OCD Family Podcast

S4E153: OCRD Series IV, Part III – ARFID: The One Diagnosis That Could Change How You See "Picky Eating" Forever

Host: Nicole Morris, LMFT
Date: November 24, 2025

Main Theme

This episode dives deep into Avoidant Restrictive Food Intake Disorder (ARFID), a frequently misunderstood eating disorder often confused with "picky eating." Host Nicole Morris explains what ARFID is (and what it isn’t), explores its subtypes, shares expert insights from Dr. Sarah Raven, and highlights lived experiences—particularly through the journey of Hannah, a young "ARFID warrior." The episode offers practical advice, support, and hope for families navigating ARFID, particularly in the context of the holidays.

Key Discussion Points & Insights

1. Framing the Issue: “Picky Eating” vs. ARFID

• Nicole addresses common questions families have about picky eating, such as:
  • Will my child outgrow extreme pickiness?
  • Is it attention-seeking or controlling behavior?
  • What happens when the child's diet starts affecting growth or health?
• ARFID is not just an extreme or stubborn form of picky eating, nor is it about manipulation or attention-seeking. It is a clinically significant disorder with serious nutritional and social consequences.
  • (Nicole, [00:52]):

    “If you've asked yourself one or more of these questions, you're in the right place. Because today we're diving into a lesser understood but incredibly important topic, Avoidant Restrictive Food Intake Disorder, or ARFID.”

• Classification: Technically a feeding and eating disorder, ARFID often co-occurs with OCD, autism, anxiety, and ADHD due to overlapping traits such as sensory sensitivities and fear-based avoidance.

2. What Is ARFID? – Core Characteristics

• Dr. Sarah Raven (from a FEAST YouTube resource, cited throughout):
  • Defining ARFID ([05:30]):

    "ARFID is characterized by a pattern of limited or restricted eating which is associated with a variety of either social, emotional, medical, nutritional or developmental consequences. The person's reason for restricting their food intake can vary."

  • It ISN’T about body image or desire for thinness, distinguishing it from anorexia/bulimia ([06:33]):

    "So what ARFID is not, is it is not something that is related to body image drive for thinness or fear of weight gain..."

• Nicole: Co-occurrence is especially common in neurodivergent populations due to sensory processing differences and difficulty identifying internal states (alexithymia). The disorder disrupts both nutrition and social functioning.
  • Quote ([07:01]):

    "Just think about how many of our social rituals center around food... The holidays bring up a lot for people who are distressed and a mess when it comes to food, eating, feared consequences and the like."

3. Case Examples: The Heterogeneity of ARFID

• Dr. Raven shares varied examples ([08:26]–[11:21]):
  • An 8-year-old who stopped eating after a choking incident and family trauma.
  • A 21-year-old male with a limited diet wanting social acceptance in adult settings.
  • A 17-year-old girl with no appetite and a history of being bullied for being underweight.
  • An 11-year-old who ate only three foods; notable family conflict around his eating.
• Nicole highlights:**
  • “Heterogeneous”—ARFID looks different in every individual, from nutritional risk to BMI, and includes children and adults of all sizes.

4. ARFID vs. Picky Eating—Key Differences

• Picky eating usually does not impact growth, isn’t persistent, and doesn't cause intense distress.
  • ([11:21]):

    "Picky eating tends to improve with age... Our food is chronic and without intervention, it absolutely could worsen."

• ARFID is marked by chronicity, risk of nutritional failure, and overwhelming anxiety or disgust around certain foods.

5. The Three Main Subtypes of ARFID ([15:09])

• Aversive Subtype:
  • Sudden onset after a traumatic event (choking, vomiting); food becomes associated with fear.
• Avoidant Subtype:
  • Lifelong extreme pickiness, mostly sensory-driven; common in autistic children ([16:55]):

    "These individuals tend to have difficulty with eating that dates way back to infancy or very early childhood."

• Restrictive Subtype:
  • Lack of biological drive, no appetite or enjoyment in food, food as a chore not pleasure.

Nicole ties these subtypes to neurodivergence and traits like alexithymia; some individuals never develop typical hunger cues.

