Avoidant Restrictive Food Intake Disorder (ARFID) is characterized by a persistent failure to meet appropriate nutritional or energy needs. This results in significant consequences, including nutritional deficiencies, reliance on supplements, or marked interference with psychosocial functioning. Unlike disorders such as Anorexia Nervosa, ARFID restriction is not driven by a fear of gaining weight or body shape concerns. Instead, food avoidance is rooted in sensory sensitivities, a general disinterest in eating, or a fear of aversive consequences like choking or vomiting.
Evidence-Based Psychotherapies for ARFID
Treatment focuses on systematically addressing the psychological and behavioral factors that limit food intake and variety. Cognitive Behavioral Therapy for ARFID (CBT-AR) is a primary evidence-based approach. It is designed to target the three core mechanisms: sensory sensitivity, low appetite, and fear of adverse consequences. CBT-AR begins with psychoeducation, helping the patient and family understand the disorder and how avoidance behaviors maintain it.
The core of CBT-AR involves graduated exposure and response prevention (ERP) to reduce anxiety associated with eating new foods. A hierarchy of challenging foods is created, and the patient is systematically exposed to the sight, smell, touch, and taste of these foods in a controlled setting. Behavioral techniques like “food chaining” are often employed. This involves introducing a new food that shares a sensory property with an already accepted food to facilitate expansion of the accepted repertoire.
For children and adolescents, Family-Based Treatment for ARFID (FBT-ARFID) empowers parents to take an active role in the refeeding process. Modeled after the approach used for adolescent Anorexia Nervosa, FBT-ARFID focuses on parental support to normalize eating patterns and increase the volume and variety of food consumed. This approach relies on parental authority to manage mealtime challenges and reduce the patient’s reliance on safety behaviors. FBT-ARFID can be effective for weight gain in younger patients.
Addressing Nutritional Deficiencies and Growth
A thorough medical and nutritional assessment is required to manage the physical consequences of ARFID, such as malnutrition and growth failure in children. The initial step is a comprehensive medical workup, including laboratory tests to identify micronutrient deficiencies and check for medical instability. Common deficiencies are often specific to the restricted food groups, including Vitamins B1, B12, C, and K, and minerals such as zinc, iron, and potassium.
Nutritional rehabilitation prioritizes correcting these deficiencies and ensuring adequate caloric intake for weight restoration and catch-up growth in youth. The Registered Dietitian calculates the patient’s estimated energy needs and develops a meal plan. This plan initially focuses on increasing the volume of foods the patient already accepts to stabilize physical health by providing sufficient macronutrients.
In severe cases, where oral intake is insufficient to prevent medical compromise or achieve safe weight gain, supplemental feeding may be necessary. Nasogastric (NG) tube feeding is a temporary intervention used in inpatient or residential settings to deliver a controlled nutritional formula. Clinicians consider this option cautiously in ARFID, as it can be a highly aversive experience that may worsen underlying oral sensitivities or fear-based avoidance.
Structuring the Multidisciplinary Treatment Team
Effective ARFID treatment requires a coordinated, multidisciplinary team approach to address medical, nutritional, and psychological aspects simultaneously. The core team consists of a medical doctor or pediatrician, a registered dietitian (RD), and a mental health specialist. Each professional provides specialized care that is integrated to ensure cohesive patient management.
The medical professional monitors the patient’s physical stability by tracking vital signs, lab results, and growth charts, while managing complications from malnutrition. The specialized ARFID dietitian designs and manages the nutritional rehabilitation plan, focusing on calculating caloric targets and developing strategies to introduce new foods. The mental health specialist uses CBT-AR or FBT-ARFID to focus on the behavioral and anxiety-related components, guiding the exposure process and providing psychological support.
The appropriate setting for treatment depends on the patient’s medical stability and the severity of restriction, following a continuum of care. Medically stable patients with good family support often begin with Outpatient treatment. More severe restriction, significant weight loss, or unstable medical markers may necessitate Intensive Outpatient (IOP) or Residential/Inpatient treatment. These higher levels of care provide 24/7 medical supervision and structured meal support before the patient transitions back to community-based treatment.