Table of ContentsView AllTable of ContentsARFID Diagnostic CriteriaProfessional ScreeningsLabs and TestsSelf-TestsSubtypesDifferential Diagnosis
Table of ContentsView All
View All
Table of Contents
ARFID Diagnostic Criteria
Professional Screenings
Labs and Tests
Self-Tests
Subtypes
Differential Diagnosis
Avoidant restrictive food intake disorder (ARFID)is a relatively new diagnosis. A person with ARFID limits the amount and/or type of food they eat.
However, ARFID is more than just being a “picky eater.” A person with ARFID might avoid a wide variety of foods because they have sensory sensitivity, an apparent lack of interest in eating, or a concern about an adverse consequence of eating, such as a fear of vomiting or choking.
Unlike withanorexia nervosa, a person with ARFID does not restrict their food intake with the goal of changing their body size, shape, or weight.
ARFID was first listed as a diagnosis in theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5)—the handbook that mental health professionals currently use to diagnose eating disorders and other mental health conditions—in 2013.ARFID used to be referred to as a “selective eating disorder.”
In this article, learn about the diagnosis of avoidant restrictive food intake disorder (ARFID), including professional screenings, labs and tests, and self-tests.
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For a child, adolescent, or adult to be diagnosed with ARFID, they must meet specific diagnostic criteria that are outlined in the DSM-5.
A person might need professional screenings and a medical assessment, including lab tests, to see if they fit the diagnosis.
A healthcare provider will also need to come up with a differential diagnosis to rule out other possible conditions that could be the cause of the person’s symptoms.
ARFID is most often diagnosed in children and adolescents, but people of any age can have the condition.More research is needed to determine how many people in the general population have ARFID.
ARFID is most often diagnosed in children and adolescents, but people of any age can have the condition.
More research is needed to determine how many people in the general population have ARFID.
To be diagnosed with ARFID, a person must meet the following criteria.
While professionals think that most people with ARFID develop the condition as children, there are no diagnostic criteria related to the age of onset. A person of any age can be diagnosed with ARFID.
ARFID can be challenging to diagnose because it is relatively new, and more research is needed to validate the screening tools used to assess for it.
When assessing a person for ARFID, healthcare providers must also consider and rule out other medical and mental health conditions that could explain a person’s symptoms.
Providers can use several screening tools to diagnose ARFID and differentiate it from other eating and feeding disorders.
Several of these tools can be used in the diagnosis of ARFID and to differentiate it from other eating disorders.
Who Can Diagnose ARFID?Any healthcare provider should be equipped to notice the signs of ARFID, especially since the symptoms could present to several different healthcare specialists.If you’re seeking care, primary care providers, registered dieticians or nutritionists, licensed social workers, psychologists, or psychiatrists can diagnose ARFID or refer you to the appropriate clinician in your area.
Who Can Diagnose ARFID?
Any healthcare provider should be equipped to notice the signs of ARFID, especially since the symptoms could present to several different healthcare specialists.If you’re seeking care, primary care providers, registered dieticians or nutritionists, licensed social workers, psychologists, or psychiatrists can diagnose ARFID or refer you to the appropriate clinician in your area.
Eating Pathology Symptoms Inventory (EPSI)
The Eating Pathology Symptoms Inventory (EPSI) is a 45-item self-report questionnaire.
It uses eight subscales to measure various features of disordered eating, including Body Dissatisfaction, Binge Eating, Cognitive Restraint, Excessive Exercise, Restricting, Purging, Muscle Building, and Negative Attitudes Toward Obesity.
The EPSI helps differentiate between anorexia and ARFID. A study found that people with anorexia had higher scores in Cognitive Restraint than those with ARFID but similar scores in Restricting.
How Eating Disorders Are Diagnosed
Eating Disturbances in Youth–Questionnaire (EDY–Q)
The Eating Disturbances in Youth–Questionnaire (EDY-Q) is a 12-item self-report questionnaire that has been evaluated for diagnosing ARFID in school-age children ages 8 to 13.
The EDY-Q can help providers distinguish between emotional food avoidance, selective eating, food restriction due to fear of aversive consequences, and weight problems.
Eating Disorder Assessment for DSM-5 (EDA-5)
The Eating Disorder Assessment for DSM-5 (called the EDA-5) is a validated, semi-structured interview that is designed to diagnose eating and feeding disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder according to standards in the DSM-5.
While providers might use the EDA-5 to assess for ARFID, further research is required to validate it for diagnosing ARFID and other feeding and eating disorders.
Pica, ARFID, and Rumination Disorder Interview (PARDI)
The Pica, ARFID, and Rumination Disorder Interview (PARDI) is a semi-structured multi-informant interview created to diagnose ARFID in children and adults.
One of the most important features of the PARDI is that it can identify the severity of ARFID and its various presentations, including sensory avoidance, fear of adverse reactions, and low interest in food.
The PARDI takes about 39 minutes to complete and is free to clinicians. It has been studied in patients with AFRID between the ages of 8 and 22, but more research is needed to determine its usefulness.
