ARFID and Autism: Understanding the Link and Seeking Support

What Is ARFID

ARFID stands for Avoidant Restrictive Food Intake Disorder. As the name suggests, people with ARFID display avoidant and restrictive behaviours around food.

Although a person with ARFID may limit the amount of food they consume or avoid certain types of food, the condition isn’t the same as Anorexia Nervosa, which often centres around a person’s fear of gaining weight.

Instead, people with ARFID may:

• Be sensitive to the way certain foods smell, look, or taste
• Feel disinterested in food
• Feel triggered by past negative experiences involving food

Why Is ARFID More Common in Autistic People?

Research suggests that 12.5% to 33.3% of individuals diagnosed with ARFID also have autism. Although more research is needed to understand why this is, it’s largely accepted that the sensory sensitivities experienced by people with autism have a part to play. 

Eating involves dealing with multiple sensory experiences all at once – smell, taste, texture, temperature, and even the sound of food. When these senses are heightened in people with autism, certain foods can feel overwhelming or even painful. For example, foods with a mushy texture, like mashed potatoes or bananas, may feel unpleasant or even revolting to someone sensitive to how things feel in their mouth. Likewise, strong-smelling foods, such as fish or certain cheeses, might be overwhelming to someone with a heightened sensitivity to odours.

The need for predictability and routine is another factor. Many autistic people find comfort in sameness and can become distressed by unexpected changes. Eating the same meals, prepared the same way, at the same times, can provide a sense of security and control. When new or unfamiliar foods are introduced, it may feel like this control is taken away.

What Does ARFID Look Like in an Autistic Person?

In autistic individuals, ARFID can present in many different ways; however, some more common signs include: 

• Limiting food choices: Eating only a handful of specific foods, sometimes as few as 5–10 items in total.
• Strong texture aversions: Avoiding entire categories of food based on how they feel, such as all soft foods or anything with lumps.
• A preference for certain brands or order on the plate: Only accepting certain brands and wanting food to be arranged in specific ways.
• Temperature and smell sensitivity: Requiring foods at very specific temperatures or becoming distressed by food odours.
• Mealtime routine dependence: Eating the same foods at the same times daily and becoming upset when routines change.
• Social eating avoidance: Refusing to eat in public places or social situations due to unpredictability.
• Physical reactions to new foods: Gagging, retching, or having panic responses when presented with unfamiliar items.
• Nutritional or weight-related issues: Showing signs of poor nutrition or significant weight changes due to the restricted diet.

In a person with ARFID, these behaviours tend to go beyond typical sensory sensitivities and can start to significantly impact health, emotional wellbeing, or everyday life. 

Is Everyone with Autism at Risk of ARFID?

No, if a person has autism, it doesn’t automatically mean they’ll develop ARFID. However, if you’re on the autism spectrum, it can be helpful to know what things are a common part of the autistic experience and what are more characteristic of ARFID.

Many autistic people have food preferences or sensitivities – and that’s completely normal. With ARFID, the main difference is that these sensitivities evolve into habits that cause significant problems with nutrition, growth, and daily life.

For example, someone with ARFID might eat only a select handful of foods, leading to weight loss, feeling ill, or missing out on social activities. This kind of eating pattern can feel distressing and is often hard to change without support.

It’s also important to note that ARFID can begin at any age. Sometimes, big life changes or extra stress can cause someone’s eating habits to become more restrictive, even if they previously managed their food preferences well.

Getting a Diagnosis and Treatment Options

If you think you might have ARFID alongside autism, reaching out to your GP is the most important first step. Getting a diagnosis can help to shed light on what’s happening and open doors to tailored support. 

After speaking with a GP or specialist, they may suggest:

• Nutritional support to make sure your basic nutritional needs are met
• Therapies like cognitive-behavioural therapy (CBT) or sensory integration therapy, which can help to manage anxiety around food and gently expand food choices.

Doctors recognise that what works for one person might look different for someone else. So, when it comes to managing ARFID, treatment plans are always individualised. 

Supporting Someone with ARFID and Autism

When encouraging a person with ARFID to eat, try to be gentle and respect their food boundaries. Bribing or pressuring someone is almost always ineffective; you’re likely to have much more success if you introduce new foods gradually in a safe, low-pressure space. If the person with ARFID does manage to eat a new food, celebrate! Even a small bite is a big step for them.

It’s also key to stick to routines as much as possible. Why not involve the person with ARFID in choosing what they’re going to eat and when they’re going to eat it? You might even invite them to prepare the food themselves before mealtime. This can help them to feel less overwhelmed by creating more predictability and control.

Finally, don’t be afraid to ask for help from a specialist. It can be hard to witness ARFID behaviours in those you care about, but remember that ARFID is a complex condition – no one expects you to have all the answers or manage it on your own. Clinicians are there to help you understand what’s going on and explore strategies that work, without judgement. 

Living with ARFID and Autism: Where to Get Support

If you have a diagnosis of autism and ARFID, you don’t need to struggle alone. There are many avenues of support that you can explore. These include: 

• Speaking to a healthcare professional: Your GP, a specialist dietitian, or a psychologist familiar with autism and eating disorders can offer guidance and treatment throughout your ARFID journey. 
• Autism organisations: Organisations like the National Autistic Society and Beyond Autism provide lots of valuable resources and advice tailored to daily challenges, including eating difficulties.
• Online communities: Don’t forget that others understand. It can be really helpful to connect with people online who share similar experiences. This can help you find reassurance and even ideas for managing food.

Reasonable Adjustments at Work

You can also seek support in the workplace. If you feel comfortable, being open with your employer or HR department allows them to recognise your needs and make reasonable adjustments for your wellbeing, such as:

• Flexible working: This might include flexible hours to help you manage mealtimes in a way that works for you. Or, the option to work from home, so you can stick to food routines that feel safe and comfortable.
• Quiet spaces in the office: Your employer may arrange a quiet or private space for meals if eating in communal areas feels overwhelming.
• Flexibility at events or work get-togethers: Finally, if your employer is aware of your ARFID, they can be more mindful of this when arranging work socials or group activities involving food, so you don’t feel uncomfortable or left out.

Small adjustments like these can help to reduce stress and make it easier to manage both ARFID and autism in your daily life. Taking those first steps to ask for help, whether from professionals, loved ones, or your employer, can make things feel much more manageable.