ARFID: Finding Treatment That Works

March 18, 2022

“It’s a phase.”

“They’ll outgrow it.”

“If they get hungry enough, they’ll eat.”

Parents and caregivers of those who struggle with ARFID know these statements all too well.

Unfortunately, these statements do not accurately describe the everyday struggle facing these individuals. Worse, they can lead to misdiagnosis and delay in treatment, which can increase the potential for medical complications.

These words of presumed assurance are not intending harm and instead are often well-meaning attempts to support families in managing the anxiety and fear that comes from seeing a loved one struggle with limited nutritional intake.

These common assumptions also demonstrate the lack of knowledge and understanding of ARFID and the difficulty those who struggle with ARFID face in finding appropriate treatment.

What is ARFID?
Avoidant/Restrictive Food Intake Disorder (ARFID) is more than just picky eating. It’s described as an aversion to food characterized into three subtypes:

  • Aversion due to sensory characteristics
  • Fear of adverse consequences
  • Lack of interest in food

Due to these varying struggles, individuals historically have sought support from a variety of different specialties including primary care, gastroenterology, and behavioral health.

ARFID is believed to account for 5-13 percent of cases in specialist psychiatric and medical settings.

Cognitive Behavioral Therapy to Treat ARFID
In 2013, ARFID was first introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which provided a name for the symptoms and struggles that many families and adults were familiar with for much longer.

With its introduction has come increased research and development of novel treatments, the most notable being Cognitive Behavioral Therapy for ARFID (CBT-AR), which was developed at Mass General Hospital’s Eating Disorders Clinical and Research Program.

CBT-AR is an evidence-based treatment that utilizes either a Family Supported or Individual Treatment model for the treatment of adolescents and adults with ARFID.

How does CBT-AR Work to Break the ARFID Cycle?
Treatment takes the approach that although food restriction was initially trigged by a biological predisposition or event such as a choking incident, it is the pattern of food avoidance and/or restriction that serves as the maintaining factor for an individual’s negative predictions about eating and its physical or psychological consequences.

Therefore, the focus of treatment is to directly target food avoidance and/or restriction to reduce or eliminate associated negative thoughts and feelings and ultimately break the cycle of ARFID symptoms.

With a focus on early changes and any medical stabilization needed, CBT-AR works to begin shifting behaviors from the start of treatment. As ARFID is still new, CBT-AR ensures our patients and their loved ones understand the biological roots of ARFID and gives them tools to meet their individualized needs.

Walden implements CBT-AR in our ARFID Intensive Outpatient (IOP) program with success for our patients. Traditionally an outpatient model can be delivered in-person and virtually while also being implemented in treatment centers for those who need more structured support.

Walden’s Unique ARFID IOP
For those who have struggled with ARFID for some time, the development of a new diagnostic category has brought hope for relief and recovery from symptoms they have long struggled with, and treatments like CBT-AR make recovery possible.

Walden’s unique virtual IOP provides highly specialized care from an expert treatment team that is trained in ARFID. The ARFID IOP is a 10-week virtual program open to individuals aged 11-17 of all ethnicities and genders. Visit for more information.