Nine-Item ARFID Screen (NIAS)
The Nine-Item ARFID Screen (NIAS) is a Likert scale with nine statements. A Likert scale is a way to gauge the intensity of a person’s response to a question or statement.
For example, the scale may ask a person if they “strongly agree,” “somewhat agree,” or “strongly disagree” with a question.
An ARFID diagnosis is suspected if a person receives scores greater than 10 on the NIAS picky eating subscale, more significant than 9 on the NIAS appetite subscale, and/or greater than 10 on the NIAS-fear subscale.
Researchers recommend clinicians use the NIAS with another validated eating disorder screening tool.
A thorough medical evaluation is an integral part of the diagnosis process for ARFID.
A person with ARFID can experience significant weight loss and deficiencies in vitamins and minerals that can impact growth and development, as well as long-term health. During diagnosis, providers must screen patients for deficiencies and rule out medical conditions that could account for a person’s symptoms.
Recommended labs and tests during the ARFID diagnosis process include:
Other diagnostic tests might be indicated to rule out specific conditions based on a person’s symptoms.
If you think that you or a loved one might have ARFID, it’s essential to talk to a member of the healthcare community. Ensuring you receive the correct diagnosis will help you get the appropriate treatment.
ARFID Is More Than “Picky Eating”
Knowing ARFID’s signs and risk factors can help you determine whether you need to talk to a healthcare professional. Many children have some level of picky eating, which usually involves avoiding one or two foods.
Parents and caregivers must understand that ARFID is more than “picky eating.” However, if a child avoids a wide variety of foods and does not outgrow food avoidance, it’s time to talk to their pediatrician.
Change in Eating Habits
For example, if a person who has a bad episode offood poisoningbegins to severely limit their diet for fear of another food poisoning experience, they should to discuss the possibility of ARFID with a healthcare provider.
Malnourishment
Malnutrition is a consequence of many eating and feeding disorders. If a person is malnourished, it might be because they have ARFID, another eating disorder, or a medical condition.
Signs and symptoms of malnutrition include:
What Does It Mean If You’re Malnourished?
ARFID Subtypes
There are no official subtypes of ARFID detailed in the DSM-5. However, research has suggested that there could be three distinct subtypes of ARFID based on clinical presentation:
One study of 77 child and adolescent patients with ARFID, ages 8 to 17 years old, determined that 39% had limited intake, 18% had limited variety, and 43% had aversive subtypes.
Differential diagnosisis a process that medical professionals use to diagnose health conditions. The process includes testing for many possibilities and ruling out conditions individually to help them make the correct diagnosis and provide the appropriate treatment. Clinicians use the differential diagnostic process when assessing a person for ARFID because many medical and mental disorders share symptoms with the condition.
Clinicians use the differential diagnostic process when assessing a person for ARFID because many medical and mental disorders share symptoms with the condition.
Medical Differential Diagnosis for ARFID
Restrictive food intake can occur in various medical conditions, including gastrointestinal diseases, food allergies, and intolerances such asceliac disease.
Other medical conditions that should be ruled out when assessing a person for ARFID include:
What Causes ARFID?
Mental Health Differential Diagnosis for ARFID
Other mental health conditions should also be considered because some might explain a person’s symptoms better than an ARFID diagnosis.
Several mental health conditions may share symptoms with ARFID, including:
Having ARFID and Another Condition
Sometimes, people with another condition, such as OCD or autism spectrum disorder, also have ARFID. When a person has more than one condition, it’s called comorbidity.
If a person with a specific mental health diagnosis demonstrates food avoidance that causes significant psychosocial, medical, and nutritional disturbances, experts recommend that the person also be diagnosed with ARFID.
Summary
Diagnosis of avoidant restrictive food intake disorder (ARFID) requires the care of a trained healthcare professional and rises above picky eating. There are several diagnostic questionnaires based on the DSM-5 criteria that professionals use to help determine if someone has ARFID. ARFID is a relatively new diagnosis and rises above picky eating. If you are concerned that you or a loved one might have ARFID, speak to a healthcare professional.
