Understanding Selective Eating Disorder (ARFID) in Children and Adults
- Scarlet Plus LLC
- Jul 28
- 3 min read
At Forbs Behavioral Health Services, LLC, serving Maryland and Washington, D.C., we treat avoidant–restrictive food intake disorder (ARFID), a condition where restrictive eating stems not from body image concerns but from sensory preferences, fear of aversive experiences, or trauma-based avoidance.
Whether in children or adults, ARFID can cause nutritional deficiencies, anxiety around meals, and social isolation. This post covers:
What ARFID is (and isn’t)
Types and core symptoms
Emotional and physical consequences
Treatment protocols and behavioral strategies
FORBS’s integrative care model
Practical supports between appointments
Page Contents
1. What Is ARFID?
ARFID is an eating disorder defined by:
Persistent restriction of food intake
Avoidance based on sensory traits (texture, smell), fear of choking or vomiting, or lack of perceived food reward
No concern for weight or body image (unlike anorexia or bulimia)
Often emerging in childhood, ARFID can persist into adulthood without intervention. It leads to weight loss, dietary dependency, or nutritional insufficiency.
2. ARFID Presentations & Symptoms
Types:
Sensory-based: extreme texture or taste aversions
Fear-based: fear of vomiting, choking, or allergies
Low appetite/reward-based: minimal interest in eating due to low pleasure or sensory responsiveness
Key Symptoms:
Limited food variety (often < 20 accepted foods)
Weight plateau or failure to gain in children
Social anxiety around meals, avoiding family, school, or date-night dinners
Difficulties across settings: school cafeterias, travel, shared meals
3. Emotional and Physical Health Impacts
Nutrient deficits: iron, calcium, vitamins
Growth delays in children; fatigue or mood swings in adults
Anxiety escalation during mealtimes
Social isolation, avoidance in social settings, or emotional distress in family dynamics
4. Evidence-Based Treatment Elements
A. Multidisciplinary Assessment
Evaluate for nutritional deficiency, underlying GI or sensory issues
First-tier intervention: involve physicians, gastroenterologists, occupational therapists
B. Behavioral and Exposure Therapy
Implement gradual food exposure hierarchies
Use positive reinforcement and measurable steps (smells, touches, tastes)
Pair new food exploration with preferred foods, decreasing anxiety over time
C. Family-Based Approach
Encourage family visual schedules, mealtime consistency, and supportive atmosphere
Teach caregivers neutral responses and avoid reinforcing avoidance unintentionally
D. Feeding Therapy & OT
Sensory integration OT helps desensitize texture or smell aversions
Feeding therapy encourages motor skills, anxiety reduction, and safe food exploration
E. Psychotherapy Support
CBT addresses anxiety tied to food avoidance
When avoidance stems from trauma (e.g., choking), trauma-informed care or EMDR may help
5. How Forbs Behavioral Health Provides ARFID Care
For children and adults at Forbs, our integrated care includes:
Comprehensive diagnostic evaluation: psychiatric, nutritional, sensory, and medical review
Collaborative treatment plans: pairing therapy with nutrition and sensory-based interventions
ABA or behavioral exposure models for children; CBT for older teens and adults
Family/school coordination: shared strategies ensure consistency across environments
Progress tracking using food logs, exposure steps, and anxiety scales
Telehealth flexibility and group support options for social eating skill development
6. Self-Guided Support Tools
Food exposure logs: note comfort, reactions; gradually add new food steps
Calm mealtime planning: reduce pressure, no commentary, timed bites, sensory preferences honored
Pre-meal mindfulness: breathe or listen to calming music before eating
Parent modeling: demonstrate trying mild, related foods gently
Peer encouragement: low-stress shared meals in controlled settings
Conclusion
ARFID is more than picky eating, it’s a complex condition requiring interdisciplinary intervention, emotional insight, and patient-centered strategies. Early, tailored support enables individuals to expand food flexibility, nourish body and mind, and engage more fully in social life.
Forbs Behavioral Health Services, LLC offers structured, compassionate ARFID treatment in Maryland and D.C., combining psychology, nutrition, sensory integration, and family support to ensure positive change.
References
Unique practice description and integrated care commitment Priority Partners
Clinic locations and treatment specialties across MD and DC AP News
