Understanding ARFID in Adults

Posted on February 11, 2026March 24, 2026 by Alison Pelz, LD, RD, CDE, LCSW

When Avoidant/Restrictive Food Intake Disorder (ARFID) is discussed, the focus is often on children. Pediatric feeding clinics, early intervention models, and parent-led treatment approaches dominate the literature and training spaces. While this work is essential, it can unintentionally leave an important group of overlooked: adults with ARRID.

People do not “grow out of” ARFID simply because they age. Many adults meet full diagnostic criteria, experience significant impairment, and struggle to access appropriate care, often because ARFID is still viewed primarily as a childhood condition.

ARFID started in childhood

If you are an adult with ARFID, your eating challenges may have started in childhood. In fact, you may not remember ever not struggling with food. Perhaps differences in your eating may have waxed and waned over the years–for some people with ARFID, when stress increases, their ability to eat decreases.

As a child, you may not have gotten any help with your eating. Your parents may have asked your well-meaning pediatrician about your food selectivity, and the pediatrician may have offered advice along the lines of: “they will grow out of it.” Children often reject new foods at first, this is a normal part of learning to eat. In the case of ARFID, more often than not, children don’t naturally “grow out of it.”

“When they get hungry enough, they will eat” is another piece of advice your parents may have received. Again, if you have ARFID, this advice doesn’t appear to be effective. Often, people who experience ARFID struggle to eat due to sensory differences, fear, and/or low hunger. Even when they may feel hungry, eating feels too overwhelming.

ARFID started after a medical condition or traumatic experience with food

Your ARFID may have developed due to medical or chronic conditions that started in childhood or adulthood. For instance, gastrointestinal disorders (IBS, gastroparesis, heartburn, etc.), chronic nausea or vomiting, pain with eating or swallowing, and sensory differences, are a few common examples.

ARFID can also develop if you had a traumatic event around food, such as a choking episode, allergic reaction, vomiting, or other medical emergency involving food.

Over time, food avoidance may become reinforced as a protective strategy, thereby reducing discomfort, symptoms, or fear of symptom flare-ups. While initially adaptive, this avoidance can evolve into a rigid restriction that persists even when medical symptoms improve.

The medical community, family, friends, and our culture at large may have indicated that your eating challenges are “all in your head.” These messages are not true but often stigmatize eating and lead to an increase in shame and embarrassment, which can then function as a barrier to accessing treatment. Treatments such as CBT-AR and client-centered treatments that pay particular attention to sensory differences are being studied.

Socializing like dating, getting together with friends, and going to work or school events is often what brings adults into treatment. Reduction in socializing can lead to feelings of isolation, depression, anxiety, and low self-confidence.

Wanting to increase body weight is another reason adults seek treatment. You may also be experiencing physical symptoms such as fatigue, low energy, and nutritional deficiencies.

ARFID treatment

You are not “just a picky eater” or “difficult,” but rather you do deserve to receive care that addresses ARFID as a legitimate eating disorder. It is not too late to change your relationship with food and, most importantly, reduce feelings of shame about your eating.

Do you want to learn more about your treatment options? Sign up for a free consultation to learn more about how I can help you.

Do you want to earn continuing education credits that are affordable, complete at your own pace and relevant to your clinical work? Sign up for the Pelz Institute newsletter and get 10% off your first Pelz Institute course!

Freshman Year of College: Why Eating Disorders May Start or Reappear

Posted on August 20, 2025March 24, 2026 by Alison Pelz, LD, RD, CDE, LCSW

The first year of college is often described as a thrilling new chapter—freedom, independence, new friends, late-night pizza, dorm life, and so much possibility. For many students, this first year is fun and exciting. But it’s also filled with major transitions—many of which are invisible until you’re in them. And for students with a history of disordered eating, or even those without, the shift can be enough to stir up or intensify existing eating disorders and their symptoms.

The Perfect Storm of Change

Think about the months, even years, leading up to college: there’s pressure to get in, choose the “right” school, imagine your dream experience, and count down to this next life stage. Students often hear, “These will be the best years of your life.” That narrative leaves little room for the complicated, and very real, emotional reality of freshman year.

