ARFID and Autism

If mealtimes have become a daily source of stress – for you or someone you care about – and you’re starting to wonder if it’s something more than just being a fussy eater, you might need to consider if it could be ARFID.

For autistic individuals, eating difficulties are extremely common, but one condition that’s increasingly recognised is Avoidant/Restrictive Food Intake Disorder, or ARFID. Unlike other eating disorders, ARFID isn’t driven by concerns about weight or body image. Instead, it’s often linked to sensory sensitivities, fear of certain food experiences, or simply a lack of interest in eating.

If you’re reading this because you suspect ARFID may be affecting you, your child, or someone you support – particularly in the context of autism – this article will help you understand what ARFID is, how it overlaps with autism, and what support is available. 

If you want to learn more about the autism spectrum you might wish to have a look at our article Level 2 Autism. If you or your child are undiagnosed and displaying symptoms of ARFID alongside a range of other autistic traits, we can offer private autism assessments for those in London, Oxford and surrounding areas. 

What Is ARFID?

ARFID stands for Avoidant/Restrictive Food Intake Disorder. It’s a recognised eating disorder [1] that involves an ongoing pattern of extremely limited eating either by type of food, amount of food, or both that leads to nutritional, physical, or psychological difficulties.

Unlike anorexia or bulimia, ARFID is not motivated by a desire to lose weight or change body shape. Instead, it can be caused by:

• Sensory sensitivities – such as strong aversions to textures, smells, or tastes
  
• Fear-based reactions – such as choking, vomiting, or allergic reactions
  
• Low interest in food or eating – simply not feeling hunger in the way others do
  

For someone with ARFID, even trying a new food can feel overwhelming – not just unpleasant, but anxiety-inducing or physically intolerable. As a result, their diet may be limited to a very small number of familiar, “safe” foods, which can cause problems with growth, health, and everyday life.

This condition often starts in childhood, but it can persist into adulthood and it’s particularly common in autistic individuals, where it often goes hand in hand with sensory issues, rigid routines, and anxiety.

Is ARFID Linked to Autism?

Yes, there is a significant association between Avoidant/Restrictive Food Intake Disorder (ARFID) and autism. Research indicates that individuals with autism are more likely to experience ARFID compared to the general population.​

A comprehensive meta-analysis published in Autism Research found that approximately 16% of individuals with ARFID also have a diagnosis of autism, while about 11% of autistic individuals meet the criteria for ARFID. These figures highlight a notable overlap between the two conditions [2].​

In the UK context, a national surveillance study reported a minimum incidence of ARFID at 3.09 per 100,000 young people aged 5 to 17 years. While this seems extremely rare, it’s important to note that the actual rates may be higher, especially considering the challenges in diagnosing ARFID, particularly among autistic individuals [3].​

The increased prevalence of ARFID in autistic populations can be attributed to several factors:​

• Sensory sensitivities: Autistic individuals often have heightened sensitivities to textures, tastes, and smells, making certain foods overwhelming or unpalatable.​
  
• Rigid routines and preferences: A preference for sameness can lead to a limited diet, with resistance to trying new foods.​
  
• Anxiety and past negative experiences: Fear of choking, vomiting, or other adverse events can result in food avoidance.​
  

Understanding the link between ARFID and autism is crucial for early identification and intervention. Recognising the unique challenges faced by autistic individuals with ARFID can lead to more tailored and effective support strategies.​

ARFID and Autism: Overlapping Symptoms and Behaviours

There’s a significant overlap between the traits associated with autism and the symptoms of ARFID. While the two conditions are distinct, the reasons why they so often occur together are rooted in shared experiences – particularly around sensory sensitivity, anxiety, and the need for routine.

Sensory Sensitivities and Food Aversion

For many autistic people, food isn’t just food, it’s a full-body experience. The texture of mashed potato might feel like wet sand in the mouth, or the sound of crunching cereal could be physically uncomfortable. Imagine trying to enjoy a meal while sitting on a fire alarm – that’s how overwhelming certain sensory inputs can be.

This is why autistic individuals with ARFID often avoid entire categories of food based on texture, smell, or appearance. It’s not about being picky, it’s about genuine discomfort or even distress that can’t be easily explained or reasoned away.

Anxiety Around Eating

In some cases, anxiety stems from past experiences – choking, gagging, or feeling unwell after eating. For autistic individuals who often have heightened interoception (internal body awareness), a single bad experience can create lasting fear. Eating, then, becomes associated with risk rather than comfort.

This anxiety may result in highly selective eating, refusal to try new foods, or even physical panic when faced with unfamiliar meals. The behaviour might look avoidant, but the underlying emotion is often fear.

