ARFID stands for Avoidant Restrictive Food Intake Disorder. ARFID is often given as a diagnosis to people with an extreme aversion to foods, often resulting in clear negative health consequences. Unfortunately, the lower end of the spectrum of ARFID is often overlooked and can have from subtle to significant consequences.

ARFID can make eating food hard. This can affect eating in public, at friends place, or at home. ARFID can make it hard to choose what to eat, what to cook, and can lead to select or pervasive malnourishment.

Why We Might Be Avoidant

There are a few common reasons why we might avoid foods. Some avoidances can be overcome with desensitisation and frequent exposure, some cannot. By identifying why you might be avoiding certain foods, you can identify more easily the foods that it is worth putting effort into acclimatising, and desensitising, and which foods to accept won’t be a part of your diet.

Sensory Nope

Sensory includes texture, taste, smell, temperature, disgust and the more elusive “feel”. Any of these can shift a perfectly good food into the “nope” category and we reject it.

We evolved to ensure that foods we consumed were good for us. Food can be bad for a number of reasons, such as it not being food, good food has gone off, or something about the food is toxic to us. This makes sense – most of us don’t like the feel of sand in our food, the way that it grits in our teeth and grinds as we try to chew. Our instinctive response is to spit the food out, because it contains something bad. We may then be put off that entire portion of the dish to avoid that feeling of sand between our teeth.

Another example is certains tastes, such as bitter. We evolved to avoid bitter foods when we are young as most plants that are poisonous taste bitter. Some people are more sensitive to bitter foods and we have a biological rejection of them even into adulthood.

If a safe food is too bitter, or unexpectedly bitter when it usually is sweet, we might reject it.

Some people, such as Autistic People, or Super Sensors, have a more extreme sensory taste and smell sensitivity perception that neurotypical people. This can mean that there are certain sensory experiences you have to certain foods that trigger the “nope” response. Often super tasters and super smellers will prefer what most people consider to be a bland diet.

Intolerance / Allergies

Many people who struggle with ARFID have an intolerance to a food or food type. You may not know that you have this intolerance, you just know (usually consciously, sometimes unconsciously) that you feel bad a bit after eating. This “feeling bad” becomes associated with all of the food types that the trigger food is in. After a while, you can find yourself accidentally restricted to only known safe foods, and avoidant of entire categories / groups of foods.

A food allergy is generally easy to spot as it causes clear medical signals, such as itching, hives, swelling, nausea, heart palpitations and feeling very ill. There are medical tests for the most common food allergies and this then arms you in avoiding those particular foods.

Intolerances are more difficult. There often isn’t a good or robust test for the intolerance, to prove definitively that you do indeed have a biological problem consuming that particular food. It is not uncommon for people to tell you that it is just in your head, that you are experiencing the nocebo effect (like the placebo effect, but you get bad outcomes instead of good), or “no one has an intolerance to that”.

While it is true that sometimes you may have a nocebo effect, it is also true that food intolerances are real. They can be hard to figure out. For example, a gluten intolerance, which is not Celiac Disease, can give some people intestinal discomfort for 3 days and brain fog for 10 days. Skipping gluten foods (wheat, rye, barley, oats and the products made from these) for a few days or even a week will not necessarily show you that you are intolerant of that food. To properly test, allergy / intolerance exclusion diets take 4 weeks per food category to show improvements. Once a category has been found with an allergen in it, you then need to slowly test each likely food in that group until you find the one (or several) that you are intolerant to. It takes patience and time.

Monash University has an excellent FODMAP diet system to help you figure out if and what your food intolerances and allergies may be.

(FODMAP = “Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols”, Polyols are also called Polysaccharides)

Change Rejection

Disgust

Behind every phobia lies the basic human emotion of disgust. Disgust is an emotion that protects us from a specific subset of harm, disease. Consider the kinds of moist, smelly, slimy objects that could make us quite sick – it would be hard for our ancestors to survive that without modern hospitals. The ancestors that learned to avoid foods that looked like this are the ones who survived to have decedents – you. While we initially learn some of what we should be disgusted with from our parents, that isn’t where the phobia comes from. We learn what to avoid from parents and other peers, the magnitude of the avoidance is generally biological.

Some of what drives ARFID avoidance is a feeling of disgust, or a phobia, relating to some foods. The more fatigued we are, measured in either low blood sugar or low neurotransmitters, then the stronger our brain will dial up the disgust of foods and the harder some foods become to eat.