6. Underlying Mechanisms & Course

• Biological predisposition: Anxious temperament, high sensory sensitivity, and cognitive rigidity.
• Negative feelings and beliefs about food are pervasive: disgust/fear/suspicion of new foods, even social environments involving food.
• Social isolation and family stress become common.
• Self-reinforcing avoidance keeps the disorder going.
  • ([22:04]):

    "With these negative emotions come a lot of thoughts and beliefs about eating food..."

7. Treatment Priorities ([29:49])

• Dr. Raven outlines a treatment priority pyramid:
  1. Nutrition and Health: Is the person medically safe? (growth, development, menstruation, athletic participation, energy, etc.)
  2. Family Dynamics: ARFID can fuel family conflict and accommodation.
  3. Social/Emotional Functioning: Can they participate in normal daily activities, go to school, socialize?
  4. Comorbidities: Anxiety disorders, autism, OCD, and increased risk for developing other eating disorders.
  5. Subjective Distress: How much does ARFID bother the individual? Does it impair their quality of life?
• Nicole:
  • “This is why people seek help. They're like, this sucks, or this is scary. Or as a parent... there is no greater fear than not being able to get your kid to eat.”

8. Evidence-Based Treatment Approaches ([35:18])

• Cognitive Behavioral Therapy (CBT)
  • Includes psychoeducation, self-monitoring, and especially exposure to avoided foods or situations.
• Family-Based Treatment (FBT)
  • Gold standard for children/teens.
  • Parents initially take responsibility for nutrition; later, responsibility transitions back to the child.
  • It may be harder to recognize ARFID as a crisis because of longstanding patterns ([37:46]):

    "So, there's a lot of fatigue in the child and in the family of having dealt with this problem for so long."

• Medical Interventions:
  • Hospitalization/feed tubes only in severe cases. Off-label medications may also be used.
• Toolbox Techniques ([40:01]):
  • Calorie boosting strategies: Liquid supplements, nutrient-dense foods, six meals a day, food fortification.
  • Food Hierarchies & Exposure Therapy: Graded exposures to feared foods/situations; three-bite rule for tolerating new foods; interoceptive exposure to body sensations from eating.
  • Food Chaining and Fading: Gradually moving from a safe/preferred food toward more challenging new foods by small, similar changes.
  • Sensory Work & Food Detective Games: Using senses to explore new foods, especially for kids.
  • Relaxation Training: Breathing, mindfulness, yoga to reduce anxiety.
  • Values Work (from ACT): Connecting recovery to client goals (friendships, dates, school).
  • Externalization: Naming the disorder (e.g., “Mr. ARFID”).

9. Recovery—What Does Success Look Like? ([49:32])

• For ARFID, recovery is not about becoming a "normal eater"—there may be lifelong pickiness if nutrition/social goals are met.
  • ([49:32]):

    "Recovery from ARFID may not ever mean being a, quote, unquote, normal eater... but still eat enough to maintain normal growth and good health."

10. Lived Experience: Hannah’s “My ARFID Life” Journey

Timestamps: Mom’s story [53:22]; Hannah’s exposures [72:23]–[83:39]

Family Context & Finding Treatment

• Hannah’s family faced years of worry, failed therapies, and the pivotal moment when Hannah lost dramatic weight and stopped growth.
• Traditional advice—“they’ll eat when they’re hungry”—didn’t work.
• Finally, they found a remote ARFID specialist; started exposure therapy and supplement nutrition.

The Importance of Motivation and Consent

• The family’s use of social media for positive motivation (not shame-based coercion!), which was effective because Hannah wanted to participate ([61:31]):

  "This was not a shame driven activity... but it was a motivator because it was a motivating tool that worked for Hannah in the past."

Navigating Social Pressures

• Holidays and family functions were fraught with misunderstanding and unsolicited advice ([63:48]):

  “A lot of people around, you don't understand what it is. And...many people just say, oh, it's just a picky eater.”

• Mom’s hope: educate others and reduce stigma by sharing on social media.

Instagram/YouTube as Exposure & Community

• The account blew up, offering community and hope to many others.
• Exposure practices shared online: Hannah chooses the food, describes its appearance, smell, taste, texture, and rates her distress (SUDS scale).

