Unlike anorexia or bulimia, individuals avoid or severely restrict food because of sensory sensitivities (to taste, smell, or texture), lack of interest in eating, or a deep fear of choking or vomiting.
Published Aug 29, 2025 | 7:00 AM ⚊ Updated Aug 29, 2025 | 7:00 AM
The condition may affect up to three to five percent of the population, but many cases go unrecognised due to lack of awareness.
Synopsis: Avoidant/restrictive food intake disorder (ARFID) is a little-known eating disorder that may affect up to five percent of the population, in which individuals avoid or severely restrict food due to sensory sensitivities, lack of interest in eating, or fear of choking and vomiting, rather than concerns over body image. Doctors say ARFID is frequently mistaken for picky eating or gastrointestinal issues, but stress that help is available and recovery is possible when the condition is diagnosed early.
When people hear the words eating disorder, what usually comes to mind are anorexia nervosa or bulimia: conditions where concerns over body image, fear of weight gain, and obsessive calorie control drive harmful eating behaviours.
But there is another disorder, far less recognised, that can be just as debilitating – one where the struggle is not with the mirror, but with food itself. It is called avoidant/restrictive food intake disorder (ARFID).
Unlike anorexia or bulimia, ARFID is not linked to body-image concerns. Instead, individuals avoid or severely restrict food because of sensory sensitivities (to taste, smell, or texture), lack of interest in eating, or a deep fear of choking or vomiting.
“ARFID is an eating disorder where individuals eat too little or avoid many foods, not because of body-image concerns but due to lack of interest in food, fear of choking/vomiting, or sensitivity to taste, smell, or texture. Although more common in children, it can persist into adulthood,” explains Dr Sudhir Kumar, neurologist at Apollo Hospitals, Telangana.
According to published studies, ARFID may affect up to three to five percent of the population, but many cases go unrecognised due to lack of awareness. It can cause serious health consequences, including poor growth in children, nutrient deficiencies, weakened immunity, low energy, and emotional distress.
Recent research suggests ARFID may be more widespread than once thought. A 2023 global study published in the Journal of Eating Disorders, analysing more than 50,000 adult respondents, found that 4.7 percent screened positive for ARFID – a figure higher than anorexia nervosa.
Alarmingly, many reported suicidal thoughts, yet very few had sought or received treatment.
In another large-scale neuroimaging study in the Netherlands, 6.1 percent of ten-year-old children displayed ARFID symptoms, with brain scans showing distinct differences in the frontal cortical regions compared to children without symptoms. This points to possible neurobiological underpinnings of the disorder.
Meanwhile, a 2024 case series from Christian Medical College, Vellore, highlighted the challenges of diagnosing ARFID in Indian adolescents, where food avoidance was often mistaken for gastrointestinal problems or dismissed as “picky eating.”
The study also noted the effectiveness of family-based therapy and cognitive behavioural therapy in treating ARFID in Indian clinical settings.
Doctors warn against confusing ARFID with ordinary picky eating, especially in children. While many children outgrow food fussiness, ARFID persists and leads to nutritional deficiencies, growth delays, weakened immunity, and emotional strain.
Adults with ARFID may struggle with fatigue, social isolation, and disruption in work and daily life.
Diagnosing ARFID in India can be difficult, as it is often mistaken for ordinary picky eating or gastrointestinal problems. Doctors here rely largely on clinical evaluation, looking for red flags such as weight loss or poor growth in children, nutrient deficiencies, reliance on supplements, or disruption of daily life.
The key difference from anorexia or bulimia is that ARFID is not rooted in body-image concerns, but in sensory aversions, lack of appetite, or fear of choking and vomiting.
While structured tools such as the Nine-Item ARFID Screen or the PARDI interview are used internationally, they are not yet common in India.
Instead, paediatricians, psychiatrists, and neurologists diagnose ARFID through detailed history-taking, growth monitoring, and blood tests for nutritional deficiencies.
At large tertiary centres such as NIMHANS, AIIMS, or CMC Vellore, psychological assessments and therapies like family-based treatment or cognitive behavioural therapy are increasingly being used. Elsewhere, nutritional rehabilitation and counselling remain the first line of management.
Dr Ganesh H, a gastroenterologist from Hubballi, told South First: “Few parents complain that their child hesitates to eat foods like Pongal, khichdi, bisibelebath etc and it could be the texture that the child here is rejecting. Though this could be for other reasons too, we doctors do look at the possibility of ARFID.”
The good news, doctors say, is that help is available. Awareness is the first step. With the right interventions such as nutritional rehabilitation, therapy to address food fears, and gradual exposure to varied foods, recovery is possible.
“Treatment involves nutritional rehabilitation, counselling to reduce food-related anxiety, and gradual, guided exposure to different foods. With early recognition and proper support, most people with ARFID can restore healthy eating and thrive,” said Dr Sudhir Kumar.
As research continues to highlight both the prevalence and neurological basis of ARFID, clinicians are calling for the same recognition and seriousness afforded to better-known eating disorders.
(Edited by Dese Gowda)
