Understanding ARFID: When Eating Challenges Go Beyond “Picky Eating”

For people living with eosinophilic esophagitis (EoE), food can be complicated. Elimination diets, fear of symptoms, texture sensitivities, and swallowing discomfort can all impact a person’s experience with eating. In some cases, these challenges may overlap with or contribute to a condition known as Avoidant/Restrictive Food Intake Disorder (ARFID).

What Is ARFID?

ARFID is an eating disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Unlike anorexia nervosa or bulimia, ARFID is not driven by body image concerns. Instead, it involves restrictive eating patterns that result in one or more of the following:

• Significant weight loss or failure to achieve expected growth (in children)
• Nutritional deficiencies
• Dependence on supplements or tube feeding
• Interference with social or daily functioning

People with ARFID may avoid foods due to sensory sensitivities (texture, smell, taste, appearance), or fear of choking, vomiting, or pain. They may show lack of interest when it comes to eating, or have a poor appetite.

Why This Matters in the Eosinophilic Community

Many people with EoE and other eosinophilic gastrointestinal diseases already navigate dietary restrictions to manage their disease. For some, repeatedly experiencing pain, food impactions, allergic reactions, or dietary restrictions can create anxiety around eating. Over time, this may lead to highly restricted food intake that goes beyond what is medically necessary.

Signs to Watch For

Families and caregivers may notice:

• A shrinking list of “safe” foods
• Avoidance that extends beyond prescribed food eliminations
• Anxiety or distress at mealtimes
• Avoidance of eating in social settings
• Poor growth or nutrient deficiencies

If eating challenges are affecting growth, nutrition, or quality of life, it’s time to seek additional support.

Diagnosis and Treatment

ARFID is typically diagnosed by a qualified mental health professional or physician familiar with eating disorders. Treatment often involves a multidisciplinary approach, which may include:

• A gastroenterologist or allergist (to manage the eosinophilic gastrointestinal disease)
• A registered dietitian with experience in both GI disease and eating disorders
• A mental health provider trained in evidence-based therapies such as cognitive behavioral therapy for ARFID

Addressing anxiety, sensory sensitivities, and nutritional gaps can improve both physical health and overall well-being.

It can be challenging to distinguish between medically necessary food avoidance and disordered eating. If you have concerns about restrictive eating patterns, talk with your healthcare team.

Resources

• APFED’s Specialist Finder
• Research study: Avoidant Restrictive Food Intake Disorder in Adults With Eosinophilic Esophagitis
• Research study: Avoidant and Restrictive Food Intake Disorder Among Children With Eosinophilic Esophagitis

Did You Know?

February 23-March 1 is National Eating Disorders Week.