Avoidant Restrictive Food Intake Disorder vs. Anorexia

Unlike anorexia, avoidant restrictive food intake disorder (ARFID) does not involve a fear of weight gain. Learn more about the differences between ARFID and anorexia.

Most people have likely heard of anorexia, but few may be aware of avoidant restrictive food intake disorder (ARFID). ARFID was previously called selective eating disorder and is characterized by extreme limitations in the types and amounts of foods consumed. The disorder was initially recognized in children, but diagnostic criteria have since been updated to recognize ARFID across the lifespan. A diagnosis of ARFID can include several different types of the disorder; however, it must involve significant distress or complications that require medical attention. Although they seem similar, there are key differences between ARFID and anorexia.

Differentiating ARFID and Anorexia

Some people may confuse ARFID and anorexia or use the terms interchangeably, as both disorders are based on the extreme restriction of food. However, ARFID does not include a fear of being fat or distress about weight, body shape or size. This distinction is important in determining the type of treatment that is appropriate.

Presentation of ARFID

Overall, ARFID means that a person severely avoids or restricts food. However, there are several different ways that ARFID can present, such as:

• Sensory sensitivity, where people avoid foods of certain types or textures, such as meat, fruits or vegetables
• Avoidance of certain foods or food altogether after choking or vomiting
• Restriction or avoidance of food due to low appetite or general disinterest in eating

In all cases, ARFID has a significant impact on a person’s health, leading to malnutrition, poor growth and low body weight. Differentiating between ARFID symptoms and types is critical to understanding and treating the causes of each disorder.

Anorexia Characteristics

In contrast to ARFID, the signs and symptoms of anorexia are underpinned by an extreme fear of weight gain. Key characteristics of anorexia include avoidance of food, restriction of energy intake, fixation on weight loss and extreme psychological distress related to body shape and size. The psychological component related to fear of weight gain is an important distinction in the clinical presentation of anorexia.

Populations Affected

The populations affected by ARFID vs. anorexia can vary widely. Initially, ARFID was recognized as extreme picky eating in toddlers and children but is now recognized in adults as well. The age of onset for ARFID is typically in childhood, and although more boys are diagnosed with ARFID than anorexia, rates of ARFID remain higher in females.

In contrast, the age of onset of anorexia is usually during adolescence and is substantially more common in females compared to males. Anorexia may be more likely than ARFID to persist into adulthood. People with both ARFID and anorexia often experience other co-occurring mental health conditions.

Treatment Variations

While ARFID and anorexia share some similarities, the two conditions also have many differences. Because of these, it’s crucial that people seek an accurate mental health diagnosis and specialized treatment for their condition.

ARFID Treatment

As a relatively new disorder, there are fewer specific treatment recommendations for ARFID. However, based on the different presentations of ARFID, treatment strategies may vary. For example:

• Avoidance of food based on a traumatic experience may benefit from cognitive treatment strategies to address fears
• Food restriction with extreme weight loss might be helped by behavioral strategies, including re-feeding or supplementation

There is ongoing research to understand the best treatments for ARFID to improve outcomes and reduce treatment duration.

Anorexia Treatment

Treatment for anorexia is similar to ARFID but must address underlying fears of weight gain as well as restrictive eating. Anorexia treatment options can include:

• Family therapy
• Cognitive behavioral therapy
• Re-nourishment and nutrition counseling

Including multiple anorexia treatments in a recovery strategy may be beneficial.

Related Topic: Atypical anorexia

Long-Term Prognosis

The long-term prognosis for ARFID and anorexia can differ, based on the additional psychological fear of weight gain in anorexia. In ARFID, it is possible that children may outgrow their disorder, as their tastes and aversions may change as they age. Recovery from anorexia may require intensive therapy or inpatient treatment. Both full and partial recovery from anorexia are possible, and successful treatments can help reduce the risk of further health complications.

For both ARFID and anorexia, recovery can be impacted by health complications related to malnutrition or other mental health conditions related to disordered eating. In general, recovery rates appear to be higher in ARFID compared with anorexia.

Key Differences: ARFID vs. Anorexia

Although they have similar features, ARFID and anorexia are distinct disorders with unique symptoms and treatments.

• ARFID involves extreme restrictive eating based on aversions, low appetite or disinterest in eating
• Anorexia is characterized by an underlying fear of weight gain
• ARFID typically begins at a younger age and affects more males than anorexia
• Treatments for ARFID and anorexia overlap, but anorexia may require additional psychological treatments to address fear of weight gain

Treatment for both ARFID and anorexia can lead to significant improvements in quality of life and health outcomes. If you or someone you care about are suffering from disordered eating related to a substance use disorder, contact The Recovery Village today to discuss available treatment options.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Sarah Dash, PHD

Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more