Table of ContentsView AllTable of ContentsTreating Children and AdultsHealthcare TeamTherapiesMedications
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Table of Contents
Treating Children and Adults
Healthcare Team
Therapies
Medications
Avoidant restrictive food intake disorder(ARFID) is an eating disorder in which a person limits the amount and/or type of foods that they eat. Unlike other eating disorders such asanorexia nervosa, a person with ARFID does not limit their diet because they want to change how their body looks or how much they weigh.
There is no standard treatment for ARFID, though different types of therapies, includingcognitive behavioral therapy(CBT), family-based therapy, and occupational therapy, are helpful. In some cases, medications are used off-label to treat ARFID.
ARFID affects both children and adults and can seriously affect a person’s physical and mental health. Theeating disordercan lead to medical complications such as weight loss and delays in growth and development.
This article will cover the various treatment options for ARFID, including different kinds of therapies, medications, and—in some cases—hospitalization.
Treating ARFID in Children and Adults
There is no standard treatment for ARFID because it is a relatively new diagnosis. Although there is extensive literature on the treatment of feeding disorders in children, there have been no rigorous clinical trials evaluating the effectiveness of ARFID treatment in teenagers or adults.
Healthcare providers rely on their clinical experience and judgment, as well as the limited available research, when treating patients with ARFID.
Tang Ming Tung / Getty Images
A multidisciplinary team of medical and mental health professionals is often recommended for treating ARFID.These may include specialists such as:
People with severe ARFID may need to be hospitalized or attend residential programs or partial hospitalization programs. The treatment setting will depend on the severity of a person’s food restriction, their level of malnutrition, and their weight. Refeeding with afeeding tube(calledenteralnutrition) is sometimes necessary.
A 2017 study found that ARFID can successfully be treated in a partial hospitalization program that is designed for eating disorders in general.Compared to patients with other eating disorders in the same partial hospitalization program, patients with ARFID had similar improvements in weight and psychological wellness, but over a shorter period of time.
In some cases, the diet restriction and refusal to eat in patients with ARFID is severe. A study from 2015 compared the outcomes of patients with ARFID and patients with anorexia nervosa who were hospitalized for nutrient insufficiency.The findings showed that ARFID patients generally required longer hospital stays than patients with anorexia (eight days compared to five days), and were more likely to need a feeding tube.
Why Do People Develop ARFID?
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy(CBT) is a type of psychotherapy that is used to treat a wide variety of mental health conditions including eating disorders. In CBT, a trained therapist helps a person learn to identify their distorted thinking patterns, change their thoughts, and ultimately change their behavior.
There is a lot of evidence in support of the effectiveness of CBT for treating eating disorders, including anorexia nervosa, bulimia nervosa, andbinge eating disorder.
However, high-quality evidence on CBT as a treatment for ARFID is lacking. Only a few case reports have suggested that CBT might be helpful for some people with the condition.
CBT-ARCognitive behavioral therapy for avoidant restrictive food intake disorder (CBT-AR) is a specialized form of CBT. The initial research on CBT-AR, published in 2020, found that 70% of participants who completed a round of CBT-AR no longer qualified for the diagnostic criteria of ARFID.CBT-AR has only been studied in people with ARFID who were 10 years of age and older, medically stable, and not using a feeding tube.
CBT-AR
Cognitive behavioral therapy for avoidant restrictive food intake disorder (CBT-AR) is a specialized form of CBT. The initial research on CBT-AR, published in 2020, found that 70% of participants who completed a round of CBT-AR no longer qualified for the diagnostic criteria of ARFID.CBT-AR has only been studied in people with ARFID who were 10 years of age and older, medically stable, and not using a feeding tube.
Family-Based Therapy (FBT)
Family-based therapy(FBT) is a type of behavioral therapy that is commonly used to treat eating disorders in children and adolescents.In FBT, blame is removed from the patient and the family, and the eating disorder is viewed as an external force. Everyone in the patient’s family is treated as a unit that is dealing with the patient’s eating disorder together.
A small study of six participants with ARFID found that after treatment with medical monitoring, medication, and FBT, all participants met their goal weight.However, more research—particularly randomized controlled trials—is needed to determine the true effectiveness of FBT for children with ARFID.
Occupational Therapy
Occupational therapiststake a holistic approach to restoring health, well-being, and functioning through assessment and techniques designed to develop or recover meaningful activities or occupations. (Eating is considered anactivity of daily living, and treatment of ARFID is within the occupational therapy scope of practice.)
Occupational therapists complete a full assessment of a person’s sensory, motor, developmental, environmental, cultural, and behavioral factors that could be impairing eating.
Kids with ARFID and co-occurringsensory processing disorder, autism spectrum disorder (ASD), or ADHD might work with an occupational therapist in an outpatient therapy setting. Patients with eating disorders may also receive occupational therapy in residential treatment or inpatient settings.