11. Hannah’s Exposures – Practical Examples

a) Safe Food Win: Nutella Pretzel Sticks ([72:23])

• Motivated to try after seeing them in store
• Uses senses to inspect, rates a 10/10, adds to her “safe food” list
• Quote:

  "These are so good. I can't stop eating them... I rate these a 10 out of 10, and I'm adding them to my safe food list." —Hannah [73:10]

b) Trying Something New – Bagel with Butter ([77:15])

• Describes sensory impact of butter on her hands; flavor is OK, but prefers plain.
• Uses feedback to inform what to try differently next time (e.g., different condiment, or utensils).

c) Feared Food – Sweet Peas ([81:02])

• Honest about dislike, describes texture and flavor:

  "It tastes like grass with bits of dirt... I'm glad to say this is going off my fear food list, but I don't think I'll be eating these again for a long time. I rate these a 4.7 out of 10." —Hannah [82:03]

• Celebrates removing it from the fear food list even if not from the favorites.

d) The “Three Bite Rule” Explained ([83:39])

• First bite is shocking, second bite is less anxious, by third bite her “brain tells Mr. ARFID to be quiet.”
• Quote:

  "On the first bite, Mr. Arfid is really loud. On the second bite, Mr. Arfid quiets down a bit... By the third bite, Mr. Brain tells Mr. Arfid to quiet down so that he could focus on the flavor that he's eating." —Hannah [84:02]

e) Externalizing ARFID

• Hannah draws a picture of “Mr. ARFID” and throws it away to start exposures, helping her separate her identity from the disorder.

12. Getting Comfortable with Discomfort: A Lesson from Hannah ([90:50])

• Facing distress is how we grow—Hannah likens trying new foods to sleeping in a sleeping bag:

  “If we don't do things that are hard and uncomfortable, we're missing out on a bunch of opportunities that can help us learn and grow.” —Hannah [91:14]

• Favorite quote from Georgia O’Keeffe:

  “I've been absolutely terrified every moment of my life and I've never let it keep me from doing a single thing that I wanted to do.”

Memorable Quotes & Moments

• Nicole:

  "You cannot shame or force your child, your partner, your loved one, your parent, another person to eat. You just can't. And if you try, you're just amplifying that distress." ([62:10])

• Dr. Raven:

  “What ARFID is not, is it is not something that is related to body image drive for thinness or fear of weight gain.” ([06:33])

• Hannah:

  "You should try to do three bites too, so you can feel like a superhero. Like me." ([84:29]) "The more I face my fears of trying new foods, the less scared I am to do it." ([91:01])

Important Timestamps

| Timestamp | Topic | |---------------|-------------------------------------------------------| | 00:52 | Opening/Why ARFID matters, host’s intro | | 05:30 | Dr. Raven defines ARFID | | 08:26 | Dr. Raven’s case examples of ARFID | | 11:21 | Nicole: ARFID vs. picky eating | | 15:09 | Dr. Raven: Three ARFID subtypes | | 20:10 | Biological & psychological underpinnings | | 29:49 | Clinical priorities in assessing/treating ARFID | | 35:18 | Evidence-based treatment toolbox overview | | 53:22 | Hannah’s mom shares family’s ARFID journey | | 72:23 | Hannah’s Nutella pretzel stick exposure | | 77:15 | Hannah tries bagel with butter | | 81:02 | Hannah faces sweet peas (feared food) | | 83:39 | Hannah explains the three-bite rule | | 90:50 | Hannah on “getting comfortable with being uncomfortable” |

Actionable Takeaways & Tone

• Validate ARFID as a real and serious disorder—not just a phase or stubborn behavior.
• Hope: Treatment is possible, but often slow and incremental. Family support and finding the right therapy are critical.
• Community: You are not alone; advocacy and education (like Hannah and her family) reduce stigma and invite support.
• Exposure matters: Facing—rather than avoiding—fears, in small, structured, and values-guided steps, is the chief pathway to recovery.
• Celebrate wins, even if small: Success is progress, flexibility, and reduced fear—not perfection or “normalcy.”

The episode wraps on an inspiring, hopeful note, with Nicole championing the power of community and bravery, as so beautifully modeled by Hannah and her family.