Rigid Routines and Food Rituals

Many autistic people rely on routine to create predictability and reduce anxiety. This applies not just to daily schedules but to mealtimes too. They may eat the same brand of food, prepared in the same way, at the same time each day. Even small changes – like a different plate or the food touching something else – can cause upset.

It might be helpful to think of it like trying to read a familiar book, only someone’s torn out the last chapter. The comfort of predictability is lost, and it’s unsettling. That’s how some autistic individuals experience changes to their eating routine.

What Are Avoidant Behaviours in Autism?

Avoidant behaviours in autism are often ways of coping with overwhelming environments or tasks. These might include:

• Avoiding eye contact
  
• Withdrawing from noisy or bright places
  
• Refusing to engage with tasks that feel too uncertain or unpredictable
  

In the context of food, this avoidance can mean refusing meals, sticking to ultra-familiar foods, or avoiding eating in social settings where the pressure or unpredictability feels too much.

Is Food Aversion Related to Autism?

Yes, very often it is. Food aversion in autism is typically linked to sensory processing differences and heightened emotional responses. This might look like gagging at certain smells, refusing foods with “lumpy” textures, or needing food to be prepared a specific way.

It’s important to remember that these behaviours aren’t chosen, they’re protective. They help the person avoid distress, even if they’re misunderstood by others.

Different Presentations of ARFID in Autistic People

ARFID doesn’t follow a one-size-fits-all pattern – especially in autistic individuals, where eating behaviours are shaped by a complex mix of sensory, emotional, and cognitive factors. Understanding these different presentations is key to recognising when someone may need support, even if their challenges don’t fit the stereotypical image of an eating disorder.

Sensory-Based Restrictions

This is one of the most common ways ARFID presents in autistic people. Certain textures, tastes, temperatures, or even the way food looks can be deeply off-putting to the point of triggering a gag reflex or physical discomfort. A child might only eat dry, beige foods like crackers or crisps. An adult may avoid anything soft or mixed, like soups or casseroles. These preferences aren’t simply quirks – they’re deeply tied to how that person experiences the world.

Fear-Based Avoidance

Some people avoid food because of a previous negative experience such as choking, vomiting, or a strong allergic reaction. Even if the risk is no longer present, the memory of that event can create lasting anxiety. This can lead to avoidance of certain foods, entire food groups, or even eating in public.

Low Appetite or Lack of Interest in Food

Others may not feel hunger in the same way as neurotypical individuals. They may forget to eat, not enjoy eating, or view it as an inconvenience. This low drive to eat can lead to unintentional restriction over time, especially when combined with other autistic traits like intense focus on specific interests or disrupted routines.

Rigid Routines and Extreme Selectivity

For some, food is more about familiarity than nourishment. Meals may need to be the same brand, served the same way, every day. Even a minor change like a different packaging or a new shape of pasta can be enough to stop someone eating altogether. These rigid routines provide structure and reduce anxiety, but can significantly limit dietary variety and nutritional intake.

No two people with ARFID will present in exactly the same way. What looks like a strong preference to one person may, to another, feel like a non-negotiable survival strategy. That’s why understanding the reason behind the behaviour is so important – it’s rarely about being “fussy,” and more often about trying to feel safe.

ARFID and Autism in Adults: A Hidden Struggle

ARFID is often thought of as a childhood condition, but for many autistic adults, the struggle with food never goes away, it just becomes more private. In fact, many adults live for years with undiagnosed ARFID, having developed coping strategies that help them get by without ever fully addressing the impact it has on their lives.

Underdiagnosis and Late Recognition

In adults, ARFID is frequently missed or misunderstood. Because it doesn’t involve concerns about weight or body image, it’s rarely picked up during routine healthcare appointments. Many adults have grown up with labels like “fussy,” “picky,” or “difficult,” without ever being asked what eating feels like for them.

For autistic adults, the picture is even more complex. Their restricted eating is often chalked up to their autism rather than explored as a distinct condition. As a result, they may go years without realising that their eating habits fall under a diagnosable disorder – or that help is available.

The Long-Term Impact

Living with ARFID as an adult can affect both physical health and emotional well-being. Limited diets can lead to nutrient deficiencies, fatigue, and gastrointestinal issues [4]. In some cases, it can impact work, travel, and social life – avoiding meals with colleagues, skipping events involving food, or feeling anxious when routines are disrupted.

Relationships can also be affected. Partners or family members may not understand why certain foods are “off-limits” or why cooking and mealtimes are so fraught. This can lead to frustration on both sides, especially when the person with ARFID finds it difficult to explain what’s going on.

For many autistic adults, eating isn’t just about food, it’s about control, predictability, and sensory regulation. And without support, these challenges can become exhausting to manage alone.

