Eating disorders affect around 1.25 million people in the UK. While anyone can experience them, recent research highlights a strong link between Avoidant/Restrictive Food Intake Disorder (ARFID) and autism. ARFID in the context of autism differs from other eating disorders. It’s often shaped by a mix of biological sensitivities, social factors, and mental health challenges – rather than body image concerns.
If left untreated, restrictive food intake disorder can have serious consequences to people’s life and health. Effective support is available; it just requires proper assessment and timely intervention.
Find out more.
What is ARFID?
Avoidant/Restrictive Food Intake Disorder (ARFID) is a type of feeding and eating disorder that involves avoiding or limiting food in a way that significantly affects a person’s weight, nutrition, or day-to-day life. This pattern of eating is not explained by food shortages, cultural or religious practices, concerns about body image, or other health conditions.
ARFID is recognised as different from other eating disorders, such as anorexia nervosa, bulimia nervosa and binge eating disorder due to its different underlying causes. These can includ:
- Lack of interest in eating
- Strong sensory sensitivities to aspects of food such as texture or smell
- Fear of negative experiences like choking or vomiting.
These reasons are often described as subtypes, but they can overlap and differ in how strongly they affect someone, suggesting a more flexible and combined way of understanding the condition.
People with ARFID often experience other mental health challenges, including anxiety, low mood, and obsessive – compulsive traits. Physical health conditions – such as digestive issues – may also occur alongside ARFID, adding to the complexity of support needs.
Is ARFID Common in Autism?
Yes. Eating and swallowing disorders, including avoidant restrictive food intake are more common in autistic children and adults due to the specific sensory sensitivities, including smell, texture or color characteristics of the food. Further, autistic children and adults often experience swallowing difficulties also due to sensory sensitivities, motor challenges or GERD which often leads to dysphagia.
Intensive studies found that 8.2-54.8% of children diagnosed with ARFID also happen to be autistic. Further, above 50% of people with ARFID also have other cooccurring neurodevelopmental, mental health, or somatic diagnoses, including:
- Anxiety
- Depression
- Sleep disorders
- Learning difficulties
There are effective strategies that can help autistic people with feeding difficulties, icnluding identifying food preferences and implementing mealtime rituals among others.
Representations of ARFID in Autistic People
In autistic people, ARFID-related eating behaviours are often consistent and long-standing, sometimes beginning in early childhood. Meals may be highly structured, with strong preferences for specific foods and resistance to trying new ones. These behaviours are not about dieting or concerns about body image, but are instead linked to sensory discomfort, anxiety, or reduced appetite. Routines around eating can also serve as a way to manage uncertainty or sensory overload in daily life.
Sensory-Based Restrictions
Sensory sensitivities are a common feature of autism and can strongly influence eating patterns. Some autistic people may avoid foods based on texture, smell, temperature, or appearance. For example, crunchy textures might be preferred while mushy foods are completely rejected. This isn’t simply about ‘picky eating’ – it reflects genuine sensory discomfort that can make certain foods unbearable to eat, even if they are familiar or nutritious.
Fear-Based Avoidance
Some autistic people develop a strong fear of the consequences of eating, such as choking, gagging, vomiting, or experiencing pain. These fears may arise from past experiences or heightened anxiety, which can lead to food avoidance that appears extreme or puzzling to others. This fear-based avoidance can be particularly difficult to address without understanding the underlying anxiety and providing safe, gradual exposure to eating in a way that builds trust.
Lack of Interest in Food
For others, ARFID may be shaped by a reduced interest in food or eating. Some autistic people may not feel hunger in a typical way or may find mealtimes unimportant or even disruptive. Eating might be overlooked unless prompted by someone else, and even then, there may be little internal motivation to eat. This can lead to missed meals, reduced nutritional intake, and weight loss, even without any clear sensory or fear-based avoidance.
Common Signs and Symptoms of ARFID in Autistic People
In autistic people, ARFID may be under-recognised or misinterpreted, as patterns of selective eating can be seen as a common part of the autistic experience. However, when food restrictions impact physical health, social life, or emotional wellbeing, it may be a sign that something more is going on.
