How Avoidant Restrictive Food Intake Disorder (ARFID) Is Treated

Medically reviewed by Steven Gans, MD

Avoidant restrictive food intake disorder (ARFID) is an eating disorder in which a person limits the amount and/or type of foods that they eat. Unlike other eating disorders such as anorexia nervosa, a person with ARFID does not limit their diet because they want to change how their body looks or how much they weigh.

There is no standard treatment for ARFID, though different types of therapies, including cognitive behavioral therapy (CBT), family-based therapy, and occupational therapy, have been found to be helpful. In some cases, medications are used off-label to treat ARFID.

ARFID affects both children and adults and can seriously affect a person’s physical and mental health. The eating disorder can lead to medical complications such as weight loss and delays in growth and development.

This article will cover the various treatment options for ARFID, including different kinds of therapies, medications, and—in some cases—hospitalization.

Treating ARFID in Children and Adults

There is no standard treatment for ARFID because it is a relatively new diagnosis. Although there is extensive literature on the treatment of feeding disorders in children, there have been no rigorous clinical trials evaluating the effectiveness of ARFID treatment in teenagers or adults.

Healthcare providers rely on their clinical experience and judgment, as well as the limited research that is available, when treating patients with ARFID.

Healthcare Team

A multidisciplinary team of medical and mental health professionals is often recommended for treating ARFID. These may include specialists such as:

• Dietitians

• Gastroenterologists

• Medical doctors

• Mental health clinicians

• Occupational therapists

• Speech-language pathologists

People with severe ARFID may need to be hospitalized or attend residential programs or partial hospitalization programs. The treatment setting will depend on the severity of a person’s food restriction, their level of malnutrition, and their weight. Refeeding with a feeding tube (called enteral nutrition) is sometimes necessary.

A 2017 study found that ARFID can successfully be treated in a partial hospitalization program that is designed for eating disorders in general. Compared to patients with other eating disorders in the same partial hospitalization program, patients with ARFID had similar improvements in weight and psychological wellness, but over a shorter period of time.

In some cases, the diet restriction and refusal to eat in patients with ARFID is severe. A study from 2015 compared the outcomes of patients with ARFID and patients with anorexia nervosa who were hospitalized for nutrient insufficiency.

The study’s findings showed that ARFID patients generally required longer hospital stays than patients with anorexia (eight days compared to five days), and were more likely to need a feeding tube.

Related: Why Do People Develop ARFID?

Therapies

Once a person’s immediate physical needs are met and they are medically stable, therapy is often the next step in ARFID treatment. There are many types of therapy that can be used, and each is offered by different specialists. In many cases, a person with ARFID is engaged in several types of therapy at the same time.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of psychotherapy that is used to treat a wide variety of mental health conditions including eating disorders. In CBT, a trained therapist helps a person learn to identify their distorted thinking patterns, change their thoughts, and ultimately change their behavior.

There is a lot of evidence in support of the effectiveness of CBT for treating eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder.

However, high-quality evidence on CBT as a treatment for ARFID is lacking. Only a few case reports have suggested that CBT might be helpful for some people with the condition.

CBT-AR

Cognitive behavioral therapy for avoidant restrictive food intake disorder (CBT-AR) is a specialized form of CBT. The initial research on CBT-AR, published in 2020, found that 70% of participants who completed a round of CBT-AR no longer qualified for the diagnostic criteria of ARFID. CBT-AR has only been studied in people with ARFID who were 10 years of age and older, medically stable, and not using a feeding tube.

Family Based Therapy (FBT)

Family based therapy (FBT) is a type of behavioral therapy that is commonly used to treat eating disorders in children and adolescents. In FBT, blame is removed from the patient and the family, and the eating disorder is viewed as an external force. Everyone in the patient’s family is treated as a unit that is dealing with the patient’s eating disorder together.

