Avoidant/Restrictive Food Intake Disorder or ARFID was formally included as a distinct diagnosis in the DSM-5 in 2013, marking a pivotal shift in how clinicians and researchers understand and approach restrictive eating behaviors across the lifespan. While there has been a recent rise in ARFID diagnoses, reflecting growing awareness of the disorder, there remains a significant need for more research into and the development of effective, targeted treatments for ARFID.
In a recent article published in Scientific American, Jennifer Thomas, PhD, co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, highlights that ARFID extends far beyond what is commonly considered “picky eating.” Unlike other eating disorders, ARFID is not driven by fear of weight gain or by body image concerns. Instead, individuals may restrict food intake because of heightened sensory sensitivities, fear of aversive events such as choking or vomiting, or a chronic lack of interest in food.
Dr. Thomas describes emerging research using functional MRI to differentiate these subtypes. Early findings suggest distinct neural circuitry may underlie each presentation, underscoring the need for tailored treatment approaches. For some, anhedonia—a reduced ability to experience pleasure—may contribute to restricted interest in food, while others are driven primarily by sensory characteristics or conditioned fears.
Dr. Thomas emphasizes that recovery from ARFID is challenging and often requires structured, evidence-based interventions such as cognitive-behavioral therapy. Spontaneous remission is rare, making early recognition and supportive care crucial.
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ARFID Is More Than Picky Eating—And the Condition Is on the Rise (Scientific American)
Thomas JJ, Holsen L, Van De Water AL, Becker KR, Breithaupt L, Burton-Murray H, Asanza E, Gydus J, Palmer LP, Stern CM, Freizinger M, Shrier LA, Bern EM, Deckersbach T, Misra M, Eddy KT, Micali N, Lawson E. Neural Response to Food Cues in Avoidant/Restrictive Food Intake Disorder. JAMA Netw Open. 2025 Feb 3; 8(2):e2460101.
Kambanis PE, Thomas JJ. Advancing the Science of Avoidant/Restrictive Food Intake Disorder (ARFID): Six Key Questions. Int J Eat Disord. 2025 Jun;58(6):1001-1007.
Jennifer Thomas, PhD is the Co-Director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, and Professor of Psychology in the Department of Psychiatry at Harvard Medical School. Dr. Thomas’s research and clinical work focus on avoidant/restrictive food intake disorder,. She has published >200 scientific articles and five books, most notablyCognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults; andThe Picky Eater’s Recovery Book: Overcoming Avoidant/Restrictive Food Intake Disorder.
