ARFID and Food-Related Support
Eating can be challenging for many reasons. For some individuals, certain food textures, smells, tastes, or appearances can feel overwhelming. Others may experience anxiety about choking or vomiting, have difficulty recognizing hunger and fullness, or find eating uninteresting and difficult to prioritize. These experiences can affect not only what someone eats, but also their nutrition, daily routines, relationships, and participation in social activities.
Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterized by significant food avoidance or restriction that affects nutritional intake, growth, health, or everyday functioning. Unlike anorexia nervosa, ARFID is not primarily driven by concerns about body shape or weight. It can occur in children, teens, and adults, including individuals with ADHD, autism, and other neurodevelopmental differences.
ARFID is different from typical picky eating. Picky eating may involve strong food preferences or a limited range of preferred foods without substantially affecting health or daily life. With ARFID, avoidance or restriction can become more persistent and have a significant impact on nutritional needs, growth, emotional well-being, or social participation. Not every selective eater has ARFID, and an appropriate clinical assessment can help determine what kind of support is needed.
How can ARFID or food-related challenges present?
Food-related difficulties can occur in different ways, and more than one experience may be present at a time.
- Sensory sensitivities: Certain textures, smells, tastes, temperatures, or food appearances are difficult to tolerate.
- Fear of unpleasant consequences: Eating may trigger fears of choking, vomiting, gagging, pain, or becoming ill.
- Low interest in eating: Hunger cues may be difficult to notice, eating may feel like a chore, someone may forget to eat, or someone may feel full quickly.
- Interoceptive differences: Recognizing and interpreting internal body signals, such as hunger, fullness, nausea, or discomfort, may be challenging.
- Executive functioning challenges: Planning meals, grocery shopping, preparing food, making decisions, and remembering to eat may feel overwhelming.
- Emotional and social stress: Meals, school cafeterias, restaurants, family gatherings, or eating with peers may cause anxiety or distress.
Frequently Asked Questions
Occupational therapy (OT) can help individuals understand and address the sensory, emotional, behavioural, and practical factors that make eating difficult. A neuroaffirming approach considers both the individual and their environment: rather than expecting someone to simply tolerate difficult foods, the Occupational Therapist explores what adjustments, skills, and supports may make eating more accessible.
Treatment is individualized and focuses on building a more comfortable relationship with food, supporting daily functioning, and helping individuals participate in eating-related activities with greater confidence and independence.
Our occupational therapy service supports children, teens, and adults who experience significant food restriction, sensory-related eating difficulties, anxiety around food, or challenges with eating routines.
Support may be helpful for individuals who:
- Have a limited range or quantity of foods they can comfortably eat.
- Experience distress or conflict during meals and snacks.
- Have difficulty noticing hunger or fullness.
- Find grocery shopping, food preparation, or meal planning overwhelming.
- Avoid social situations involving food.
- Need support with eating routines at home, school, work, or in the community.
Occupational therapists work across the lifespan. Recommendations are tailored to the individual’s age, developmental needs, and goals. Support often focuses on different themes across age groups:
- Children: Sensory exploration, mealtime routines, caregiver strategies, and participation in everyday activities
- Teens: Increasing independence, school routines, social eating, and food preparation.
- Adults: Independent meal planning, grocery shopping, consistent eating routines, workplace demands, and social situations involving food
Virtual appointments may be appropriate for teens and adults, and for some children. In-person sessions may be recommended when direct observation or hands-on support is beneficial. The appropriate format is determined on an individual basis.
An initial occupational therapy session explores how food-related challenges affect everyday life. This may include discussion of:
- Current eating patterns, food preferences, and foods that feel difficult to tolerate
- Sensory experiences and environmental factors affecting eating
- Awareness of hunger, fullness, and other internal body signals
- Anxiety, emotional regulation, and avoidance patterns
- Executive functioning, meal planning, and food preparation
- Family routines, school or work demands, and social participation
When appropriate, standardized assessment tools, including the Sensory Processing Measure, Second Edition (SPM-2), may be considered to explore broader sensory processing patterns. The choice of assessment tools depends on age, clinical needs, and the referral question.
Recommendations may include occupational therapy, collaboration with a dietitian, and consultation with a medical professional where indicated.
Strategies depend on the individual’s needs and goals and may include:
- Sensory problem-solving: Identifying sensory preferences and adjusting the eating environment, including smells, lighting, noise, textures, and food presentation.
- Interoceptive awareness: Using visual scales, body maps, and guided check-ins to help individuals notice and interpret body signals before, during, and after eating.
- Food exploration: Using gradual, individualized approaches to build familiarity with food properties and experiences without pressure or coercion.
- Routine-building: Developing practical meal and snack schedules, visual reminders, and systems for remembering to eat.
- Executive functioning support: Creating grocery lists, planning manageable meals, identifying familiar go-to foods, and reducing decision fatigue.
- Emotional regulation: Identifying strategies that support regulation before, during, and after meals.
- Social participation: Preparing for restaurants, school lunches, family gatherings, travel, and other situations involving food.
- Caregiver coaching: Helping caregivers understand sensory needs, reduce mealtime stress, and create supportive routines.
Depending on the individual’s presentation and the clinician’s training, approaches may incorporate food chaining, elements of the Sequential Oral Sensory (SOS) approach, and gradual food exploration.
A neuroaffirming approach recognizes that individuals experience food and sensory information differently. It focuses on understanding the reasons behind food avoidance and adapting supports to the individual rather than treating differences as a lack of willingness or cooperation.
This may involve modifying the environment, respecting sensory preferences, making routines more predictable, supporting communication, and building skills at an appropriate pace. The goal is to improve access to adequate nutrition and everyday activities without shame, blame, or unnecessary pressure.
ARFID can affect nutritional health, growth, and physical well-being. Occupational therapy can support sensory needs, routines, emotional regulation, and daily functioning, but it does not replace medical assessment or nutritional care.
Individuals who are underweight, losing weight, experiencing growth concerns, or struggling to maintain adequate food or fluid intake should receive medical assessment and appropriate nutritional support. A family physician or pediatrician can help monitor physical health, while a registered dietitian can assess nutritional adequacy and help guide nutrition-related goals.
If there are signs of medical instability or severe restriction, a higher level of specialized eating-disorder care may be required.
