Disordered Eating

ARFID is when someone avoids certain foods, limits how much they eat or does both. 

Beliefs about weight or body shape are not reasons why people develop ARFID. 

Someone might be avoiding and/or restricting their intake for a number of different reasons. The most common are the following: 

• They might be very sensitive to the taste, texture, smell, or appearance of certain types of food, or only able to eat foods at a certain temperature. This can lead to sensory-based avoidance or restriction of intake. 

• They may have had a distressing experience with food, such as choking or vomiting, or experiencing significant abdominal pain. This can cause the person to develop feelings of fear and anxiety around food or eating, and lead to them to avoiding certain foods or textures. Some people may experience more general worries about the consequences of eating that they find hard to put into words and restrict their intake to what they regard as ‘safe’ foods. Significant levels of fear or worry can lead to avoidance based on concern about the consequences of eating. 

• In some cases, the person may not recognise that they are hungry in the way that others would, or they may generally have a poor appetite. For them, eating might seem a chore and not something that is enjoyed, resulting in them struggling to eat enough. Such people may have restricted intake because of low interest in eating. 

It is very important to recognise that any one person can have one or more of these reasons behind their avoidance or restriction of food and eating at any one time. In other words, these examples are not mutually exclusive. This means that ARFID might look quite different in one person compared to another. Because of this, ARFID is sometimes described as an ‘umbrella’ term – it includes a range of different types of difficulty. Nevertheless, all people who develop ARFID share the central feature of the presence of avoidance or restriction of food intake in terms of overall amount, range of foods eaten, or both. 

ARFID has 3 different domains….fear of an aversive consequence in relation to food and eating or drinking, a lack of interest in food , or avoidance of food based on sensory characteristics of food. This is different to other eating disorders. 

The DSM‑5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) sets out the medical criteria used to diagnose Avoidant/Restrictive Food Intake Disorder (ARFID).

A child or young person may have ARFID if they have an eating difficulty that leads to not getting enough food or energy. This may include:

• low interest in food

• avoiding food because of sensory issues

• fear of negative experiences such as choking, vomiting or pain

The eating difficulty must cause one or more of the following:

• significant weight loss, or not growing as expected

• nutritional deficiency (not getting key vitamins or minerals)

• needing tube feeding or nutritional supplements

• problems with everyday life, such as not being able to join in social activities

The eating problem must not be caused by:

• not having enough access to food

• cultural or religious practices around food

The child or young person must also not have:

• anorexia nervosa

• bulimia nervosa

• concerns about weight or body shape

The eating difficulty must not be fully explained by another medical condition or disability. If another condition is involved, the eating difficulty must be more severe than would usually be expected and must need extra clinical support.

It is normal for many children to be picky eaters. This does not mean they have ARFID.

Some children also get upset at mealtimes because of age, sensory needs or changes in routine. They may find the smell, sight or sound of eating difficult.

ARFID can look different in each child. Not every child will show the same signs. Below are some possible signs.

Possible signs of ARFID

A child may:

• eat a range of foods, but not enough overall to stay healthy

• find it hard to notice when they are hungry

• feel full after only a few bites

• take a long time to eat, or say eating feels like “hard work”

• skip meals, especially when busy or focused on something else

• be sensitive to food textures, smells or temperatures

• seem like a “picky eater”

• always eat the same meals

• eat something different from the rest of the family

• only eat foods of a similar colour (for example, mostly beige foods)

• avoid social events where food is present

• be very anxious at mealtimes

• chew food very carefully or take tiny bites and sips

• lose weight, or not gain weight as expected

• have nutritional deficiencies, such as anaemia from low iron

• need supplements to meet their nutrition and energy needs

  Read more
  

ARFID can look different from one person to another. Because of this, children and young people may need support from different services and professionals.

ARFID is not yet included in the NICE guidelines for eating disorders. This does not mean it should be ignored. Your GP should still make a referral to the right service for support.

A young person with ARFID may receive help from:

• the local community eating disorders service

• Child and Adolescent Mental Health Services (CAMHS)

• community paediatrics

• hospital paediatric teams

• private specialists, such as:

  • dietitians

  • speech and language therapists

  • psychologists

  • occupational therapists

What treatment looks like

(Suggested alternative: Types of Support Your Child May Receive)

Treatment is usually tailored to the individual child. It depends on:

• the type of eating difficulty

• what is keeping the difficulty going

• any sensory, physical or emotional needs

Most children receive treatment as outpatients, meaning they visit appointments and return home the same day.

Common treatments include:

• family‑based treatment (often used with young people)

• cognitive behavioural therapy (CBT)

• behavioural approaches, including gradual exposure to new foods

• anxiety management strategies

• medication, sometimes used to reduce anxiety

A child’s physical health must also be checked regularly. This could be done by:

• their GP

• a physician

• a paediatrician

Some children may need support from a dietitian to help meet nutritional needs. Others may need help with sensory issues that affect eating.