Interventions are individualized to the person with ARFID but can include tactile play to promote oral acceptance, food-chaining techniques, social stories about self-feeding and eating,operant conditioning, andsensory diets.
Supporting Your Child With ARFID at Home
If you have a child with ARFID, here are some ways to be supportive of them at home:
Speech Therapy
Aspeech therapist(speech-language pathologist) is another kind of rehabilitation professional who can be part of an ARFID treatment team. Speech therapists treat issues relating to speech, hearing, andswallowing.
In the context of ARFID, a speech therapist can help people who have a food aversion that leads to swallowing difficulty (dysphagia).
Speech therapists work with people of all ages, using a variety of interventions. For example, they can help a person become more comfortable swallowing different textures through techniques like pre-chaining, food chaining, and feeding programs that target different consistencies.
Swallowing Exercises for Dysphagia From Neurological Causes
Medications to Treat ARFID
However, based on their experience and review of the research that is available, a healthcare provider might decide to prescribe a medication off-label for a patient with ARFID.
Medications that are sometimes prescribed off-label for ARFID include:
Clinicians also need to consider the other medications a person is taking before they decide to prescribe an off-label treatment. Many people with ARFID have another (co-occurring) mental health condition, such asattention deficit hyperactivity disorder(ADHD).
Stimulant medications that are used to treat ADHD have been found in both research and clinical practice to suppress appetite and exacerbate ARFID.If a person has both ARFID and ADHD, their doctor will need to adjust their medications accordingly.
Although ARFID is considered a mental health condition, like other eating disorders, it can also have profound physical consequences. Medical treatment for ARFID is needed to prevent long-term health consequences of weight loss and malnutrition.
Medications Used to Treat Eating Disorders
Summary
There is no standard treatment for ARFID, and high-quality research is limited on the effectiveness of the available options. Various kinds of therapies, such as CBT, family-based therapy, and occupational therapies are used to treat ARFID. In some cases, medications are used to treat the symptoms of ARFID
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Brigham KS, Manzo LD, Eddy KT, et al.Evaluation and treatment of avoidant/restrictive food intake disorder (ARFID) in adolescents.Curr Pediatr Rep. 2018;6(2):107-113. doi:10.1007/s40124-018-0162-yThomas JJ, Lawson EA, Micali N, et al.Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment.Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5Strandjord SE, Sieke EH, Richmond M, et al.Avoidant/restrictive food intake disorder: illness and hospital course in patients hospitalized for nutritional insufficiency.J Adolesc Health. 2015;57(6):673-678. doi:10.1016/j.jadohealth.2015.08.003Ornstein RM, Essayli JH, Nicely TA, et al.Treatment of avoidant/restrictive food intake disorder in a cohort of young patients in a partial hospitalization program for eating disorders.Int J Eat Disord. 2017;50(9):1067-1074. doi:10.1002/eat.22737Linardon J, Wade TD, de la Piedad Garcia X, et al.The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis.J Consult Clin Psych.2017;85(11):1080–1094. doi:10.1037/ccp0000245Bryant-Waugh R.Avoidant restrictive food intake disorder: an illustrative case example.Int J Eat Disord. 2013;46(5):420-423. doi:10.1002/eat.22093Thomas JJ, Becker KR, Kuhnle MC, et al.Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: feasibility, acceptability, and proof-of-concept for children and adolescents.Int J Eat Disord. 2020;53(10):1636-1646. doi:10.1002/eat.23355Fitzpatrick KK, Forsberg SE, Colborn D.Family-based therapy for avoidant restrictive food intake disorder: families facing food neophobias. InFamily Therapy for Adolescent Eating and Weight Disorders: New Applications.1st ed. Routledge; 2015:256–276.Spettigue W, Norris ML, Santos A, et al.Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments.J Eat Disord. 2018;6. doi:10.1186/s40337-018-0205-3Nemours Kids Health.Avoidant restrictive food intake disorder.Sant’Anna AMGA, Hammes PS, Porporino M, et al.Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program.J Pediatr Gastroenterol Nutr. 2014;59(5):674-678. doi:10.1097/MPG.0000000000000467Thomas JJ, Brigham KS, Sally ST, et al.Case 18-2017—an 11-year-old girl with difficulty eating after a choking incident.N Engl J Med. 2017;376(24):2377-2386. doi:10.1056/NEJMcpc1616394Brewerton TD, D’Agostino M.Adjunctive use of olanzapine in the treatment of avoidant restrictive food intake disorder in children and adolescents in an eating disorders program.J Child Adolesc Psychopharmacol. 2017;27(10):920-922. doi:10.1089/cap.2017.0133Pennell A, Couturier J, Grant C, et al.Severe avoidant/restrictive food intake disorder and coexisting stimulant treated attention deficit hyperactivity disorder.Int J Eat Disord. 2016;49(11):1036-1039. doi:10.1002/eat.22602