Selective Eating and Food Avoidance
Autistic people may have a longstanding pattern of eating a limited range of foods, often tied to strong preferences or aversions. While some degree of selective eating is common, ARFID can develop when the avoidance becomes more extreme – leading to restricted intake that affects growth, energy levels, or overall health. In these cases, eating may feel more like a source of stress than nourishment, with certain foods consistently refused due to appearance, brand, or familiarity.
Anxiety Around Mealtimes
Mealtimes can become highly stressful for autistic people with ARFID. The anxiety may stem from past negative experiences – such as choking, vomiting, or being pressured to eat – or from the unpredictability of shared eating environments. This distress might show up as avoidance of family meals, reluctance to eat in public, or becoming upset when routines are disrupted. In some cases, the anxiety is so intense that it leads to skipped meals or nutritional deficiencies.
Avoidance Based on Sensory Characteristics
Food-related sensory sensitivities are a core feature of ARFID in autistic people. The smell, texture, temperature, or taste of food can trigger strong aversive reactions. A mushy texture, a bitter aftertaste, or a strong smell can make a food completely unacceptable. For some, even the sight or sound of food being prepared can be overwhelming. These sensory-driven avoidances are not a matter of preference – they’re often involuntary, intense, and emotionally charged.
Impact of ARFID on Autistic People
ARFID can have a deep impact on autistic people, affecting not just eating habits but overall health and wellbeing. ARFID often leads to significant weight loss, food aversion, nutritional gaps, and emotional stress. These effects are often overlooked, especially when food restrictions are mistaken for typical autistic traits.
Physical Health Consequences
Restricted eating can cause significant weight loss, low energy, and slowed growth. Many autistic people with ARFID also experience nutritional deficiencies, such as low iron or vitamin D, which affect daily functioning. Some may need supplements or medical support if their intake is too limited.
Social and Emotional Effects
ARFID can make social situations difficult. People may avoid events involving food, leading to isolation or anxiety. Being misunderstood or pressured to eat can worsen distress, while the ongoing struggle with food can lower confidence and increase frustration.
Disrupted Routines and Daily Life
ARFID can affect school, work, or home routines. Preparing safe meals may take extra time and planning, and even small changes – like a different brand or packaging – can cause distress or refusal to eat. This can add pressure for both the person and those supporting them.
Evidence-Based Treatment Approaches
Supporting autistic people with ARFID involves understanding the reasons behind food avoidance and using approaches that respect sensory preferences, communication styles, and emotional needs. Evidence-based treatments focus on gradually improving eating habits while reducing anxiety and distress around food. A flexible, person-centred approach is key, as progress often takes time and depends on trust, consistency, and collaboration.
Cognitive Behavioural Therapy (CBT) and ARFID
CBT can help autistic people with ARFID by addressing fears or negative associations with food. Therapy may focus on building tolerance to new foods, reducing anxiety around eating, and developing coping strategies in a structured way. Adaptations are often needed to match communication styles and thinking patterns.
Occupational Therapy for Sensory Issues
Occupational therapists can support people who avoid food due to sensory challenges. Through sensory-based feeding strategies, they work to increase tolerance to smells, textures, or tastes at a comfortable pace. This may include play-based or practical approaches that feel safe and respectful of each person’s limits.
Drinking and Swallowing Support
Some autistic people with ARFID struggle with drinking or swallowing due to sensory sensitivities or fear of choking. Feeding specialised techniques can be used to support safer and more manageable intake. These approaches often focus on easing sensory discomfort, adjusting food or fluid textures, and supporting hydration and nutrition in ways that feel acceptable to the person.
Autism and Eating Disorders Support with Nurseline Community Services
ARFID and other eating disorders can deeply affect eating habits and everyday life – particularly for autistic people, where sensory differences, anxiety, and communication needs can make support more complex. At Nurseline Community Services, we provide specialised clinical support for people with both mental health needs and autism, with tailored approaches that respect each person’s preferences, routines, and lived experience.
Our Autism and Eating Disorders Support includes crisis placements for people who need urgent and structured help with eating difficulties, along with short- and long-term support options. We offer Positive Behaviour Support (PBS), compassionate care from community psychiatric nurses, and input from multimedia and communication specialists to help people understand, express, and manage their needs.
If you or someone you support needs urgent crisis care, short- or long-term support, or help with transitioning into the community, we are here for you.
Contact us today or make a referral.