Starting college means stepping away from nearly everything that has felt familiar. Students leave behind the structure of high school, the predictability of home, their longstanding support systems, routines, and even the foods they’re used to eating. Meals in college are different—not just the food, but the context: dining halls, roommates watching what you eat, lack of privacy, food availability at odd hours. Schedules shift. Sleep is often disrupted. Social dynamics become more fluid and uncertain.

Our nervous systems thrive on predictability. When that predictability disappears, our bodies and brains notice.

Nervous Systems Don’t Just “Adjust”

The human nervous system is designed to keep us safe and regulated. When life feels overwhelming or uncertain, the body often reaches for something to regain a sense of control or grounding. For some students, that might be diving into academics or social life. For others—especially those with a history of disordered eating—old symptoms may resurface as a way to self-soothe, manage anxiety, or feel a sense of mastery in a suddenly unpredictable environment.

Even for students who have never struggled with an eating disorder before, the stress of transition can be enough to tip the scale. Eating disorders aren’t really about food. They are adaptive responses to stress, trauma, and dysregulation. And while they may seem counterproductive from the outside, they often serve a protective function—numbing overwhelming feelings, offering structure, or creating a sense of control.

When the Fun and the Stress Coexist

It’s important to recognize that freshman year doesn’t have to be miserable for it to be dysregulating. Students (and parents) are often surprised that eating disorder behaviors emerge during what appears to be a “good” year. It’s a common misconception that if a student is socializing, attending classes, or even enjoying college, they must be doing fine. But excitement and stress can coexist. A student might love their college experience and still be struggling silently with food or body image.

What can college students and families do?

Normalize the complexity of transitioning to college. Including feelings of worry, fear, and isolation.
Check in with yourself or your college student about disruptions to routine, the changes in eating patterns, and the emotional rollercoaster of being away from home.
Support emotional regulation strategies beyond food and body control—like mindfulness, journaling, movement, and connecting with others.
Encourage care, especially for students with a history of an eating disorder. Ongoing therapy or nutrition support through telehealth can make a significant difference.
Watch for warning signs that may get masked by the “college is fun” narrative—changes in weight, food rituals, isolation, or excessive focus on body image.
Reinforce that relapse is not failure, but a signal from the nervous system that something is overwhelming. It’s an invitation for support, not shame.

Final Thoughts

Freshman year is a season of growth, challenge, and self-discovery. It’s normal for it to feel both exciting and hard. When we understand the nervous system’s role in regulation—and how eating disorders often function as misguided coping tools—it becomes easier to see why symptoms might arise or return during this time.

By naming these challenges openly, we can help students and families feel less blindsided—and offer the compassionate, proactive support that helps them not just survive freshman year, but move through it with resilience.

If you would like to know more about how I work with families and college students with eating disorders, please feel free to contact me.

Understanding ARFID: More Than Picky Eating

Posted on August 12, 2025August 12, 2025 by Alison Pelz, LD, RD, CDE, LCSW

Avoidant/Restrictive Food Intake Disorder (ARFID) often remains underrecognized and misunderstood.

Adults who have struggled with Avoidant/Restrictive Food Intake Disorder for most of their life may feel it is impossible for things to be different. Parents who have a child struggling with ARFID have, more often than not, literally tried everything to help their kiddo eat, but nothing seems to be working. ARFID is complex, it isn’t simple “picking eating”.

Although ARFID is a newer diagnosis, there is nothing new about it.

Prior to being added to the DSM-5, it was included in a broader category called “Feeding Disorder.” It was added to the DSM-5 in order to develop better ways to treat it.

Parenting a Child with ARFID

If you are a parent, well-meaning doctors may have minimized your child’s selective eating. This can be particularly true if your child is on track with growth. This can be frustrating for a number of reasons. You spend significant time to figure out how to feed your child – and it takes a lot of mental energy and often can feel very limiting to keep dealing with this challenge day after day.