Helplines and support groups

England Helpline
0808 801 0677
help@beateatingdisorders.org.uk

Online support groups:
https://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/i-need-support-now/online-support-groups/

If you feel that you or your child may have ARFID, you may also find these resources useful:

• ARFID Awareness UK
  https://www.arfidawarenessuk.org/

• Avoidant Restrictive Food Intake Disorder by Rachel Bryant‑Waugh
  A guide for parents

• What is ARFID?
  https://abuhb.nhs.wales/files/mental-health/paediatric-psychology-coping-with-my-condition/helpful-tips-leaflet-pdf/

Pica is when a person eats or mouths items that are not food.
These items might include stones, dirt, metal or faeces.

Children and young people who are neurodivergent may experience pica for different reasons. These can include:

• not knowing which items are safe to eat

• seeking sensory input from taste or texture

• trying to reduce anxiety or stress

• trying to relieve pain or discomfort

• having low iron levels

• continuing mouthing behaviour from babyhood

• using the behaviour to get attention

• using the behaviour to avoid a task

You could try to:

• Set up a simple sorting activity where your child sorts edible and inedible items.

• Use PECS (Picture Exchange Communication System) to help them learn which items are safe to put in their mouth. Give rewards for using safe items.

• Offer safe alternatives with a similar texture, such as carrot sticks, chewy tubes, popcorn or chewing gum.

• Visit the GP or dentist to check for medical issues, pain or nutritional deficiencies. Ask about referral to an occupational therapist if needed.

• Increase structured activities in the child’s day so there is less unoccupied time.

• Stay calm and give a firm “no” with limited eye contact if the behaviour happens. Back this up with a visual symbol.

• Reduce demands that may be causing stress.

• Distract the child and redirect them to a safe activity.

Using social stories

A social story can help explain why non‑food items (especially faeces) must not be eaten.
Social stories describe a situation clearly and show what is expected.

You can add pictures if helpful.

An example social story about not eating faeces might include:

• “I do not eat poo.”

• “Poo is dirty and smells bad.”

• “I do not touch poo with my hands.”

• “Poo goes in the toilet.”

• “I sit on the toilet and poo into the toilet.”

• “If I want something to eat, I ask for a food that is safe to eat.”

The National Autistic Society has information on social stories:

Read more about social stories

Example of a social story

Everyone has their own eating style, and many ways of eating can still be healthy.
But some eating patterns are linked to worries about body weight or body shape.
For example, a person may fear being a healthy weight or fear becoming fat.
These thoughts can affect the body and daily life.

These patterns are called eating disorders. Eating disorders can be a way of coping with difficult feelings or stressful experiences.

Below is information about anorexia nervosa.

Anorexia nervosa

A person with anorexia nervosa is underweight and afraid of gaining weight.
They may:

• severely limit what they eat

• avoid foods they believe will make them gain weight

• purge (for example, vomiting or using laxatives)

• exercise too much to lose weight

A child or young person may have anorexia if they show some of the following signs:

• if under 18, being smaller or lighter than expected for their age

• missing meals or eating very little

• avoiding foods they think are “fattening”

• believing they are fat, even when they are a healthy weight or underweight

• taking medicines to reduce hunger

• periods not starting in girls and young women

• physical symptoms such as:

  • feeling light‑headed or dizzy

  • hair loss

  • dry skin

Treatment for under‑18s

Children and young people with anorexia should be offered:

• family therapy (this is usually the first approach)

• talking therapies such as:

  • CBT (cognitive behavioural therapy)

  • adolescent‑focused psychotherapy

Find out more at NHS England

A person with bulimia nervosa is usually within a healthy weight range.
They often binge‑eat, which means eating large amounts of food in a short time and feeling out of control.
They then use harmful methods to try to stop weight gain. This might include:

• making themselves vomit

• using laxatives or diuretics

• fasting

• doing extreme amounts of exercise

Symptoms of bulimia

A person may:

• eat very large amounts of food quickly (binge eating)

• purge after a binge by vomiting, using laxatives, fasting or exercising too much

• fear putting on weight

• judge themselves harshly because of their body shape or weight

• have mood changes, such as feeling tense or anxious

These signs can be hard to spot. People with bulimia often hide their behaviour.

Treatment for children and young people

Young people with bulimia are usually offered:

• family therapy – the family meets with a therapist to understand bulimia and learn how to support recovery

• cognitive behavioural therapy (CBT) – if family therapy is not suitable

More information on

Eating Disorder Not Otherwise Specified (EDNOS)

EDNOS describes eating difficulties where a person shows some, but not all, signs of anorexia nervosa or bulimia nervosa.

If your child seems withdrawn, moody or easily upset, it can be hard to talk to them.
It may feel even harder if they do not believe they have a problem.

But talking is an important part of their recovery. Keep trying.
They may sound angry, even if they are actually scared or unsure.
They may find it hard to express their feelings, so try to be patient and listen.

