ARFID Counselling
Avoidant/Restrictive Food Intake Disorder, usually known as ARFID, is an eating disorder in which someone avoids certain foods, restricts the amount they eat, or both.
Unlike anorexia or bulimia, ARFID is not driven by concerns about weight, shape or wanting to lose weight. The difficulty is around the experience of eating itself. (nhs.uk)
For some people, ARFID has been present for as long as they can remember. For others, it can develop following a frightening or unpleasant experience with food.
It can sometimes be dismissed as “fussy eating”, particularly when someone has always had a limited range of foods. But ARFID can have a significant impact on physical health, emotional wellbeing, relationships and everyday life.
What ARFID can look like
ARFID can look very different from one person to another.
You may recognise some of the following:
Eating only a fairly limited range of foods
Being particularly sensitive to certain textures, tastes, smells, temperatures or appearances
Having a strong preference for particular brands or very specific versions of foods
Finding unfamiliar foods extremely difficult or anxiety-provoking
Feeling frightened of choking, vomiting or having an allergic reaction
Avoiding foods following a previous frightening experience
Having very little interest in food or eating
Finding eating a chore rather than something enjoyable
Forgetting to eat or not noticing hunger
Feeling full very quickly
Taking a long time to eat meals
Becoming anxious when eating away from home
Avoiding restaurants, holidays or social occasions because of food
Relying on a small number of foods that feel “safe”
Someone with ARFID may experience one of these patterns or several of them at the same time. (Beat)
Different ARFID presentations
ARFID is often understood in terms of three broad presentations.
Sensory sensitivity
Some people experience food very intensely.
Texture, smell, taste, appearance or temperature may make particular foods feel genuinely unbearable. Foods that seem quite ordinary to somebody else may create a very strong disgust or sensory response.
This is very different from simply disliking a food.
Pressure to “just try it” can often increase anxiety rather than help.
Fear of something bad happening
For others, eating has become associated with danger.
This may follow an experience such as choking, vomiting, severe abdominal pain or another frightening event. The person may begin avoiding the food involved and then gradually become frightened of other foods as well.
Sometimes there is no single event. There may instead be an ongoing fear of choking, being sick, having an allergic reaction or experiencing discomfort after eating.
Avoidance can feel like the safest way of preventing that feared outcome.
Low interest in food or eating
Some people simply have very little drive to eat.
They may not notice hunger in the same way as other people, may become full very quickly, or may find eating tedious and easy to forget.
Food may have very little reward value for them, particularly when they are busy or absorbed in something else.
Over time, this can make it difficult to eat enough even when the person understands intellectually that their body needs more nourishment.
These different presentations can overlap, and ARFID does not always fit neatly into one category. (Beat)
ARFID and neurodivergence
ARFID can occur alongside autism and ADHD, and sensory processing differences can be particularly relevant for some people. Anxiety disorders can also occur alongside ARFID. (Beat)
For somebody with sensory sensitivities, the texture, smell or feel of food may be much more intense than it is for somebody else.
ADHD can sometimes bring different difficulties, such as not noticing hunger, forgetting to eat, becoming absorbed in something else or finding the practical process of preparing and eating food difficult.
Where neurodivergence is part of the picture, I think it is important to understand and work with it rather than trying to force somebody into an approach that does not fit the way their brain works.
“But I’ve always eaten like this”
One of the difficulties with ARFID is that people can spend years believing that their way of eating is simply part of who they are.
You may have been called picky, difficult or fussy as a child. You may have learned to avoid situations involving food or developed very elaborate ways of making sure that something you can eat will always be available.
Because ARFID does not necessarily involve body dissatisfaction or fear of weight gain, people may not realise that their difficulties could be part of an eating disorder.
You also do not have to be underweight to have ARFID. It can occur in people of any body size. (Beat)
The impact of ARFID
Living with a restricted range of foods can affect much more than nutrition.
Going to a restaurant, travelling, staying with somebody else, attending a wedding or even eating with friends can become stressful.
You might spend considerable time checking menus beforehand, bringing your own food or avoiding social situations altogether.
There can also be embarrassment and shame, particularly when other people comment on what you eat or try to persuade you to eat something you cannot manage.
For some people, restricted intake can also lead to weight loss or nutritional deficiencies and may require medical or dietetic support. (Beat)
How I work with ARFID
My approach is integrative, which means that I adapt the work according to what is driving the restriction for you.
There is no benefit in simply telling somebody with ARFID to “eat more” or forcing exposure to foods without first understanding what makes eating difficult.
Instead, we can begin by becoming curious about your experience of food and identifying what is maintaining the avoidance.
Depending on your needs, our work may include:
Understanding your individual pattern of avoidance or restriction
Exploring sensory sensitivities around food
Working with anxiety and fear around eating
Exploring previous frightening experiences involving food
Looking at thoughts about choking, vomiting or other feared consequences
Developing greater awareness of hunger and other body signals
Establishing a more regular eating pattern where this is needed
Gradually increasing flexibility around food
Exploring the impact of ARFID on relationships and social life
Developing strategies for eating away from home
Understanding ADHD, autism or other neurodivergence where relevant
Reducing shame around eating and replacing judgement with curiosity
The aim is not to force you to eat everything or to turn you into somebody who suddenly loves food.
It is to help eating feel safer, less restrictive and less dominant in your life, while gradually widening your choices where that is possible and helpful.
I draw on person-centred therapy, CBT-informed approaches, psychodynamic thinking and psychoeducation while adapting the work to the individual in front of me.
I also hold a Master Practitioner qualification in Eating Disorders and Obesity and have specialist training and experience in working with eating disorders.
Working alongside other professionals
Because ARFID can sometimes result in inadequate nutrition, significant weight loss or nutritional deficiencies, psychological therapy may need to sit alongside medical or dietetic support.
Where appropriate, I may recommend involvement from your GP or a dietitian so that your physical and nutritional health can be properly assessed and supported.
This is particularly important when somebody is eating a very small amount or has an extremely restricted range of foods.
You are not simply being difficult
One of the things people with ARFID can experience repeatedly is being misunderstood.
Being told to “just try it”, being pressured to finish food or having attention drawn to what you are eating can increase anxiety and shame.
ARFID is not a choice, and overcoming it is not simply a matter of trying harder.
Understanding why certain foods or situations feel so difficult is often a much more useful place to begin.
Online ARFID counselling
I offer online counselling for adults across the UK.
Online therapy can work particularly well for ARFID because you are able to talk from the familiarity of your own home and, where useful, explore difficulties around food in your own environment.
If food choices have become increasingly restricted, eating creates significant anxiety, or your relationship with food is limiting the things you can do, you are welcome to get in touch.