Note: This article is for information purposes only and does not replace professional medical advice. If you’re concerned about your or your loved one’s eating, please speak to your GP or a trusted health professional.
Daily food struggles for these individuals go well beyond normative “picky eating”. Instead, foods can trigger an acute stress response, which makes eating feel physically unsafe. While friends and family might try reassuring and coaxing their Autistic loved one into eating, this well-intentioned approach can feel dismissive and be ineffective.
This food struggle is now recognised as part of a complex condition known as Avoidant Restrictive Food Intake Disorder (ARFID), which was formally added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) in 2013, replacing the earlier category of “Feeding Disorder of Infancy or Early Childhood.”
ARFID is an eating disorder that can present in people of any age, though most commonly appears in infancy or early childhood. It is characterised by restriction of the quantity and/or variety of foods an individual consumes.
Unlike other eating disorders, this avoidance is not driven by concerns about body weight, shape, or fear of gaining fat. Individuals with ARFID may want to eat more or gain weight, but find themselves unable to overcome their strong aversions.
Instead, ARFID is shaped by multiple underlying factors, including sensory sensitivities, past trauma, anxiety, fears of choking or vomiting, medical conditions, and/or differences in how internal body signals like hunger and fullness are perceived.
To be diagnosed with ARFID, an individual must meet all four of the following DSM-V criteria:
1. The individual must not be eating enough to grow well, get the nutrients they need, or participate fully in life (for example, avoiding school camp or social events because of food).
2. The intake restriction isn’t better explained by culture or circumstance (such as religious fasting or food insecurity).
3. The individual does not have weight or body image concerns, as you might see with anorexia or bulimia.
4. The avoidance or restriction is not better explained by another condition, such as a psychiatric condition or gastrointestinal disease – unless the eating challenges go beyond what’s typical for that condition.
The true prevalence of ARFID is hard to estimate due to a lack of research. However, a scoping review of ARFID in the Australian population found a prevalence between 0.5 and 5% in children and adults (Kennedy et al., 2023).
ARFID can lead to severely restricted diets and result in:
But it’s not just physical health that’s affected. Individuals with ARFID often experience disruptions to various aspects of daily life. Social situations involving food – such as family gatherings, birthday parties, school lunchtimes, Halloween trick or treating, or dining out with friends – can become sources of stress and isolation. The fear of being thrown into scenarios with unfamiliar or disliked foods may lead individuals to avoid these experiences altogether, limiting their social interactions and/or engagement in school or the workplace.
Research has found that ARFID is associated with lower mental health-related quality of life compared with both other eating disorder diagnoses and individuals without eating disorders (Hay et al., 2017) (Smith et al., 2021). Measures of psychosocial health and school functioning are also significantly lower in individuals with ARFID, indicating a substantial negative impact on overall quality of life (Krom et al., 2019).
While there is limited research on the prevalence of ARFID, studies have found that between 1.98% of children and adults in the general population have the disorder. However, emerging research shows ARFID has increased prevalence in Autistic populations, rising to up to 16.27% (Sader et al., 2025) – and the combination of autism and ARFID can make things especially challenging.
Sensory processing refers to the different ways our brain takes in, filters and interprets sensory cues. Sensory sensitivity refers to the acuity with which stimuli affects us.
Many Autistic individuals have a heightened perception to sensory stimuli, which can trigger a complex stress response in their body. Certain food textures, flavours, smells, colours or temperatures can feel genuinely unsafe, overwhelming or even painful. For some, just seeing or smelling a certain food may cause distress or gagging.
For many Autistic people, consistency in daily experiences – including food – is deeply reassuring, and disruptions to this predictability can be unsettling. This preference is challenged when foods such as apples – which may be crisp and sweet one time, but floury or sour the next – make each eating experience highly unpredictable.
Some Autistic individuals have difficulty sensing internal body signals like hunger, fullness, pain or nausea. This is known as interoceptive difference. Individuals who don’t feel hunger cues clearly, may not feel hungry at all. They might forget to eat, eat extremely slowly or get easily distracted during mealtimes. Whereas those with hypersensitive interoception, may feel satiated too quickly.
Autistic individuals often exhibit deep, sustained focus on a narrower range of interests or activities than non-autistic people. This attentional style is known as monotropism. Monotropism often leads Autistic individuals into deep states of hyperfocus, known as flow states, especially when engaged in areas of strong personal interest (SPINs). When attention is taken over by that single attentional scope, competing stimuli is filtered out. This can make it especially difficult to acknowledge hunger pains and shift to eating.
In some cases, food allergies, intolerances, reflux or gastrointestinal problems like constipation that are often co-occurring in the Autistic population, may trigger avoidance. Individuals who experience discomfort or pain while or because of eating may start to avoid a wider range of foods than necessary, just to feel safe. Over time, this list can become extremely limited.