You can help by:

• staying calm and planning what you want to say

• avoiding blame or judgement

• focusing on their feelings, not their actions

• not commenting on their appearance

• using “I” statements such as “I’m worried because you don’t seem happy”

• avoiding talk about diets, calories or weight

• not feeling hurt if they do not open up straight away

• remembering that secretive behaviour is part of the illness, not a rejection of you

Try these mealtime tips

Mealtimes can be especially challenging. These tips may help:

• If your child is in treatment, ask their team for help with mealtime plans.

• Create meal plans together and agree on them in advance.

• As a family, agree not to talk about portion sizes, calories or anything related to the meal.

• Avoid low‑calorie or diet foods at home or eating them in front of your child.

• Keep the atmosphere light and positive, even if you feel stressed.

• If your child tries to control the meal by cooking it, gently ask them to do other tasks, like setting the table.

• Try not to focus only on your child during the meal. Enjoy your own food and keep normal conversation going.

• Plan a family activity after the meal, such as a game or watching TV, to help distract them from wanting to purge or overexercise.

• If a meal goes badly, try not to worry. Move on and try again next time.

If your child is being treated for an eating disorder, their treatment team will play a big role in their recovery.

But your love, support and patience are also very important.

You can help by:

• learning as much as you can about eating disorders, so you understand what is happening

• reminding your child often that you love them and will always support them

• helping them know what professional help is available

• suggesting activities that are not related to food, such as hobbies or meeting friends

• asking them what they want or need from you

• being honest about your own feelings, which may help them share theirs

• showing a healthy approach to food and exercise

• building their confidence by praising positive actions, like being kind or trying something new

Get support for yourself

(Suggested alternative: Support for Parents and Carers)

You do not have to cope alone.

Ask your GP or a member of your child’s treatment team for advice on helping at home.

It is also important that the whole family understands the situation and gets support.
The following organisations offer online advice:

• Anorexia and Bulimia Care – advice for family and friends

• Beat – supporting someone with an eating disorder

• Family Lives – information on eating disorders

• Young Minds – help for parents

Your GP may also know about local support groups for parents caring for someone with an eating disorder.

It can be hard to get a teenager to talk about what is worrying them.
The tips below may help.

Do not judge your teenager

Begin by assuming they have a good reason for their behaviour.
Show them you respect their thinking and are curious about their choices.

If you avoid calling their behaviour “silly” or “wrong”, they are more likely to open up and explain their reasons.

Try not to assume you know what is wrong

Avoid guessing what the problem is.

Instead of asking:
“Are you being bullied?”
try saying:
“I’ve been worried about you. You don’t seem your usual self. What’s going on at the moment? Is there anything I can help with?”

This opens a gentle and safe conversation.

Be clear you want to help

If you think they may be using drugs or drinking too much, be kind but direct.
Ask them calmly and let them know you will support them through any difficulty.

Be honest yourself

Teenagers notice when adults do not follow their own advice.
If you tell them not to drink too much, but you drink too much yourself, they may point it out.

Try to act in a responsible way. This helps build trust.

Help your teenager think for themselves

Instead of trying to be the expert on their life, help them think things through.

You can:

• talk about the possible consequences of their choices

  • For example: “How does smoking weed make you feel the next day? How might that affect your football match?”

• help them question what they hear from friends

  • “Paul said X. Is that what you think too?”

• remind them what they are good at

  • This builds confidence and helps them cope with challenges.

• encourage them to find information from trusted websites about topics such as drugs, sex or smoking

• help them think of ways to manage difficult feelings

  • “When you feel like that, what could help you feel better?”

You can help your teenager by talking through the positives and negatives of their actions.
This helps them learn to make safer and more thoughtful decisions.

Pick your battles with your teenager

If teenagers hear constant criticism or nagging, they may stop listening.
Try to let small issues go, such as clothing choices or hairstyles.
This helps keep communication open, so you can talk calmly about more serious topics like drugs, alcohol or sex when needed.

Try not to react to angry outbursts

Teenagers often take out their emotions on the people they trust most.
This does not mean they hate you.
It usually means they feel confused, upset or overwhelmed and do not know how to express it.

Try not to take hurtful comments personally.

Help your teenager feel safe

Many teenagers worry that telling an adult will make things worse.
Let them know you want to help and will not act without talking to them first.

If they tell you about bullying, reassure them:

• bullying is not acceptable

• it is not their fault

• you will help them work through it

Support them to feel confident by saying you will face the problem together.

Ask your teenager the right questions

You may learn more by asking open questions.
Open questions encourage conversation and feel less confrontational.

For example, if your teenager has an eating disorder, direct questions such as:

• “What did you eat for lunch?”

• “Did you make yourself sick?”

may lead to shut‑down or dishonest answers.

Instead, try:

• “How are you?”

• “How has your day been?”

• “What’s been on your mind today?”

These questions help your teenager talk about feelings, not actions.