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Brigham KS, Manzo LD, Eddy KT, et al.Evaluation and treatment of avoidant/restrictive food intake disorder (ARFID) in adolescents.Curr Pediatr Rep. 2018;6(2):107-113. doi:10.1007/s40124-018-0162-yThomas JJ, Lawson EA, Micali N, et al.Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment.Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5Strandjord SE, Sieke EH, Richmond M, et al.Avoidant/restrictive food intake disorder: illness and hospital course in patients hospitalized for nutritional insufficiency.J Adolesc Health. 2015;57(6):673-678. doi:10.1016/j.jadohealth.2015.08.003Ornstein RM, Essayli JH, Nicely TA, et al.Treatment of avoidant/restrictive food intake disorder in a cohort of young patients in a partial hospitalization program for eating disorders.Int J Eat Disord. 2017;50(9):1067-1074. doi:10.1002/eat.22737Linardon J, Wade TD, de la Piedad Garcia X, et al.The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis.J Consult Clin Psych.2017;85(11):1080–1094. doi:10.1037/ccp0000245Bryant-Waugh R.Avoidant restrictive food intake disorder: an illustrative case example.Int J Eat Disord. 2013;46(5):420-423. doi:10.1002/eat.22093Thomas JJ, Becker KR, Kuhnle MC, et al.Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: feasibility, acceptability, and proof-of-concept for children and adolescents.Int J Eat Disord. 2020;53(10):1636-1646. doi:10.1002/eat.23355Fitzpatrick KK, Forsberg SE, Colborn D.Family-based therapy for avoidant restrictive food intake disorder: families facing food neophobias. InFamily Therapy for Adolescent Eating and Weight Disorders: New Applications.1st ed. Routledge; 2015:256–276.Spettigue W, Norris ML, Santos A, et al.Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments.J Eat Disord. 2018;6. doi:10.1186/s40337-018-0205-3Nemours Kids Health.Avoidant restrictive food intake disorder.Sant’Anna AMGA, Hammes PS, Porporino M, et al.Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program.J Pediatr Gastroenterol Nutr. 2014;59(5):674-678. doi:10.1097/MPG.0000000000000467Thomas JJ, Brigham KS, Sally ST, et al.Case 18-2017—an 11-year-old girl with difficulty eating after a choking incident.N Engl J Med. 2017;376(24):2377-2386. doi:10.1056/NEJMcpc1616394Brewerton TD, D’Agostino M.Adjunctive use of olanzapine in the treatment of avoidant restrictive food intake disorder in children and adolescents in an eating disorders program.J Child Adolesc Psychopharmacol. 2017;27(10):920-922. doi:10.1089/cap.2017.0133Pennell A, Couturier J, Grant C, et al.Severe avoidant/restrictive food intake disorder and coexisting stimulant treated attention deficit hyperactivity disorder.Int J Eat Disord. 2016;49(11):1036-1039. doi:10.1002/eat.22602
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Brigham KS, Manzo LD, Eddy KT, et al.Evaluation and treatment of avoidant/restrictive food intake disorder (ARFID) in adolescents.Curr Pediatr Rep. 2018;6(2):107-113. doi:10.1007/s40124-018-0162-yThomas JJ, Lawson EA, Micali N, et al.Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment.Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5Strandjord SE, Sieke EH, Richmond M, et al.Avoidant/restrictive food intake disorder: illness and hospital course in patients hospitalized for nutritional insufficiency.J Adolesc Health. 2015;57(6):673-678. doi:10.1016/j.jadohealth.2015.08.003Ornstein RM, Essayli JH, Nicely TA, et al.Treatment of avoidant/restrictive food intake disorder in a cohort of young patients in a partial hospitalization program for eating disorders.Int J Eat Disord. 2017;50(9):1067-1074. doi:10.1002/eat.22737Linardon J, Wade TD, de la Piedad Garcia X, et al.The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis.J Consult Clin Psych.2017;85(11):1080–1094. doi:10.1037/ccp0000245Bryant-Waugh R.Avoidant restrictive food intake disorder: an illustrative case example.Int J Eat Disord. 2013;46(5):420-423. doi:10.1002/eat.22093Thomas JJ, Becker KR, Kuhnle MC, et al.Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: feasibility, acceptability, and proof-of-concept for children and adolescents.Int J Eat Disord. 2020;53(10):1636-1646. doi:10.1002/eat.23355Fitzpatrick KK, Forsberg SE, Colborn D.Family-based therapy for avoidant restrictive food intake disorder: families facing food neophobias. InFamily Therapy for Adolescent Eating and Weight Disorders: New Applications.1st ed. Routledge; 2015:256–276.Spettigue W, Norris ML, Santos A, et al.Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments.J Eat Disord. 2018;6. doi:10.1186/s40337-018-0205-3Nemours Kids Health.Avoidant restrictive food intake disorder.Sant’Anna AMGA, Hammes PS, Porporino M, et al.Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program.J Pediatr Gastroenterol Nutr. 2014;59(5):674-678. doi:10.1097/MPG.0000000000000467Thomas JJ, Brigham KS, Sally ST, et al.Case 18-2017—an 11-year-old girl with difficulty eating after a choking incident.N Engl J Med. 2017;376(24):2377-2386. doi:10.1056/NEJMcpc1616394Brewerton TD, D’Agostino M.Adjunctive use of olanzapine in the treatment of avoidant restrictive food intake disorder in children and adolescents in an eating disorders program.J Child Adolesc Psychopharmacol. 2017;27(10):920-922. doi:10.1089/cap.2017.0133Pennell A, Couturier J, Grant C, et al.Severe avoidant/restrictive food intake disorder and coexisting stimulant treated attention deficit hyperactivity disorder.Int J Eat Disord. 2016;49(11):1036-1039. doi:10.1002/eat.22602
Brigham KS, Manzo LD, Eddy KT, et al.Evaluation and treatment of avoidant/restrictive food intake disorder (ARFID) in adolescents.Curr Pediatr Rep. 2018;6(2):107-113. doi:10.1007/s40124-018-0162-y
Thomas JJ, Lawson EA, Micali N, et al.Avoidant/restrictive food intake disorder: a three-dimensional model of neurobiology with implications for etiology and treatment.Curr Psychiatry Rep. 2017;19(8):54. doi:10.1007/s11920-017-0795-5
Strandjord SE, Sieke EH, Richmond M, et al.Avoidant/restrictive food intake disorder: illness and hospital course in patients hospitalized for nutritional insufficiency.J Adolesc Health. 2015;57(6):673-678. doi:10.1016/j.jadohealth.2015.08.003
Ornstein RM, Essayli JH, Nicely TA, et al.Treatment of avoidant/restrictive food intake disorder in a cohort of young patients in a partial hospitalization program for eating disorders.Int J Eat Disord. 2017;50(9):1067-1074. doi:10.1002/eat.22737
Linardon J, Wade TD, de la Piedad Garcia X, et al.The efficacy of cognitive-behavioral therapy for eating disorders: a systematic review and meta-analysis.J Consult Clin Psych.2017;85(11):1080–1094. doi:10.1037/ccp0000245
Bryant-Waugh R.Avoidant restrictive food intake disorder: an illustrative case example.Int J Eat Disord. 2013;46(5):420-423. doi:10.1002/eat.22093
Thomas JJ, Becker KR, Kuhnle MC, et al.Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: feasibility, acceptability, and proof-of-concept for children and adolescents.Int J Eat Disord. 2020;53(10):1636-1646. doi:10.1002/eat.23355
Fitzpatrick KK, Forsberg SE, Colborn D.Family-based therapy for avoidant restrictive food intake disorder: families facing food neophobias. InFamily Therapy for Adolescent Eating and Weight Disorders: New Applications.1st ed. Routledge; 2015:256–276.
Spettigue W, Norris ML, Santos A, et al.Treatment of children and adolescents with avoidant/restrictive food intake disorder: a case series examining the feasibility of family therapy and adjunctive treatments.J Eat Disord. 2018;6. doi:10.1186/s40337-018-0205-3
Nemours Kids Health.Avoidant restrictive food intake disorder.
Sant’Anna AMGA, Hammes PS, Porporino M, et al.Use of cyproheptadine in young children with feeding difficulties and poor growth in a pediatric feeding program.J Pediatr Gastroenterol Nutr. 2014;59(5):674-678. doi:10.1097/MPG.0000000000000467
Thomas JJ, Brigham KS, Sally ST, et al.Case 18-2017—an 11-year-old girl with difficulty eating after a choking incident.N Engl J Med. 2017;376(24):2377-2386. doi:10.1056/NEJMcpc1616394
Brewerton TD, D’Agostino M.Adjunctive use of olanzapine in the treatment of avoidant restrictive food intake disorder in children and adolescents in an eating disorders program.J Child Adolesc Psychopharmacol. 2017;27(10):920-922. doi:10.1089/cap.2017.0133
Pennell A, Couturier J, Grant C, et al.Severe avoidant/restrictive food intake disorder and coexisting stimulant treated attention deficit hyperactivity disorder.Int J Eat Disord. 2016;49(11):1036-1039. doi:10.1002/eat.22602
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