Some disgust response become phobias which can affect our lives more than just avoiding a particular food because we think it is horrible.

Food-Related Phobias

Food phobias are irrational fear, disgust or anger emotional reactions to certain aspects of food. Sometimes a phobia can be triggered by a real life experience, but more often it is an inherited biological trait.

When phobias are hereditary, you will often find a blood family member who also has a phobia. Their phobia may not be the same as what you are experiencing, nor even food related, but on average, the phobia is similar. When this occurs, it is a strong indicator that the phobia is hereditary, where the phobia your brain decided fits best is food related.

Once we have a phobia, we often construct stories around the phobia and then act out those stories. This can add foods to the phobic list, or make our methods for managing the phobic response ritualistic.

Phobias are not logical. You can not rationalise with a rogue emotion as if it were a rational human. In therapy, some rationalisation can be helpful to prompt your willingness to challenge the phobia, however, this needs to be a part of a fear desensitisation program.

A phobia is different to the above “Nope” and “Sensory” issues, which you cannot desensitise from.

Here is a list of some particular named phobias. If the phobic reaction you have is not listed, that doesn’t mean that it isn’t a real phobia, it just may not be common enough to either be on the list or named.

Out of Spoons

Spoon Theory is the basic idea that doing things costs energy, and we simplify tracking that energy via discreet Spoons. Some tasks cost us more spoons than for average people, and so are considered expensive.

At the end of the day, after we have finished school, or come home from work, or struggled with being awake and conscious for 8 or so hours, we can be quite low on neurotransmitters; aka spoons.

First of all, you are waiting until you are out of spoons to choose what to make and out of neurotransmitter to solve how to make it. To fix that, make a choice and look up a recipe earlier in the day.

Second, make things easier, not harder. Yes, cutting up your own veggies is cheaper, but if they were precut, you may be more likely to use them. In this spirit, aim for quick and easy meals that are still mostly homemade, tasty and nutritious.

Third, are you struggling with mild ARFID? The AuDHD version is fast, sugar, carbohydrate, protein and salt over most other foods. Fruit and vegetables are far less desirable, as they rarely prompt dopamine and are also inconsistent. This requires more speciality help.

Fourth, don’t push “nope” food into yourself. “Nope” foods are the odd food that your brain just says “nope” to.
Mine is creamed corn. I love every other kind of corn, but I can’t do creamed corn. *Shrug*

Lastly: reheats are love. If you can cook a decent lunch, cook extra and have that for tomorrow night’s dinner.

Dopamine Diet Chasing

When we were hunter gatherers, types of food that were hard and highly rewarding were things that can be broken down to glucose, various amines and salt. Salt was easy to get at the coast of the oceans, or in the middle of deserts, but hard to get everywhere else. Each of these has an important role to play in how we think and feel.

Summary:

The core Dopamine Chasing Foods are:

• Fat
• Carbohydrates / Sugars (complex and simple)
• Protein
• Salt

None of these foods are inherently bad when part of a balanced diet. Often, when diets are out of balance such as eating disorders, these foods become dominant instead of balanced, and the foods that should be the in majority become low to non-existent. For more information on what a well balanced healthy diet looks like, check out Nutrition, Health in Body and Mind.

When we eat these particular foods, our brain releases some stored Endorphins and Dopamine Neurotransmitter to reinforce the behaviour (eating those foods), and our brain doesn’t mind doing this as it has detected that the majority of the ingredients needed to replenish the supply of these neurotransmitters has just been consumed. With the increase in glucose (from the food) plus the released Dopamine and Endorphins, we can think more clearly, push ourselves harder and stabilise our mood. We often find an immediate benefit in our ability to think and feel, which can then lead to a complex reinforcing feedback loop (eat more of this whenever we feel off) that is at the core of many eating disorders (eating to feel better).

For a full explanation of this, look at our section on Dopamine and Eating Disorders.

Managing ARFID

It is important to know why you (or the person you are helping) is avoidant. Once we know this, we can start to take some actions for those avoidances, expanding the food palate while cognisant that some things cannot be eaten.

Dieticians who specialise in ARFID are your best friend for this. Next is a therapist to help you with your cognitive and emotional reasoning that you use to justify your avoidance / restriction and their resultant behaviours.

Additionally, to help discover what food allergies and intolerances you may have, consider using the FODMAP method.