The Seriousness of Being a Picky Eater: ARFID

Picky eaters-- we all had that one childhood friend who never ate certain foods, or perhaps we were that picky eater. The term ‘picky eater’ has been used so colloquially that the seriousness of its implications in adulthood are often overlooked. Even in childhood, this is normally dealt with lightly-- we tend to assume that the child will eventually eat when they are hungry, and that avoiding certain foods is just a phase. However, being a picky eater is sometimes not just a phase in a child’s life. It can be signs of avoidant/restrictive food intake disorder (ARFID), which has been added to the DSM-V in 2013. Although we commonly think of bulimia or anorexia as common eating disorders, ARFID is also a mental disorder, but with trauma-based causes instead of those related to self-esteem and perception of one’s body image.

ARFID may stem from infancy, especially with premature babies who have spent time in the NICU with tubes in both their noses and mouths. A choking incident can be a trigger for ARFID, as it associates objects in the mouth with the choking. Other causes are also trauma-based, to the point where it convinces one that food is dangerous and potentially deadly. Those with ARFID truly believe that food, especially if in their mouths, will lead to death. This raises the significance of recognizing this disorder, because food is necessary for survival and health. Of course, those who were mere picky eaters in childhood can face an exacerbation of symptoms and develop ARFID. However, it is important to recognize that being a picky eater does not necessarily mean one has ARFID.

Social anxiety is a condition that may be present as well, especially with certain social events involving eating and dining. ARFID is therefore more than just picky eating-- it can be severe to the point of affecting one’s social life and skills. On a related note, those with autism spectrum conditions and ADHD are more likely to suffer from this type of eating disorder as well. Additionally, the diet is very limited for one with ARFID; there can be about 20 to 30 items that one would only eat, but the list gradually shortens as time goes by. There is unwillingness to try new foods, as the individuals have the genuine concern of food being harmful and dangerous. This leads to either severe malnourishment or to obesity, depending on which foods are only being consumed, as well as other physical symptoms.

While ARFID is treatable, it is important to remember that it can not be treated like other eating disorders. Food exposure, which may work with anorexia, does not apply to ARFID and can in fact exacerbate symptoms. It helps if one is motivated to overcome ARFID and is willing to change their lifestyle. This is especially true for teenagers, as social life can be heavily impacted by this disorder. Unlike other disorders, where medication can be prescribed, ARFID is treated better when interacting with therapists, nutritionists, and psychiatrists. Effective treatment includes cognitive behavioral treatment, perhaps in conjunction with anxiety treatment if applicable. Group therapy and having meals in groups has also been found to be helpful. While eating disorders are definitely of serious concern, they can also be treated and overcome if there is a proper diagnosis, motivation to accept change, and proper treatment.


Stephanie Chan