Avoidant-restrictive food intake disorder (ARFID) is a newly described diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). While not a new disorder, this is the first time it has been clearly defined and criteria for diagnosis has been codified. While ARFID can be diagnosed in any age except for neonates / infants, it is most commonly seen in older children and young adolescents. ARFID is an eating disorder in which patients do not consume adequate intake to meet their nutritional needs but do not have body image issues or fear of weight gain as is seen in other eating disorders. Restrictive eating must lead to adverse outcomes, including poor growth, weight loss, inadequate weight gain, nutritional deficiencies, dependance on nutritional supplements to meet nutritional / caloric need, or psychological impairment that requires treatment. Food avoidance and selective eating patterns are a hallmark of this disorder.

Patients or their caregivers may report a low appetite or low interest in eating; food avoidance due to taste, texture, or smell; or they may report prior negative experiences with food such as vomiting or choking. ARFID is differentiated from a picky eater in that patients with ARFID are picky to the point where it adversely affects their overall food intake, leading to nutritional deficiencies or inadequate growth.

The underlying causes of this disorder are often multifactorial, involving a wide range of possible conditions, including anxiety, depression, traumatic experiences, and sensory issues. Higher rates of autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), developmental and cognitive disorders, and sensory issues are found in patients with ARFID. While the true prevalence is unknown, ARFID was found in 15%-20% of patients in day treatment eating disorder programs.

ARFID can lead to many adverse sequalae, including malnutrition, electrolyte disorders, cardiac instability and arrythmias, and amenorrhea.