ARFID and Autism – Diagnosis and Treatment in the UK

Getting a diagnosis of ARFID, especially when autism is also present, can be challenging – particularly within the NHS. While awareness of ARFID is increasing, it remains under-recognised in both children and adults, and support can vary significantly depending on where you live.

Access to Diagnosis and Support

If you’re seeking help through the NHS, your first step will usually be your GP. For children, referrals are often made to CAMHS (Child and Adolescent Mental Health Services), while adults may be referred to community mental health teams or local eating disorder services. However, access to specialist ARFID assessment is still limited, and waiting lists can be long.

Some families report being passed between services – with autism seen as a “better fit” than an eating disorder, or vice versa – leading to delays in receiving appropriate help. This is especially common when ARFID symptoms are mistakenly viewed as simply part of autism, rather than a distinct condition that deserves its own support.

Although the NHS is working to improve understanding and provision, many people turn to private providers to access timely assessments and interventions.

Autism ARFID Treatment – What Works?

Effective treatment for ARFID in autistic individuals should be individualised, non-judgemental, and ideally provided by a multidisciplinary team – often involving psychologists, occupational therapists, dietitians, and sometimes speech and language therapists.

Key therapeutic approaches include:

• Cognitive Behavioural Therapy (CBT) – Adapted CBT can help address the thoughts and behaviours surrounding eating, particularly where anxiety or rigid thinking is involved.
  
• Exposure Therapy – Gradual, supported exposure to new foods or food-related situations can reduce fear-based avoidance over time. For autistic individuals, this needs to be paced carefully and collaboratively.
  
• Sensory Integration Support – Occupational therapists can work with individuals to understand and manage sensory sensitivities that affect eating – such as tolerance for different textures, smells, or temperatures.
  
• Parent and Family Involvement – For children and teenagers, involving parents or caregivers in therapy is often crucial. This helps create a consistent and supportive approach at home and reduces the pressure on mealtimes.
  
• Nutritional Guidance – Involving a dietitian ensures that nutritional needs are met and helps make food exploration safe and manageable.
  

The most effective support acknowledges both the ARFID symptoms and the individual’s autistic identity without trying to “normalise” eating habits that may serve a purpose in their sensory or emotional regulation. The goal isn’t to force change, but to expand comfort zones in a way that’s respectful, sustainable, and empowering.

Getting Help with ARFID and Autism at Oxford CBT

Whether you’re a parent worried about your child’s eating habits, or an adult who’s quietly struggled with food for years, recognising the signs of ARFID, particularly in the context of autism, can be the first step toward meaningful change.

At Oxford CBT, we understand how complex the relationship between autism and eating can be. That’s why we offer compassionate, tailored support for individuals and families affected by ARFID. Our clinicians are experienced in working with both autistic clients and eating-related challenges, and we take a thoughtful, non-pressured approach to therapy.

We provide:

• Specialist assessments for ARFID and co-occurring autism
  
• Cognitive Behavioural Therapy (CBT) adapted for sensory and emotional needs
  
• Family support to help create calmer, more manageable mealtimes
  
• Guidance on building confidence around food at a pace that feels safe
  

Oxford CBT has a team of professional therapists specialised in CBT-E which is a specialist treatment for eating disorders. CBT-E is a leading evidence-based treatment for many eating disorders, usually delivered 1:1. The treatment is recommended for adults (18 and above) in current NICE guidance and usually lasts around 6-12 months. Sessions can be delivered remotely or in person.

If you’d like to explore therapy or assessment options, please get in touch with the Oxford CBT team. We’re here to help you take that next step – with expertise, empathy, and a plan that fits you.

References

1. National Eating Disorders. https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/ 
2. Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, Duffy F. The Co-Occurrence of Autism and Avoidant/Restrictive Food Intake Disorder (ARFID): A Prevalence-Based Meta-Analysis. Int J Eat Disord. (2025) Mar;58(3):473-488. doi: 10.1002/eat.24369. Epub 2025 Jan 6. PMID: 39760303; PMCID: PMC11891632. https://pmc.ncbi.nlm.nih.gov/articles/PMC11891632/ 
3. BMJ – https://adc.bmj.com/content/108/Suppl_2/A372.1 
4. Brown-Borg and Buffenstein (2017) Cutting back on the essentials: Can manipulating intake of specific amino acids modulate health and lifespan?. Ageing research reviews. https://pubmed.ncbi.nlm.nih.gov/27570078/ 

Author – Tom Murfitt

With over a decade’s experience in providing Cognitive Behavioural Therapy, Tom has worked in both the NHS and private sector to help adults and children to overcome a range of difficulties and improve their mental wellbeing. In addition to being an experienced CBT therapist, Tom is also an accredited Mindfulness teacher, providing courses locally, in businesses and schools. You can read more about us here. 

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