Why won’t you eat? – The question that hides a little-known disorder with very real consequences
It’s not about being picky. It’s not just a matter of taste. And it’s definitely not bad table manners.
Avoidant/Restrictive Food Intake Disorder — or ARFID — is something much deeper and more complex. And most of all, it’s something misunderstood — far beyond what we usually call “fussy eating.”
The most troubling part? Family and friends often don’t get it. They confuse it with stubbornness or attention-seeking. And while they’re confused, the child (or adult) is quietly suffering.
Diagnosis takes time, because ARFID doesn’t always have a face. Sometimes, it’s invisible.
Georgia opens up: “Many people thought I was just spoiled — that I was choosing to eat this way on purpose. They didn’t realize it wasn’t a choice. I’ve had people try to put food on my plate — and that only made my anxiety worse. Instead of helping, it made me feel even more pressured and misunderstood.”
More than just picky eating
When a child avoids food, the typical reaction is a casual, “They’ll grow out of it.” But what if they don’t? What if that refusal isn’t just a phase, but a deep-rooted fear that grows with them over time? What if the child we call “picky” or “difficult” is actually trying to tell us something?
ARFID can show up at any age, but it most often begins in childhood or adolescence, and it often goes undiagnosed for years, sometimes well into adulthood.
ARFID has nothing to do with dieting or preoccupation with weight or body image. It’s a separate, recognized mental health disorder, officially added to the DSM-5 — the diagnostic guidebook of the American Psychiatric Association — in 2013.
It’s defined by an intense restriction of food intake, either in variety, quantity, or both. Yet despite its impact, it often goes unnoticed and undiagnosed. It’s not anorexia nervosa — because it’s not driven by a desire to lose weight or change how one looks. ARFID is its own condition, with its own unique course. And sadly, it’s still widely misunderstood.
This is food avoidance in silence — not because you don’t want to eat, but because you simply can’t. The child who “eats nothing” might not just be struggling physically. Often, they’re dealing with intense emotional distress — anxiety, aversion, or a vague, overwhelming fear triggered by food. At its core, ARFID stems from fear, sensory sensitivities, and low appetite. It’s real. It’s serious. And it deserves to be recognized for what it truly is.
Enjoyment or rejection: when taste, smell, and texture become barriers
For some people, a single bite of food can feel overwhelming. They experience flavors with such intensity that the act of eating becomes a challenge rather than a pleasure. These individuals are often called supertasters — a term used for those with a biological predisposition to heightened taste perception, especially when it comes to bitter or sweet foods. It’s believed they have more taste buds than average, which can make everyday foods — like fruits and vegetables — taste uncomfortably bitter. The result? Disgust, anxiety, and complete avoidance. But it’s not just the flavor that causes distress.
Marina, for example, says that just one bite of dark chocolate feels so bitter and harsh, it repels her instantly — like eating something spoiled. And for others, the issue isn’t taste at all. Texture, smell, even the color of food can be a trigger. Peter, for instance, can’t handle anything with a creamy or puréed consistency. Just imagining a spoonful of yogurt or velouté soup is enough to make him gag — even if he’s hungry. For people with sensory sensitivities, this kind of food avoidance often starts in early childhood and can persist into adulthood. It’s not about being fussy or stubborn — it’s about how their brain processes sensory input, and how intense that can feel.
When food becomes fear — not just rejection
This means that certain categories of food may be avoided because of a traumatic experience, such as choking, vomiting, or intense abdominal pain — creating a fear around eating and an avoidance of foods associated with danger. Some people may even experience more general concerns about the consequences of eating, which are difficult to express in words, and they end up limiting their intake to foods they consider “safe.”
Yiannis, for example, remembers the time he nearly choked on a fish bone as a child. Since then, he has completely stopped eating any kind of meat — the only thing he manages, and even that with difficulty, is a little bit of minced meat from time to time.
When food doesn’t “spark” the appetite
It might sound strange, but for some people, food simply doesn’t hold any appeal. Yes — there are those who genuinely forget to eat. For them, eating feels like a chore — something they do out of necessity, not pleasure. They may have a naturally low appetite or a delayed response to hunger cues.
Katerina, for instance, can go almost an entire day without eating — not because she’s trying to, but because, as she puts it, “it just didn’t cross my mind.” It’s only when she starts to feel dizzy or completely drained that she realizes she hasn’t eaten anything since morning.
Every “no” to food might be a silent “help me” — The consequences of ARFID
ARFID isn’t just about being picky. Unlike simple selective eating, it can seriously impact a person’s nutritional intake — and, in turn, their overall health. Deficiencies in key nutrients like fiber, iron, calcium, and B vitamins are common, leading to symptoms such as fatigue, dizziness, constipation, hair loss, and even slowed heart rate (bradycardia).
Many people with ARFID also struggle to meet their basic energy needs. This can result in weight loss or stunted growth — especially in children. But here’s the catch: weight alone doesn’t define ARFID. The disorder can affect people of any body size. In fact, some individuals may avoid fruits and vegetables but rely heavily on calorie-dense, low-nutrient foods — leading to weight gain and nutritional deficiencies at the same time.
But the consequences aren’t just physical. A simple dinner out can trigger intense anxiety.
Birthday parties, school events, or family meals can feel like emotional minefields. Relationships suffer. Social lives shrink. Isolation becomes routine. Children and teens may even lose friendships — not because they don’t want to connect, but because they can’t join in when food is involved.
ARFID can also take a toll on school or work performance. Low energy, poor concentration, general discomfort, and disrupted sleep become invisible barriers to daily life. And the quieter these struggles are, the harder they are for others to notice.
In more severe cases, medical intervention is necessary — from nutritional supplements to tube feeding. ARFID can lead to long-term complications: weakened bones, delayed development, even hospitalizations. For someone with ARFID, food isn’t comfort. It’s a threat. And every fear, every avoidance, leaves lasting marks — on the body, and on life.
When it’s not ARFID
Not all avoidant or restrictive eating is a sign of ARFID. The diagnosis doesn’t apply when food avoidance is due to cultural or religious practices, like fasting or traditional dietary customs. It also doesn’t apply when someone avoids certain foods because of allergies, medical treatments, or simply because food isn’t available. ARFID is distinct from other eating disorders — like anorexia nervosa — because it’s not driven by concerns about weight or body image. People with ARFID aren’t trying to lose weight or control their shape. They don’t engage in behaviors like excessive exercise or calorie restriction for appearance-related reasons.
It’s also important to rule out medical conditions that can affect appetite or weight.
Things like type 1 diabetes, hyperthyroidism, chronic infections, gastrointestinal diseases (like Crohn’s or celiac disease), or swallowing disorders (like achalasia) can all lead to reduced food intake — but for very different reasons. That’s why a thorough medical evaluation is essential before diagnosing ARFID.
It ensures that the root cause of the eating difficulties is understood — and that the right kind of support is given.
Is ARFID treatable?
Yes — absolutely. While ARFID can be chronic and complex, early intervention makes a big difference. Treatment typically involves a team of specialists — including psychologists, dietitians, and pediatricians — working together to support the individual. It may include: a) gradual exposure to new foods, b) anxiety management techniques, c) building self-esteem and confidence around eating. Family involvement is key. A supportive, understanding environment can make all the difference in helping someone feel safe enough to try, to trust, and to heal. With the right care, it is possible to rebuild a healthy relationship with food — and to reclaim a better quality of life.
Palikrousis L. Thomas, Psychologist, MSc, PhD(c)