Nutritional deficits can impact both physical health and emotional well-being, which is why early detection of ARFID is important–so it doesn’t turn into a life-long struggle. Understanding ARFID is crucial for effective intervention, and a comprehensive treatment strategy tailored to the individual’s specific needs is necessary.

Understanding ARFID

Avoidant/Restrictive Food Intake Disorder is not just a simple case of picky eating; it is a complex psychological condition that can cause significant nutritional and reduced quality of life, particularly if it endures into adulthood.

Unlike other eating disorders that are often driven by concerns about weight and body image, ARFID is characterized by an avoidance of food based on sensory sensitivity, lack of interest in eating, depressed appetite, and/or fear of adverse consequences such as choking, throwing-up, or an allergic reaction.

Individuals grappling with ARFID may face a persistent difficulty when it comes to eating sufficient quantities or varieties of food. This can stem from deep-seated anxiety, gastrointestinal discomfort, or past negative associations with food.

Recognizing Avoidant/Restrictive Food Intake Disorder Symptoms

Persistent avoidance of specific foods or food groups or low food intake are characteristic of ARFID. Physical responses such as gagging may coincide with this avoidance of certain foods.

The eating patterns of individuals with ARFID reveal a restrictive intake that fails to meet their physiological needs. Without treatment, ARFID can lead to potential nutritional deficiencies, weight loss, or developmental delays, irrespective of age, gender, or body weight.

Behavioral signs and changes in eating that may indicate ARFID include:

Poor appetite
Getting full quickly
Avoiding eating due to fear of choking
Picky eating that often gets worse over time

Avoidant Restrictive Food Intake Disorder (ARFID) is often misinterpreted as a phase among children or as mere pickiness in adults; however, it represents a significant feeding or eating disorder that hinders one’s capacity to consume an adequate variety and volume of food.

Impact of ARFID on Everyday Life

ARFID’s restrictive eating patterns in children can lead to low energy, isolation, and anxiety around meal times. For caregivers, it can be a struggle to know how to feed your child, or it can take lots of effort to prepare foods that you know they will eat in order to support growth.

For older children and adolescents, ARFID can make socializing, which often happens around food (such as parties, sleep overs, family events or team dinners), anxiety provoking for both the child and parents. The disorder’s consequences radiate outward, often simmering into familial tensions and social rifts, as loved ones grapple with the complexities of ARFID.

Adults with ARFID tend to have a decrease in quality of life. Moreover, the fear of eating outside one’s comfort zone can hinder personal and professional growth, particularly when mealtime activities are involved.

Ultimately, the disorder’s grasp can dampen overall quality of life, exerting a significant emotional toll.

Approaches to Treating ARFID

The main goal of treatment for ARFID is supporting the sufferer with eating enough (and enough variety) to keep their body nourished. For children, treatment works to support growth. Treatment for children, adolescents, and adults can help to improve overall quality of life.

Improved quality of life looks different depending on the individual with ARFID. For some, that may mean eating most food. For others, it may mean expanding the variety of food just a bit to improve nutrition and make eating easier.

Avoidant/Restrictive Food Intake Disorder treatment usually focuses on making eating or feeding a priority.

That is, for most folks, increasing the number of times each day they eat meals and snacks. Due to the nature of ARFID, eating often gets put off because it is uncomfortable for the person to eat, or they simply aren’t hungry.

Structured meal planning can be an effective strategy for managing ARFID, as it introduces routine and predictability into the dining experience. By brainstorming menus in advance, individuals and families gain clarity and a sense of control over their food choices.

Having structure and making eating a priority can help make sure people are getting adequate nutrition and reduce mealtime stress.

In addressing the dietary concerns that stem from Avoidant/Restrictive Food Intake Disorder, we take a gradual approach to food exposure. Food exposures are designed in collaboration with the client and/or the family in order to personalize care.

Incremental exposure to food means starting with foods that are less anxiety-provoking, and building up to a more diverse diet over time. Food-related anxieties can be deconstructed, facilitating the individual’s encounters with previously feared foods in a safe and controlled environment. While some foods may never feel safe or comfortable for the person to eat.

