Avoidant Restrictive Food Intake Disorder

ARFID is persistent failure to meet nutritional needs due to avoidance or restriction of food (low interest, sensory sensitivity, fear of aversive consequences like choking or vomiting), without body image disturbance.

• Prevalence 3 to 5% in community; often in children, with autism, ADHD, anxiety, gastrointestinal disease, and about 5% to 22% of eating disorder clinic presentations.
• Presentations: sensory sensitivity, lack of interest, fear of aversive consequences.
• Complications: weight loss, growth failure, micronutrient deficiency, enteral feeding dependence, psychosocial impairment.

• Very limited repertoire of foods, picky eating, refusal to eat after choking or vomiting event, early satiety, poor appetite.
• Low weight or faltering growth, dependence on supplements or tube, amenorrhoea, bradycardia, fatigue.
• No fear of weight gain or distorted body image (distinct from anorexia nervosa).

• DSM-5 criteria and ARFID screening (NIAS, PARDI).
• Medical assessment: growth chart, BMI, vital signs, orthostatics, ECG, electrolytes (potassium, phosphate, magnesium), glucose, full blood count, ferritin, zinc, vitamin B12, folate, 25 hydroxyvitamin D, thyroid, coeliac serology.
• Exclude organic GI disease (coeliac, eosinophilic oesophagitis, reflux, motility), anorexia nervosa, depression, trauma, social anxiety, autism.
• Swallowing assessment when choking fear.

• Medical stabilisation and nutritional rehabilitation, with refeeding precautions (phosphate, thiamine 100 mg, potassium monitoring).
• CBT for ARFID (CBT-AR, 20 to 30 sessions), family based treatment for children, graded exposure to feared foods, food chaining.
• Oral supplements (1.5 kcal/mL), nasogastric feeding for severe malnutrition or when oral intake unsafe.
• Pharmacology: mirtazapine 7.5 to 30 mg at night to boost appetite, SSRI (sertraline 25 to 100 mg) for anxiety; cyproheptadine 2 to 4 mg for children with low appetite; olanzapine 2.5 mg in selected cases.
• Treat comorbid anxiety, autism, GI disorders; multidisciplinary team including dietitian.