12 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.National Eating Disorders Association (NEDA).Avoidant restrictive food intake disorder (ARFID).American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013.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/s11920-017-0795-5Archibald T, Bryant‐Waugh R.Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions.JCPP Adv. 2023;3(2):e12160. doi:10.1002/jcv2.12160Forbush KT, Wildes JE, Pollack LO, et al.Development and validation of the eating pathology symptoms inventory(Epsi).Psychol Assess. 2013;25(3):859-878. doi:10.1037/a0032639Kurz S, van Dyck Z, Dremmel D, et al.Early-onset restrictive eating disturbances in primary school boys and girls.Eur Child Adolesc Psychiatry. 2015;24(7):779-785. doi:10.1007/s00787-014-0622-zSysko R, Glasofer DR, Hildebrandt T, et al.The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders.Int J Eat Disord. 2015;48(5):452-463. doi:10.1002/eat.22388Bryant-Waugh R, Micali N, Cooke L, et al.Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10-22.Int J Eat Disord. 2019;52(4):378-387. doi:10.1002/eat.22958Burton MH, Dreier MJ, Zickgraf HF, et al.Validation of the nine item ARFID screen (Nias) subscales for distinguishing ARFID presentations and screening for ARFID.Int J Eat Disord. 2021. doi:10.1002/eat.23520Brigham 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-ySpettigue 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/s40337-018-0205-3Norris ML, Spettigue W, Hammond NG, et al.Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder.Int J Eat Disord. 2018;51(2):170-173. doi:10.1002/eat.22814
12 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.National Eating Disorders Association (NEDA).Avoidant restrictive food intake disorder (ARFID).American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013.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/s11920-017-0795-5Archibald T, Bryant‐Waugh R.Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions.JCPP Adv. 2023;3(2):e12160. doi:10.1002/jcv2.12160Forbush KT, Wildes JE, Pollack LO, et al.Development and validation of the eating pathology symptoms inventory(Epsi).Psychol Assess. 2013;25(3):859-878. doi:10.1037/a0032639Kurz S, van Dyck Z, Dremmel D, et al.Early-onset restrictive eating disturbances in primary school boys and girls.Eur Child Adolesc Psychiatry. 2015;24(7):779-785. doi:10.1007/s00787-014-0622-zSysko R, Glasofer DR, Hildebrandt T, et al.The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders.Int J Eat Disord. 2015;48(5):452-463. doi:10.1002/eat.22388Bryant-Waugh R, Micali N, Cooke L, et al.Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10-22.Int J Eat Disord. 2019;52(4):378-387. doi:10.1002/eat.22958Burton MH, Dreier MJ, Zickgraf HF, et al.Validation of the nine item ARFID screen (Nias) subscales for distinguishing ARFID presentations and screening for ARFID.Int J Eat Disord. 2021. doi:10.1002/eat.23520Brigham 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-ySpettigue 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/s40337-018-0205-3Norris ML, Spettigue W, Hammond NG, et al.Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder.Int J Eat Disord. 2018;51(2):170-173. doi:10.1002/eat.22814
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.
National Eating Disorders Association (NEDA).Avoidant restrictive food intake disorder (ARFID).American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013.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/s11920-017-0795-5Archibald T, Bryant‐Waugh R.Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions.JCPP Adv. 2023;3(2):e12160. doi:10.1002/jcv2.12160Forbush KT, Wildes JE, Pollack LO, et al.Development and validation of the eating pathology symptoms inventory(Epsi).Psychol Assess. 2013;25(3):859-878. doi:10.1037/a0032639Kurz S, van Dyck Z, Dremmel D, et al.Early-onset restrictive eating disturbances in primary school boys and girls.Eur Child Adolesc Psychiatry. 2015;24(7):779-785. doi:10.1007/s00787-014-0622-zSysko R, Glasofer DR, Hildebrandt T, et al.The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders.Int J Eat Disord. 2015;48(5):452-463. doi:10.1002/eat.22388Bryant-Waugh R, Micali N, Cooke L, et al.Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10-22.Int J Eat Disord. 2019;52(4):378-387. doi:10.1002/eat.22958Burton MH, Dreier MJ, Zickgraf HF, et al.Validation of the nine item ARFID screen (Nias) subscales for distinguishing ARFID presentations and screening for ARFID.Int J Eat Disord. 2021. doi:10.1002/eat.23520Brigham 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-ySpettigue 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/s40337-018-0205-3Norris ML, Spettigue W, Hammond NG, et al.Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder.Int J Eat Disord. 2018;51(2):170-173. doi:10.1002/eat.22814
National Eating Disorders Association (NEDA).Avoidant restrictive food intake disorder (ARFID).
American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed. Washington D.C.: 2013.
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
Archibald T, Bryant‐Waugh R.Current evidence for avoidant restrictive food intake disorder: Implications for clinical practice and future directions.JCPP Adv. 2023;3(2):e12160. doi:10.1002/jcv2.12160
Forbush KT, Wildes JE, Pollack LO, et al.Development and validation of the eating pathology symptoms inventory(Epsi).Psychol Assess. 2013;25(3):859-878. doi:10.1037/a0032639
Kurz S, van Dyck Z, Dremmel D, et al.Early-onset restrictive eating disturbances in primary school boys and girls.Eur Child Adolesc Psychiatry. 2015;24(7):779-785. doi:10.1007/s00787-014-0622-z
Sysko R, Glasofer DR, Hildebrandt T, et al.The eating disorder assessment for DSM-5 (EDA-5): Development and validation of a structured interview for feeding and eating disorders.Int J Eat Disord. 2015;48(5):452-463. doi:10.1002/eat.22388
Bryant-Waugh R, Micali N, Cooke L, et al.Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10-22.Int J Eat Disord. 2019;52(4):378-387. doi:10.1002/eat.22958
Burton MH, Dreier MJ, Zickgraf HF, et al.Validation of the nine item ARFID screen (Nias) subscales for distinguishing ARFID presentations and screening for ARFID.Int J Eat Disord. 2021. doi:10.1002/eat.23520
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
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
Norris ML, Spettigue W, Hammond NG, et al.Building evidence for the use of descriptive subtypes in youth with avoidant restrictive food intake disorder.Int J Eat Disord. 2018;51(2):170-173. doi:10.1002/eat.22814
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