A small study of six participants with ARFID found that after treatment with medical monitoring, medication, and FBT, all participants met their goal weight. However, more research—particularly randomized controlled trials—is needed to determine the true effectiveness of FBT for children with ARFID.

Occupational Therapy

Occupational therapists take a holistic approach to restoring health, well-being, and functioning through assessment and techniques designed to develop or recover meaningful activities or occupations.

[Eating is considered an activity of daily living, and treatment of ARFID is within the occupational therapy scope of practice.]

Occupational therapists complete a full assessment of a person’s sensory, motor, developmental, environmental, cultural, and behavioral factors that could be impairing eating.

Kids with ARFID and co-occurring sensory processing disorder, autism spectrum disorder (ASD), or ADHD might work with an occupational therapist in an outpatient therapy setting. Patients with eating disorders may also receive occupational therapy in residential treatment or inpatient settings.

Interventions are individualized to the person with ARFID, but can include tactile play to promote oral acceptance, food chaining techniques, social stories about self-feeding and eating, operant conditioning, and sensory diets.

Supporting Your Child With ARFID at Home

If you have a child with ARFID, here are some ways to be supportive of them at home:

• Be a role model by serving and eating a variety of foods.

• Encourage your child to try new foods, but do not force them to eat.

• Reward positive eating behaviors.

• Avoid blaming or criticizing your child for their eating struggles.

Speech Therapy

A speech therapist (speech-language pathologist) is another kind of rehabilitation professional that can be part of an ARFID treatment team. Speech therapists treat issues relating to speech, hearing, and swallowing.

In the context of ARFID, a speech therapist can help people who have a food aversion that leads to swallowing difficulty (dysphagia).

Speech therapists work with people of all ages, using a variety of interventions. For example, they can help a person become more comfortable swallowing different textures through techniques like pre-chaining, food chaining, and feeding programs that target different consistencies.

Related: Swallowing Exercises for Dysphagia From Neurological Causes

Medications to Treat ARFID

Prescription medication is not usually a first-line treatment for ARFID. There are currently no randomized controlled trials that support the use of any prescription medication for treating ARFID, and no drugs have been approved by the Food and Drug Administration (FDA) to treat the disorder.

However, based on their experience and review of the research that is available, a healthcare provider might decide to prescribe a medication off-label for a patient with ARFID.

Medications that are sometimes prescribed off-label for ARFID include:

• Cyproheptadine: This is an antihistamine that can stimulate appetite. It can be helpful for infants and young children with ARFID who have lost interest in food and are underweight.

• Mirtazapine: This antidepressant, also known as Remeron, is sometimes used to stimulate appetite and has a tendency to lead to weight gain. It may help reduce mealtime fear, but evidence to support its use for ARFID is limited to case reports.

• Lorazepam: This benzodiazepine, more commonly known as Ativan, is sometimes prescribed to reduce anxiety related to eating.

• Olanzapine: This is an atypical antipsychotic also known as Zyprexa. It is sometimes used to decrease anxiety and cognitive rigidity affecting a person’s food beliefs, and it can promote weight gain.

Clinicians also need to consider the other medications a person is taking before they decide to prescribe an off-label treatment. Many people with ARFID have another (co-occurring) mental health condition.

One example of a co-occurring condition that a person with ARFID may have is attention deficit hyperactivity disorder (ADHD). Stimulant medications that are used to treat ADHD have been found in both research and clinical practice to suppress appetite and exacerbate ARFID. If a person has both ARFID and ADHD, their doctor will need to adjust their medications accordingly.

Although ARFID is considered a mental health condition, like other eating disorders, it can also have profound physical consequences. Medical treatment for ARFID is needed to prevent long-term health consequences of weight loss and malnutrition.

Related: Medications Used to Treat Eating Disorders

Summary

There is no standard treatment for ARFID, and high-quality research is limited on the effectiveness of the options that are available. Various kinds of therapies, such as CBT, family-based therapy, and occupational therapies are used to treat ARFID. In some cases, medications are used to treat the symptoms of ARFID

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