Avoidant restrictive food intake disorder, more commonly known as ARFID, is a condition characterised by the person avoiding certain foods or types of food, having restricted intake in terms of overall amount eaten, or both.Someone might be avoiding and/or restricting their intake for a number of different reasons. The most common are the following:

• They might be very sensitive to the taste, texture, smell, or appearance of certain types of food, or only able to eat foods at a certain temperature. This can lead to sensory-based avoidance or restriction of intake.
• They may have had a distressing experience with food, such as choking or vomiting, or experiencing significant abdominal pain. This can cause the person to develop feelings of fear and anxiety around food or eating, and lead to them to avoiding certain foods or textures. Some people may experience more general worries about the consequences of eating that they find hard to put into words, and restrict their intake to what they regard as ‘safe’ foods. Significant levels of fear or worry can lead to avoidance based on concern about the consequences of eating.
• In some cases, the person may not recognise that they are hungry in the way that others would, or they may generally have a poor appetite. For them, eating might seem a chore and not something that is enjoyed, resulting in them struggling to eat enough. Such people may have restricted intake because of low interest in eating.

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Because ARFID includes a range of different types of difficulty that contribute to the avoidance or restriction of food intake, there is a wide range of possible signs and symptoms, not all of which would necessarily occur in one person. Possible signs of ARFID include:

• Eating a reasonable range of foods but overall having much less food than is needed to stay healthy.
• Finding it difficult to recognise when hungry.
• Feeling full after only a few mouthfuls and struggling to eat more.
• Taking a long time over mealtimes/finding eating a ‘chore’.
• Missing meals completely, especially when busy with something else.
• Sensitivity to aspects of some foods, such as the texture, smell, or temperature.
• Appearing to be a “picky eater”.
• Always having the same meals.
• Always eating something different to everyone else.
• Only eating food of a similar colour (e.g. beige).
• Attempting to avoid social events where food would be present.
• Being very anxious at mealtimes, chewing food very carefully, taking small sips and bites, etc.
• Weight loss (or in children, not gaining weight as expected).
• Developing nutritional deficiencies, such as anaemia through not having enough iron in the diet.
• Needing to take supplements to make sure nutritional and energy needs are met.

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