, forgetting to eat, or general disinterest in meals
Picky eating that gets worse over time: Food choices that become narrower rather than broader
Difficulty with social eating: Avoiding shared meals, refusing to eat at school or gatherings, or eating very little in front of others
Long mealtimes: Taking a very long time to eat because of reluctance or difficulty swallowing
Specific brands or preparations: Eating a food only if it is a certain brand or prepared a particular way
Hiding or discarding food
Refusing new foods
Needing distractions to eat: Such as TV, reading, or games
Chewing or swallowing difficulties that affect how much a person eats
Relying on supplements: Shakes or bars in place of solid foods
ARFID is not driven by concerns about weight or body shape. These emotional signs often surround mealtimes and the prospect of eating unfamiliar foods.
Anxiety or distress around food: Strong anxiety, panic, or distress around mealtimes, new foods, or feared foods
Irritability or frustration when pressured to eat non-preferred foods
Social anxiety: Feeling anxious or embarrassed about eating in front of others
Fear of choking, vomiting, or illness while eating, often after a distressing experience
Low mood or low energy, which can come with poor nutrition
Thoughts about food safety or sensory qualities, rather than calories or weight
ARFID Treatment
ARFID behaviors, such as avoiding certain foods or fearing eating, can come from underlying emotional concerns, including past food-related trauma. For neurodivergent people, they often relate to broader sensory sensitivities. Because ARFID shows up differently in each person, no single approach fits everyone.
At PPG, we tailor treatment to each person’s needs, challenges, and circumstances. Care draws on approaches such as cognitive behavioral therapy for ARFID (CBT-AR), and for children and teens, parent-supported approaches such as SPACE. We coordinate with registered dietitians, medical providers, and therapists to restore physical health and build sustainable plans for the long term. The work is always collaborative.
What to Expect
Initial Consultation
We talk through your concerns or your child’s, and answer your questions about how treatment works.
Assessment
Your clinician reviews eating patterns, food preferences, growth and health history, and any sensory or anxiety concerns.
Treatment Plan
Together we set goals and decide who should be involved, such as parents, a dietitian, or a medical provider.
Ongoing Review
We review progress regularly and adjust the plan as needs change.
Care That Connects Across Specialties
ARFID often overlaps with anxiety, ADHD, and sensory differences, and our clinicians coordinate care when it does.
ARFID, or Avoidant/Restrictive Food Intake Disorder, is an eating disorder in which a person eats too little food or too narrow a range of foods. It can come from sensory sensitivities, fear of adverse reactions to food, or low interest in eating.
How is ARFID different from picky eating?
Picky eating is common in childhood and usually does not affect growth, health, or daily life. ARFID involves restriction severe enough to cause nutritional deficiencies, weight or growth concerns, reliance on supplements, or significant disruption at home, school, or in social settings.
Is ARFID about body image or weight?
No. Unlike anorexia, ARFID is not driven by concerns about weight or body shape.
Who does ARFID affect?
ARFID can affect people of any age. It often begins in childhood and can continue into adulthood. It frequently occurs alongside anxiety, ADHD, or autism.
How is ARFID treated?
Treatment is tailored to the person and often includes cognitive behavioral therapy for ARFID (CBT-AR), with support from a dietitian and medical provider. For children and teens, parents are involved in treatment.
What is the role of parents in treatment?
For children and teens, parents help support progress between sessions. Approaches such as SPACE focus on reducing accommodations around food and responding to anxiety in ways that help children build flexibility.
Do you offer a group for ARFID?
Yes. We offer a collaborative ARFID group for adolescents and caregivers. Contact us for current dates and details.
Can I attend sessions online?
Yes. Sessions are available in person at our Chappaqua and Hartsdale offices and by secure video.
What if there is an emergency?
PPG provides outpatient care and is not an emergency service. If you are having thoughts of harming yourself, call or text 988, the Suicide & Crisis Lifeline, at any time. If you or someone you care about has chest pain, fainting, a very fast or irregular heartbeat, is refusing all food and fluids, or you are in immediate danger, call 911. For eating disorder information, support, and referrals, you can also call the National Alliance for Eating Disorders helpline at 866-662-1235, Monday through Friday, 9 a.m. to 7 p.m. Eastern Time.
