How Therapists Can Recognize ARFID in Clients

By: A Guest Contributor to The Eating Disorder Center’s Blog

Avoidant Restrictive Food Intake Disorder (ARFID) is being identified more often as awareness grows, but it can still be difficult to recognize — especially because the symptoms are different from other eating disorders. Many therapists work with clients who struggle around food but don’t always express body image concerns, which can make ARFID easier to miss. Or many therapists might be working on anxiety, depression, OCD or other mental health concerns, a client’s relationship with food might not come up naturally in the flow of their conversation. Which is totally understandable! This blog aims to help therapists and other mental health providers understand common signs of ARFID. We’ll also talk about screening questions to keep in mind while in session with clients. 


What Is ARFID?

ARFID is an eating disorder marked by ongoing difficulty eating enough food or difficulty eating a wide enough variety of foods. This restriction is not always related to weight, shape, or a desire to change one’s body. Although some clients with ARFID can absolutely still struggle with body image - we live in diet culture after all - their primary concern tends to be related to other food experiences. This includes, sensory sensitivities, fear of negative experiences with food (like vomiting or choking), or very low interest in eating. 


Why Screen For ARFID? 

ARFID often leads to nutritional concerns, low energy, stress around meals, or difficulty participating in social situations involving food. Many of our clients feel overwhelmed around meal times. And parents of children with ARFID struggle with feeding, meal planning and grocery shopping for their families. 

ARFID can also lead to increased restriction and malnutrition, which could trigger anorexia or another eating disorder. 

In order to prevent mental health and physical health complications, flagging ARFID is important! 


Common Ways ARFID Shows Up

Clients with ARFID may present in different ways, but these patterns are especially common:

1. Strong Sensory Sensitivities
Some of our clients are extremely sensitive to food textures, smells, temperatures, or flavors. They may rely on a small group of “safe foods” and feel distressed when asked to try new foods. 

2. Fear-Based Avoidance
Past experiences like choking, vomiting, or severe nausea can lead to intense anxiety around eating. Even the possibility of something going wrong can cause someone to avoid many foods or entire meals. Some clients with ARFID have had a past traumatic experience with food, while others have the fear that something could go wrong. 

3. Low Interest in Food
Some clients report little appetite or motivation to eat. Food may feel like a chore rather than something enjoyable, leading to skipped meals or inadequate intake.

It’s common for clients to experience more than one of these patterns at the same time.

4. An ADHD or Autism Diagnosis
There is a correlation between neurodivergence and ARFID. Of course, not all clients who are neurodivergent have ARFID and not all clients who have ARFID are neurodivergent. However, if a client has been diagnosed with ADHD or autism, it could be a clue to ask more questions about this client’s relationship with food. 


How Clients Often Describe Their Experience

Clients may not label their experience as an eating disorder, and they might not even have heard of ARFID before, but you might hear statements like:
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• “I’ve always been extremely picky.”
• “There are only a few foods I feel safe eating.”
• “Eating is stressful or exhausting.”
• “I know I need to eat, but nothing sounds good.”
• “Certain textures make me gag or panic.”

These comments can signal that food avoidance is having a meaningful impact on daily life.

3 Simple ARFID Screening Questions for Therapists

While these questions aren’t a full scale ARFID screening questionnaire, the hope is that asking these questions will give you an indication of needing to explore food more. These questions are intentionally brief and essay to integrate into sessions: 

1. Are there many foods you avoid because of texture, taste, smell, or fear of getting sick or choking?
   
   
2. Does eating feel stressful, overwhelming, or like a burden most of the time?
   
   
3. Has your eating ever caused problems with energy, health, or social situations (like eating with others)?
   
   

If clients respond “yes” to multiple questions, further assessment or referral to an ARFID dietitian is recommended. 


Next Steps When ARFID Is Suspected

When ARFID seems likely, collaboration with a dietitian or provider experienced in ARFID treatment, like an occupational therapist or a speech and language pathologist, can be essential. Treatment often focuses on nutritional adequacy, reducing food-related anxiety, and gradually expanding food variety in a supportive, non-shaming way.

At Courage to Nourish, we take a responsive feeding approach to treating ARFID. What this means is we do not force clients to try foods if they aren’t ready for them. We focus first on nourishment - because malnutrition can cause more anxiety about food. Then, we discuss with our clients starting with trying higher priority foods. For example, perhaps a client often goes to a certain restaurant with friends and it’s their goal to participate in this outing. We would start with trying foods from that restaurant. 

We also work closely with family members when appropriate, especially involving parents and caregivers for our younger clients.  

About the Author

Alex Raymond is the founder and owner of Courage to Nourish. She opened Courage to Nourish to create a practice that aligns with her values in eating disorder recovery. She is a Certified Eating Disorder Dietitian and Approved Supervisor through iaedp. Additionally, Alex is a proud anti-diet dietitian and works with her clients through a Health At Every Size © and intuitive eating framework. ​

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The Eating Disorder Center is a premier outpatient eating disorder therapy center founded by Jennifer Rollin. We specialize in helping children, teens, and adults struggling with anorexia, binge eating disorder, bulimia, OSFED, and body image issues. We provide eating disorder therapy in Rockville, MD, easily accessible to individuals in Potomac, North Potomac, Bethesda, Olney, Silver Spring, Germantown, and Washington, D.C. We also provide eating disorder therapy in Arlington, Virginia and virtually throughout Virginia. Additionally, we offer eating disorder therapy virtually in Florida, Pennsylvania, and California. We provide eating disorder and EMDR trauma therapy in Rockville, Maryland and virtually throughout Maryland and Virginia. We provide eating disorder recovery coaching via Zoom to people worldwide. Connect with us through our website at www.theeatingdisordercenter.com