ARFID vs. Picky Eating

Avoidant restrictive food intake disorder (ARFID) and picky eating share similarities, but also important differences. Discover the differences between ARFID and picky eating.

For many parents, having young children means plenty of negotiating to get them to eat their vegetables, taste new foods or finish what’s on their plate. Eating difficulties are common in childhood, but they can be concerning to parents who know how important good nutrition is for growth and development.

There are different types of restrictive eating behaviors that vary in severity. These range from general picky eating to more extreme eating disorders, such as avoidant restrictive food intake disorder (ARFID). There are several key differences when considering ARFID vs. picky eating.

Where Does Picky Eating End and Disordered Eating Begin?

Picky eating and eating disorders share some similarities, so it can be difficult for parents to tell whether their child is just a picky eater or if there is a more severe problem. The line between being picky eater vs. having an eating disorder often depends on a few different things:

• Whether there is an underlying fear related to eating
• The extent of restriction
• How much it impacts health.

While picky eating can certainly make parents anxious, disordered eating is even more serious. It can be extreme and persistent while putting healthy growth and development at risk.

ARFID Misdiagnosis

Any type of avoidance or refusal to eat may seem like an eating disorder, but correctly diagnosing ARFID is dependent on specific criteria. ARFID can be misdiagnosed if food restriction is due to lack of available food, is part of cultural practice (i.e., fasting) or is explained by another health condition.

ARFID might be misdiagnosed if a child refuses to eat or only eats a limited variety of foods based on their likes and dislikes. Importantly, ARFID is typically linked to avoidance or refusing food based on fears or anxieties about eating, like choking or illness. ARFID may also be misdiagnosed if food avoidance behaviors are a reflection of anxiety or behavioral disorder.

Key Differences Between ARFID and Picky Eating

Because ARFID and picky eating share similar characteristics it can be difficult to tell the two conditions apart. While picky eating is fairly common in children, most will outgrow this phase on their own and still enjoy eating the foods they prefer. ARFID however, is a more serious condition driven lack of interest in food that can lead to nutritional deficiencies. The following breaks down more of the key differences between picky eaters and individuals with avoidant restrictive food intake disorder.

Picky Eaters

Picky eating is quite common during childhood, and it’s estimated that between 8% to 50% of children are picky eaters. Picky eating involves avoidance of certain types of foods — often vegetables — as well as having very clear preferences for certain foods and generally avoiding new foods. Some parents may prepare a separate meal for a child who is a picky eater.

Signs of a picky eater might include:

• Lower weight than non-picky eaters
• Behavior problems
• Refusal to accept or try a wide range of foods
• Eating only very specific foods
• Eating very slowly

Although these signs and symptoms can be very frustrating for parents, they do not necessarily mean that a child has an eating disorder. In fact, there are several key points that are unique to picky eating:

• Children will likely outgrow this phase: Over half (58%) of picky eaters will recover after two years
• Picky eaters can function normally in social situations involving food: Picky eaters will often be able to find a food that they enjoy, and they will not normally experience anxiety leading up to or during the event
• Picky eaters do not allow fears to drive their eating choices: Food choices among picky eaters are usually driven by preference, rather than fear
• Picky eaters are interested in eating the foods they enjoy: Children who are picky eaters will often happily eat foods that they do like (even if the variety may be limited)

Although picky eating can be upsetting, it does not carry the same level of distress and risk as a diagnosable eating disorder.

Individuals with ARFID

The signs and symptoms of ARFID are more severe and impairing than picky eating. In the Diagnostic and Statistical Manual of Mental Disorders version 5 (DSM-5), criteria for an eating disorder includes significantly low weight, reliance on supplementation for nutritional needs and significant impact on normal functioning.

Some of the main signs and symptoms that could indicate ARFID are:

• Failure to maintain a healthy weight
• The need for feeding tubes or supplements to receive appropriate nutrition
• Experience anxiety leading up to or during social events that serve food
• Avoidance of food based on sensory aspects or fear of negative consequences (taste, choking, etc.)
• Lack of interest in food

These ARFID symptoms can have a significant impact on how a child behaves and whether they are able to live normally. This can also be very distressing for parents, as these symptoms can impact their child’s development and, in severe cases, have long-lasting effects. Addressing ARFID symptoms can improve nutrition status and long-term health.

What Parents Should Know About Extreme Picky Eating

In most cases, picky eating can be a fairly normal phase of childhood development. At extreme levels, however, picky eating can lead to malnourishment, cause behavioral problems or indicate the risk or presence of an eating disorder.

There are several signs that parents can look out for if they are concerned about their child’s eating behavior. In particular, parents should take note of severe anxiety or fear surrounding food, rather than just a dislike or preference.

Picky eating tends to peak during the preschool years, and it often goes away after a couple of years or in later childhood. However, if extreme picky eating persists, this may indicate an eating disorder that requires professional attention. If extreme picky eating leads to significant weight loss or nutritional deficiencies, these can have effects later in life and should be addressed and/or treated.

Treatment for ARFID

Because picky eating is quite common in children, parents may feel like their concerns and frustrations are not heard or not taken seriously. This can make it difficult to get treatment for children with ARFID.

However, there are several ARFID treatment options available that can address some of the fears or anxieties related to food, target behaviors surrounding food and focus on re-nourishment and weight gain. As a relatively new category of eating disorder, less is known about specific treatments for ARFID. However, treatment for ARFID must address the underlying anxiety or fear that is causing food avoidance or restriction.

Some of the possible treatment options for ARFID include:

• Family therapy
• Cognitive-behavioral therapy
• Treatment of anxiety
• Weight gain and re-nourishment strategies

The best treatment strategies for parents and children dealing with ARFID depend on the individual as well as the severity of the condition. To discuss possible treatment options for ARFID, contact The Recovery Village today. 

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. 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