Efforts are channeled into ensuring balanced nutritional intake while concurrently addressing emotional and cognitive barriers. Over time, the individual learns to associate eating with safety rather than distress, thus gradually dismantling the cycle of avoidance that characterizes ARFID.

My Approach to ARFID Treatment

When I am working with children with ARFID I work closely with their caregivers. I have learned from my training in Cognitive-Behavioral Therapy for ARFID that I can bring the expertise in eating disorders, and the parents & kiddo bring the expertise on their family, food beliefs, culture, and abilities (to name a few).

With adults with ARFID I use a similar mindset. I bring skills to the table to treat the eating disorder and they bring their expert knowledge of themselves.

Are you concerned that you or your child are dealing with Avoidant/Restrictive Food Intake Disorder? Sign up for a free consultation to learn more about how I can help you and your family.

Sick Enough: A Guide to the Medical Complications of Eating Disorders is a Must-Read

Posted on April 2, 2025June 3, 2025 by Alison Pelz, LD, RD, CDE, LCSW

Sick Enough by Dr. Jennifer L. Guadiani is a great resource both for those experiencing an eating disorder and for those who love them.

This book breaks down complex medical topics into bite-sized pieces. It helps readers understand the real medical complications of eating disorders while addressing barriers to treatment.

Dr. Jennifer L. Gaudiani, author of Sick Enough, is a board certified-internal medicine doctor specializing in the treatment of eating disorders. She is also the founder of the Gaudiani Clinic: an outpatient medical practice specializing in the treatment of eating disorders. Before that work, she worked at ACUTE Center for Eating Disorders and Severe Malnutrition, which treats people with extreme medical complications of eating disorders. Dr. Gaudiani has spoken on this topic worldwide, is published in scientific journals and much more.

All people with an eating disorder deserve care and treatment. This is a simple but powerful idea that is reinforced again and again throughout Sick Enough.

Maybe you think your eating disorder “isn’t that bad”. Or feel like you don’t “look” like you have an eating disorder”. Unfortunately, these are common beliefs. Many reasons contribute. Many folks who experience eating disorders feel or are made to believe that their disorder isn’t legitimate. Maybe they don’t fit the mold of “type” of people who get eating disorders. Or they’ve experienced their eating disorder minimized by well-meaning but underinformed mental health providers, doctors, and even family members.

Eating disorders affect people’s physical health, not just their mental health. It is important to know how being underfed and undernourished can affect the body. People with bulimia, binge eating, and anorexia can experience these effects. Undernourishment can happen across the weight spectrum. It affects the digestive tract, mood, muscle tone, and much more.

Yes, Gaudiani emphasizes, all who experience eating disorders are “Sick Enough” to warrant treatment.

Why read Sick Enough?

In Part I, “Not Enough Calories” Gaudiani initiates an important discussion on what happens to the mind and body when enough calories are not consumed over time. With intentionally dramatic and jarring chapter titles like “30,000 Foot View: What Happens When You Starve Yourself?,” and “Going Into Hibernation and The Empty Tank.”

Gaudiani starts off by introducing the reader to the “cave person brain”. This part of our brain regulates some of the most basic bodily functions. Furthermore, what our brains do to keep us alive when our body is underfed. She illustrates the devastating effects (regardless of body size) that not getting enough calories can have on both physical health and psyche.

Examining Unexplored Biases in Sick Enough:

Refeeding syndrome*, which describes the condition of introducing food too much too quickly to someone who has been malnourished. Refeeding can present a real danger to patients. Gaudiani takes time to explore how the more common, equally dangerous condition of “underfeeding” is historically overlooked in eating disorder treatment, largely due to weight bias in the field.

Genetic variability is another concept Gaudiani explores within Sick Enough. As clinicians we are often baffled when a client who suffers from a severe eating disorder gets their lab work back and it all looks “normal.”Many providers can also be shocked to learn a client has lost their menstrual cycle without appearing to have lost much weight. In exploring how different people react to inadequate food intake, Dr.Gaudiani gives a thorough discussion on genetic variability as a reason we see things like this.

