ICD-116B83	AVOIDANT-RESTRICTIVE FOOD INTAKE DISORDER (ARFID) Avoidant-restrictive food intake disorder
ICD-10F98.2	Feeding disorder of infancy and childhood
DSM-5-TRF50.82	Avoidant/Restrictive Food Intake Disorder

1. Definition and nosology

Avoidant/Restrictive Food Intake Disorder (ARFID; ICD-11: 6B83; DSM-5-TR: F50.82) — significant weight loss, nutritional deficiency, enteral feeding dependence, or psychosocial impairment resulting from avoidance or restriction of food intake. No body image disturbance or fear of weight gain (key difference from anorexia).

2. History

• DSM-IV ‘Feeding Disorder of Infancy or Early Childhood’ — only in children.
• DSM-5 (2013) — ARFID expanded to all ages.

3. Epidemiology

• Prevalence: 0.3–3.2% (~5–14% in eating disorder clinics).
• Gender: approximately equal (unlike anorexia).
• Onset: predominantly in childhood and adolescence.
• Comorbidity: autism spectrum, anxiety, OCD.

4. Aetiology and pathogenesis

• Sensory sensitivity (food texture, smell, appearance) — especially on autism background.
• Fear of choking or vomiting trauma.
• Low interest in food (low appetite, low food interest).

5. Clinical features

Three clinical presentations

• Sensory sensitivity — “picky eating” – limited food variety, texture sensitivity.
• Low interest in food — low hunger, no stimulus to food.
• Fear (choking, vomiting) — avoidance following a specific triggering event.

Results: significant weight loss or insufficient weight gain (in children), nutritional deficiencies (iron, zinc, vitamins), dependence on enteral feeding, social disruption (school meals, eating with peers).

6. Diagnosis

6.1 Unified diagnostic criteria

A. As a result of avoidance or restriction of food intake, at least one of:

1. Significant weight loss or failure to achieve adequate weight gain;
2. Significant nutritional deficiency;
3. Enteral feeding or oral nutritional supplement dependence;
4. Significant psychosocial impairment.

B. Disorder not explained by existing nutritional deficiency or cultural experience.

C. Does not occur in the context of anorexia or bulimia; no body image disturbance.

D. Not better explained by another medical or mental condition (e.g., allergy, OCD).

6.2 Source-specific clarifications

• DSM-5-TR / ICD-11 — same.
• NICE NG69 — specific intervention rules for ARFID.

6.3 Diagnostic algorithm

1. Clinical interview and dietary history.
2. NIAS (Nine Item ARFID Screen) — screening.
3. Medical evaluation — weight, height, BMI, laboratory nutritional deficiency.
4. Screening for autism and OCD.
5. Exclusion of allergy and GI pathology.

6.4 Differential diagnosis

7. Examination and assessment

• NIAS, EDE-Q.
• Weight, height, BMI history.
• Laboratory: complete blood count, ferritin, zinc, vitamin D, B12, folate.
• Autism screening (M-CHAT, ADOS).

8. Treatment

1. Multidisciplinary approach: nutritionist + CBT therapist + feeding-occupational therapist.
2. FBT-ARFID — adapted by Lock J.
3. CBT-AR — Cognitive Behavioral Therapy for ARFID (Thomas J.J.) — manualized.
4. Stepped food exposure — gradual introduction of new food types.
5. Sensory integration elements (on autism background).
6. Medical: nutritional correction; severe case enteral feeding.
7. SSRIs for comorbid anxiety; no FDA-approved specific medication for ARFID.

Source-specific specifications

• NICE NG69 — graded food exposure.
• Thomas J.J. CBT-AR — a new evidence base.

Treatment methods

1. CBT for ARFID (CBT-AR — CBT for ARFID) — Thomas (Thomas J.J.) — Manualized; protocols tailored to sensory, low interest, fear subtypes.
2. FBT-ARFID — The role of the family in the exposure to food.
3. Stepped Food Exposure — New food approach → touch → taste → swallow steps.
4. Nine-Item ARFID Screen (NIAS — Nine Item ARFID Screen) — 3 subtype screening.

9. Prognosis

• With a multidisciplinary approach, improvement in most patients.
• Long-term follow-up in the context of autism and OCD.

10. Myths and misconceptions

Myth 1: “ARFID is just ‘picky eating’”

Evidence: Clinical diagnosis requires significant functional impairment or nutritional deficiency.

Myth 2: “The patient can be forced to eat by starvation”

Evidence: Hunger strategy ineffective in ARFID and harmful to family-child relationship; stepwise exposure recommended.

Myth 3: “ARFID is a ‘mild form’ of anorexia”

Evidence: distinct clinical unit; body image disturbance and weight concern absent; intervention differs.

Myth 4: “ARFID on the autism spectrum cannot be treated”

Evidence: sensory integration and behavioral approaches are also effective in the context of autism.

Myth 5: “The patient will outgrow it”

Evidence: It can progress without treatment; early intervention prevents nutritional complications.

11. Sources

1. WHO. ICD-11. 6B83 ARFID. 2024.
2. APA. DSM-5-TR. 2022.
3. NICE NG69. 2017/2020.
4. Thomas J.J., Eddy K.T. Cognitive-Behavioral Therapy for ARFID. Cambridge University Press; 2018.
5. Zickgraf H.F., Ellis J.M. Initial validation of the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS). Appetite 2018;123:32–42.
6. Lock J., Le Grange D. Treatment Manual for Anorexia Nervosa: A Family-Based Approach. 2nd ed. New York: Guilford Press, 2013.