Avoidant/restrictive food intake disorder (ARFID) is found at higher rates in certain clinical populations and within certain neurotypes.

Increasingly, researchers and clinicians are considering the question of whether certain strict eating behaviours are a patient’s necessary responses to manage a medical condition-such as a food allergy or gastrointestinal issues-or whether these eating behaviours have strayed into the harmful territory of ARFID (or other disordered eating) symptoms. This distinction is particularly important as studies are finding that ARFID-related symptoms decrease a person’s quality of life without showing benefits in managing their medical condition.

Gastrointestinal Conditions: A Risk Factor for ARFID

If you’ve ever experienced bad nausea, vomiting, or ongoing stomach pain, it makes sense that you’d start being very cautious about what you eat.

But among adults who visit specialty gut clinics, studies have found that a surprising number meet the criteria for ARFID. For example, one large study found that about 6% of patients had full ARFID, and another 17% had significant symptoms that were close (Murray et al., 2020).

In another group of people struggling with gastroparesis – a condition where the stomach empties very slowly – nearly 40% showed clear signs of ARFID. And the more severe their gut symptoms were, the worse their eating problems became (Murray et al., 2020b).

Another study of adults with gastroparesis found that those who had both gastroparesis and ARFID were most likely to report that the ARFID symptoms began after their gastroparesis diagnosis (Hollis, Murray & Parkman, 2024).

To further explore the link between gastrointestinal symptoms and ARFID, a large study asked adults who self-identified as “picky eaters” to report about gastrointestinal issues and ARFID symptoms. Those with gastrointestinal issues reported more fear of unpleasant consequences eating than those without gastrointestinal issues. The researchers suggested that food avoidance behaviours of adults with gastrointestinal disorders may be driven by heightened fears of unpleasant eating consequences because of their history of gastrointestinal symptoms (Nicholas et al., 2021).

It’s a reminder that living with a challenging gut condition can sometimes change eating patterns in ways that go beyond what’s medically necessary.

Inflammatory Bowel Disease and Eating Fears

Inflammatory bowel diseases (like Crohn’s disease and ulcerative colitis) often cause people to rethink what they eat, especially during a flare-up. In one study, about 17% of adults with IBD screened positive for ARFID symptoms – and those with ongoing inflammation were even more likely to be at risk (Yelencich et al., 2022).

But even when IBD is in remission, eating challenges can linger. Even when symptoms were under control, around 1 in 10 patients with ulcerative colitis showed signs of excessively restrictive eating (Burton-Murray et al., 2024).

Allergies and Food Intolerances: When Fear Shapes Eating

For people with food allergies or intolerances, being careful about what they eat is lifesaving. But sometimes the fear of a reaction can cause eating to narrow even more than it needs to.

In a small study, nearly 80% of adults attending either an allergy clinic or a general practice reported avoiding foods. Many of them showed eating patterns that closely resembled ARFID – even though they started out just trying to avoid allergic reactions (Fitzgerald & Frankum, 2017).

Autoimmune Conditions: When the Body’s Attack Leads to Restriction

Autoimmune diseases, like systemic sclerosis, often come with a long list of gastrointestinal problems. In patients with systemic sclerosis, nearly half showed signs of ARFID symptoms – and worse gut symptoms meant worse eating problems (Gonzalez et al., 2024).

Coeliac Disease: Navigating a Gluten-Free Life

Managing coeliac disease requires strict avoidance of gluten. But for some people, food restriction goes beyond what’s necessary.

In one study, over half of adults with coeliac disease showed signs of ARFID – and interestingly, they weren’t managing their disease any better than those without ARFID symptoms (Bennet et al., 2022).

Another study found that ARFID symptoms persisted even after a year of following a gluten-free diet. Patients who had a history of weight loss were especially at risk (Atkins et al., 2024).

Neurodiverse experiences of ARFID

Emerging research also highlights an interplay between ARFID symptoms and certain neurotypes, such as Tourette syndrome or Autism Spectrum Disorder.

For example, one study surveyed 53 adults with Tourette syndrome and an equal number of neurotypical adults. Compared to the neurotypical adults, the adults with Tourette syndrome reported more food avoidance and ARFID-associated behaviours (Smith, Gutierrez & Ludlow, 2022).

Another study involved 74 young adults with autism and 40 without autism. Compared to those without autism, the young adults with autism reported more concerning eating behaviours that characterise ARFID. This study also found that certain autism diagnostic criteria (sensory sensitivities, and restricted interests) were significantly associated with ARFID screening scores. The researchers suggested that people with autism can experience autism-focused eating behaviours along with-not instead of-typical eating disorder symptoms (Young et al., 2022).

While the characteristics of certain neurotypes-like being extra sensitive to specific tastes, smells and textures-can naturally affect eating behaviours, some experts are concerned that the expectation that neurodiverse people will show food avoidance may make it harder to recognise when a neurodiverse person is struggling with ARFID. Research indicates that ARFID behaviours pose a risk of nutritional deficiency diseases in neurodiverse and neurotypical people alike.

A review of case studies from 1993 to 2019 found 76 reported cases of people with autism who developed severe nutritional deficiencies due to ARFID. The most common issue was scurvy (from not getting enough vitamin C), followed by vision problems linked to vitamin A deficiency. Interestingly, over 60% of these people were at a healthy weight for their age, which shows that ARFID can affect anyone, no matter their body size. That’s why these researchers recommend that anyone showing signs of ARFID should be tested for nutrient deficiencies (Yule et al., 2021).

Why It Matters

Overall, the growing research into ARFID and its common co-occurring diagnoses are building a bigger picture of the complexity and distinct features of ARFID. This research is helping us to better understand the underlying mechanisms of both ARFID and co-occurring diagnoses, and is raising awareness of how important it is to screen for ARFID in certain populations which may otherwise have their experiences of ARFID overlooked.

It’s easy to think that if someone has a medical reason to avoid certain foods, any kind of eating restriction must be fine. But as these studies show, when eating becomes too restricted, it can harm both mental and physical health.

ARFID can lead to malnutrition, social isolation, and a lower quality of life – even if it started with good intentions.

That’s why it’s so important for doctors, patients, and caregivers to recognize when careful eating has crossed into problematic territory.

With the right support, it’s possible to manage health conditions and rebuild a healthy relationship with food.

Does this resonate with you? Does this research make you think differently?

If it’s happened to you, it matters. Your experience belongs in this conversation.
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