The book’s final section dives into the relationship and intersection of eating disorders and different gender identities, sexual orientations, ages, and chronic health conditions like diabetes. Gaudiani wraps it all up by providing a brief discussion on caring for those who have long and enduring eating disorders, and those who decline eating disorder care.

Throughout the book Dr. Gaudiani weaves in critical discussions on weight bias and weight stigma, and how they function as barriers to accurate diagnosis, treatment and care, as well as diving into and deconstructing pseudo science popularized by diet and wellness culture.

Sick Enough may be a challenging read at times–it goes into detail about some of the more rare medical complications of eating disorders which feel daunting to the reader.

While Gaudiani does her best at acknowledging the complexities of eating disorders within various identities–something historically excluded from the eating disorder treatment space– most of these sections are brief and not in-depth. Missing entirely is a discussion on neurodiversity and how it can complicate eating disorders and eating disorder treatment–RDs for Neurodiversity and Eating Disorder and Autism Collective are resources outside the scope of this book to begin learning more about neurodiversity and how it impacts eating disorders.

Who is Sick Enough for?

Medical professionals
Those who are experiencing an eating disorder and their loved ones
Caregivers

Sick Enough is loaded with invaluable vignettes and metaphors that can be used with clients–as a therapist and dietitian, it helps me communicate and collaborate more effectively with my client and the whole treatment team, as well as helping me advocate for clients in spaces that aren’t eating disorders friendly.

If you are a clinician wanting to learn more about eating disorders and their treatment, sign up here to receive free eating disorder resources in your inbox.

As a therapist who is also a dietitian, I can help you understand what is going on from both angles. If you are in Texas and interested in working with me, click here to fill out a contact form. I would love to support you and your child on your journey to health.

*Please consult your doctor if you think you have an eating disorder before beginning treatment.

Cover Image courtesy of Taylor & Francis, 2019

4 Ways to Build Momentum in Eating Disorder Recovery

Posted on July 23, 2019July 18, 2019 by Alison Pelz, LD, RD, CDE, LCSW

Are you just starting out on your recovery journey? Or have you been in treatment for a while and feel like your recovery is stalled? You’re not alone.

Here are four tips to help build momentum or re-energize your eating disorder recovery.

Establish a complete eating disorder treatment team.

Without professional treatment, eating disorders tend to get worse, not better.

Unfortunately, getting inadequate treatment, such as stopping treatment prematurely or having an incomplete treatment team, happens all too often. It can lead to hopelessness about ever recovering, slow down recovery or lead to recovery burnout.

The gold standard of care in eating disorder treatment is to have a multidisciplinary team. An eating disorder treatment team usually consists of a therapist, registered dietitian, medical doctor, psychiatrist, family therapist, and possibly other specialists. Click here to learn more about how to find a therapist and establishing a treatment team.

Make recovery a priority.

Recovery can feel like a full-time job, which can be downright exhausting. Eating disorder recovery is definitely a marathon and not a sprint. It takes time to understand how the eating disorder serves you and to establish new healthier patterns to cope with life.

Recovery doesn’t happen in a vacuum. Recovery happens while you are in school or working and involved with family, friends, and hobbies. So, it is easy for recovery to be put on the back burner given all of the obligations you may be juggling.

Making recovery a priority is important because without recovery, your eating disorder negatively affects all areas of your life occupation or school, relationships, physical and mental health, and overall quality of life.

Having acceptance that recovery is going to take time and energy is a good first step to making it a priority. Carving out time in your day for self-care, meal planning, eating, rest, and treatment appointments can help you feel less overwhelmed.

Learn to say no.

This is a tough one for me and so many of my clients. Sometimes saying yes is like a reflex because it is so automatic.

Learning to say no is a must in order to make recovery a priority. Furthermore, you may learn in treatment that saying yes too much may be contributing to or exacerbating your eating disorder symptoms.