Some Autistic children have motor planning challenges around chewing and swallowing, which increases their risk of adverse eating experiences, including choking, gagging, vomiting and/or biting their tongue or cheek. The association between pain and frightening events, is then reinforced with each adverse eating experience.
If an individual has frightening or painful experiences associated with eating – such as gagging, choking or vomiting – they may develop strong fears around certain foods or eating situations. This kind of food-related anxiety can make it really hard to try new things or participate in social activities.
Understanding the reasons behind your loved one’s eating challenges is the first step to supporting them – not with pressure – but with patience, compassion, and practical tools.
Effective treatment for ARFID is typically tailored to the individual and often involves a multidisciplinary team, including dietitians familiar with sensory needs, medical practitioners, psychologists, and occupational therapists. The approach is guided by the specific challenges the person faces and the factors believed to be sustaining those difficulties.
The goal of treatment isn’t to “fix” the Autistic individual’s eating. The priority is to gently build a sense of safety and trust in one’s own body, in a way that respects the individual’s needs and autonomy. Some helpful things to remember from Melbourne-based neuro-affirming clinical nutritionist and AuDHD advocate, Margo White are that:
“As clinicians, caregivers, and loved ones, we need to let go of rigid ideas about what eating ‘should’ look like and instead focus on what actually supports the individual,” Margo advises. “When we do this, we make room for a relationship with food that is built on trust, not fear. And that’s where real progress begins.”
Hay, P., Mitchison, D., Collado, A. E. L., González-Chica, D. A., Stocks, N., & Touyz, S. (2017). Burden and health-related quality of life of eating disorders, including avoidant/restrictive food intake disorder (ARFID), in the Australian population. Journal of Eating Disorders, 5(1), 21. https://doi.org/10.1186/s40337-017-0149-z
Hay, P., Aouad, P., Le, A., Foroughi, N., Brown, E., & Touyz, S. (2023). Epidemiology of eating disorders: Population, prevalence, disease burden and quality of life informing public policy in Australia—a rapid review. Journal of Eating Disorders, 11(1), 23. https://doi.org/10.1186/s40337-023-00738-7
Kennedy, H. L., Hitchman, L. M., Pettie, M. A., Bulik, C. M., & Jordan, J. (2023). Avoidant/restrictive food intake disorder (ARFID) in New Zealand and Australia: A scoping review. Journal of Eating Disorders, 11, 196. https://doi.org/10.1186/s40337-023-00987-4
Krom, H., van der Sluijs Veer, L., van Zundert, S., Otten, M. A., Benninga, M., Haverman, L., & Kindermann, A. (2019). Health related quality of life of infants and children with avoidant restrictive food intake disorder. The International journal of eating disorders, 52(4), 410–418. https://doi.org/10.1002/eat.23037
Sader, M., Weston, A., Buchan, K., Kerr-Gaffney, J., Gillespie-Smith, K., Sharpe, H., & Duffy, F. (2025). The co-occurrence of autism and avoidant/restrictive food intake disorder (ARFID): A prevalence-based meta-analysis. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24369
Cobbaert, L., Millichamp, A.R., Elwyn, R. et al. Neurodivergence, intersectionality, and eating disorders: a lived experience-led narrative review. J Eat Disord 12, 187 (2024). https://doi.org/10.1186/s40337-024-01126-5
Mahler, K. (2024) Interoception & Feeding: What is the Connection? kelly-mahler.com. https://www.kelly-mahler.com/resources/blog/interoception-and-feeding-and-arfid/
Neff, M. (n.d.) Anorexia vs. ARFID: Understanding the Differences in Neurodivergent Eating Disorders. Neurodivergent Insights. https://neurodivergentinsights.com/anorexia-and-arfid/?srsltid=AfmBOop04eecgDJ4hStbBJuKIgB6c9h0uUsbIvo-j8lx5Qiz_I-RlSJh
Rozenblum, Y. (n.d.) Avoidant Restrictive Food Intake Disorder (ARFID). Literally Ausome. https://literallyausome.com.au/arfid/
White, M. (n.d.) Why Fed Is Best for People with ARFID and Feeding Differences. Whole Body Nutrition. https://www.wholebodynutrition.com.au/blog/why-fed-is-best-for-people-with-arfid-and-feeding-differences
The Reframing Autism team would like to acknowledge the Traditional Owners of the lands on which we have the privilege to learn, work, and grow. Whilst we gather on many different parts of this Country, the RA team walk on the land of the Awabakal, Birpai, Whadjak, and Wiradjuri peoples.
We are committed to honouring the rich culture of the Aboriginal and Torres Strait Islander peoples of this Country, and the diversity and learning opportunities with which they provide us. We extend our gratitude and respect to all Aboriginal and Torres Strait Islander peoples, and to all Elders past and present, for their wisdom, their resilience, and for helping this Country to heal.
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