Not setting firm boundaries can lead to feelings of hopelessness, worry, anger, and resentment, to name a few negative emotions. When we over-extend ourselves, often eating disorder behaviors are used to cope.

Although there are several reasons why people struggle with saying no, often fear is the primary culprit. You may fear missing out, hurting others feelings, appearing selfish or rude, being judged, and feeling rejected.

Learning how to set boundaries takes lots of practice, so be patient with yourself. If you notice that you struggle in saying no, discuss this with your therapist and other treatment providers.

Ask for help.

Working on your eating disorder recovery is something that you are responsible for. However, that doesn’t mean that you have to do it alone.

As you know, loved ones can’t eat for you or attend your appointments for you, but they certainly can support you in your recovery in many different ways.

As you go through recovery, you are going to need help, and that is okay. Often, part of what keeps people stuck in the eating disorder is isolation and feeling like they have to recover alone.

Barriers to asking for help often include fear of appearing weak, feelings of shame or guilt, or worry about burdening others. Your fears most likely are unfounded, as most people like to help others.

So what does asking for help in recovery look like?

Well, at different times in your recovery, it could mean different things. But, for some, it could be eating a meal with someone, it could mean being social, or it could mean simply talking.

It could also mean asking loved ones to learn more about eating disorders or attending a family therapy session or doctor’s appointment.

Consider making a list of people whom you could ask for help by asking yourself, “Who has my best interest at heart and who believes in me?”. Having some people in mind ahead of time can make it easier to ask for help.

Lastly, don’t feel like you have to be in crisis to ask for help. If you have any inkling that you may need help, reach out. Sometimes just the act of reaching out and talking to someone can be supportive.

The recovery road is always bumpy. But, having a strong treatment team as a foundation, making recovery a priority, setting firm boundaries, and calling on loved one for support can often make the bumps feel more manageable.

2018 Year In Review

Posted on December 18, 2018December 5, 2018 by Crowncreatives

As we come into the end of the year, I wanted to reflect on the posts I’ve published here in the last year, so here is 2018 in review!

If you’ve read the blog before or visited my site, you’ll know that my mission is to help people make peace with food & their bodies. My goal is to help people challenged with ED and other food & weight-related concerns to move from constantly worrying about food and their weight to being free to create the lives they want.

This year, I wrote a lot about recovery, intuitive eating, and supporting loved ones with eating disorders, to name a few topics. I’ve compiled every single post from this year, so you can catch up if you missed a post or refresh your memory if you’d like!

Are you already feeling diet culture pressure?

Before the new year, read why you should Forget About Diets To Improve Your Health This Year. Another concept to become familiar with is how Rejecting the Diet Mentality is Key to Healing Your Relationship with Food.

How can you support the people in your life to develop positive body image and/or work through disordered eating?

Here are 5 Surprising Ways to Support Your Loved One with an Eating Disorder and a post especially for Dads: 6 tips to Help your Daughter Develop a Positive Body Image.

Recovery from an eating disorder is not an easy process.

This year I wrote about 4 Tips to Cope with Weight Gain in Recovery from Anorexia Nervosa, Tips to Support Eating Disorder Recovery this Semester, 5 Steps to Reconnect with Exercise in Eating Disorder Recovery, and How to Stay on Track with Eating Disorder Recovery during the Summer: Tips for College Students.

Are you curious about Intuitive Eating?

Here are 3 Important FAQs about Intuitive Eating that you should know.

Recognizing that it’s time to get treatment for your eating disorder is a huge step.

Here are 5 Signs That It Is Time to Get Treatment for Your Eating Disorder.

And finally, a treatment team can make all the difference.

Here are my tips on how Building a Treatment Team to Help You Conquer Your Eating Disorder, and 5 Ways a Dietitian Can Help Reduce Binge Eating.

I hope you have enjoyed all of the posts from this year! Please let me know if there are any topics you would like for me to cover in 2019. If you’re looking for even more resources, make sure you’re following me on Facebook and Pinterest – I share tons of resources from me + other experts in the field on both platforms!