When Picky Eating is Actually a Psychiatric Disorder

As a child, Sophia Dionisos was frequently called a picky eater. “I struggled with eating any types of food,” says Dionisos, now 23, who works as a phlebotomist. She had to force herself to eat every day. From 8^th grade until age 21, the 5’4” Dionisos weighed 80 pounds and subsisted on approximately 600 calories a day.

Born in Russia, she had spent the first three years of her life in an orphanage where she was malnourished. But even after Dionisos was adopted by a family in Ohio and gained access to plenty of food, she didn’t have much of an appetite and found many flavors and seasonings overwhelming.

Dionisos now knows her issues with food were an eating disorder—but not one that most people have ever heard of. She has avoidant/restrictive food intake disorder (ARFID), a psychiatric disorder that is like an extreme version of picky eating.

Many kids outgrow picky eating—but that doesn’t usually happen with ARFID. This disorder, which often emerges in childhood, can affect people throughout their lives, according to the latest research. It’s as prevalent as other eating disorders and studies show it affects people of all ages.

Cases of ARFID are also on the rise, increasing by 305 percent from 2018 to 2022, according to a 2023 FAIR Health white paper. That doesn’t necessarily mean that we’re in the midst of an ARFID epidemic. It may be that the disorder is becoming more widely recognized since it was added to the DSM-5, the bible of psychiatric diagnoses, in 2013. Before that, people were often told they were just picky or dramatic or controlling around food.

“There are a lot of adults who are not getting the attention they need,” says psychologist Cynthia Bulik, a distinguished professor of eating disorders at the University of North Carolina at Chapel Hill. “People don’t want to believe this is a psychiatric disorder but it is—and long-term it can lead to nutritional deficiencies, impact relationships, and potentially be socially disruptive.”

(Eating Disorders Are on the Rise in Older Women.)

Dionisos finally got targeted help for her eating disorder earlier this year when she checked into The Emily Program's Adult ARFID Center of Excellence in Durham, North Carolina—which opened in January as the country’s first inpatient treatment program dedicated solely to treating ARFID. Dionisos, who was also experiencing major depressive disorder, spent five months there, doing therapy, learning to eat solid foods, and conquering her fear of fullness.

“Understanding that I don’t want to live like this anymore helped me get comfortable with feeling fullness in my body,” Dionisos says.

Unlike other eating disorders, ARFID isn’t driven by distress over body shape or weight. “It can affect people with all body types and sizes,” says Bulik. Instead, it seems to be triggered by sensory sensitivities related to the smell, taste, or texture of food; a fear of choking or vomiting or other potentially problematic consequences of eating; or simply a low appetite or lack of interest in food. These are considered the three subtypes of ARFID, though someone can have more than one type.

“What we’re learning is that ARFID has a lot of neurobiological features,” says Jennifer J. Thomas, a professor of psychology at Harvard Medical School and co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital. For example, people with ARFID have higher levels of cholecystokinin (CCK), a hormone that helps people feel full, while in a fasted state.

Research also shows that people with the fear-based type of ARFID have increased activation in the amygdala—the brain’s fear- and emotion-processing center—when they’re exposed to images of different foods. Similarly, another study found that those with the sensory type of ARFID show greater activation in the brain’s sensory areas while looking at pictures of food, and those with a lack of interest in food experience lower activation in the hypothalamus, the brain region that regulates appetite.  

People who have certain medical conditions also seem to be at higher risk for ARFID. It’s unclear why but research suggests it’s especially common in people who have attention-deficit/hyperactivity disorder, autism, obsessive compulsive disorder (OCD), and anxiety or depressive disorders. Meanwhile, ARFID symptoms are common among adults with gastrointestinal disorders such as irritable bowel syndrome or functional dyspepsia, according to a study in a 2025 issue of the journal Gastroenterology. This may be because people with chronic gastrointestinal disorders often develop anxiety about eating, Thomas says.

(Why So Many People With Eating Disorders Have ADHD.)

And ARFID has a strong genetic component, with a heritability of 79 percent, higher than that of anorexia nervosa, bulimia nervosa, and binge-eating disorder, which are also known to run in families. “Identical twins are more likely to be concordant for ARFID than fraternal twins,” notes Thomas. (Interestingly, Dionisos has a semi-identical twin who does not have ARFID. “We look identical but our DNA is not the same,” she explains.)  

Whatever the underlying influences, ARFID can have significant ripple effects. “If someone’s variety of foods becomes restricted, they can develop nutrient deficiencies,” says Kayla Warechowski, lead dietitian at The Emily Program’s Adult ARFID Center of Excellence in Durham. In children, these often include insufficient amounts of vitamin B1 and B2, C, K, as well as zinc, iron, and potassium, research has found.

Adolescent and young adult males with ARFID often experience different medical effects such as lower heart rates, lower total cholesterol, and higher hemoglobin levels, says Jason Nagata, an associate professor of pediatrics at the University of California, San Francisco. Because men have higher metabolic needs, he explains, they may experience more severe malnutrition from insufficient caloric intake. This could explain the lower heart rates. “When the body is in a state of malnutrition, all the organs slow down and go into almost hibernation mode,” he says. “The significantly lower heart rate in males could lead to arrhythmias.” 

The consequences also can be social. Kids report being teased or feeling uncomfortable going to sleepovers or summer camp, says Tracy Richmond, an adolescent medicine expert and director of the eating disorders program at Boston Children's Hospital. In adults, social impairment can also be intense—"there’s more stigma and shame in adults because they have the awareness that people may be judging them,” says Thomas.

But now that the disorder has gained more attention, new avenues have emerged for identifying and supporting people who have it.

ARFID is usually diagnosed based on clinical interviews, in which a patient describes a typical day of eating and what’s getting in the way of their eating other foods, plus a medical evaluation to see if they have nutrient deficiencies or faltering growth trajectories. 

Eric Pascarelli, 37, an independent filmmaker based in Indianapolis, was diagnosed with ARFID in 2020. His diet consisted of fewer than a dozen foods such as cheese pizza, hamburgers, French fries, bananas, pancakes, milk, and ice cream. Not only was he uninterested in trying new foods but, he says, “I would get a gag reflex if I put certain textures in my mouth.”

After his diagnosis, Pascarelli found a community of adults with the disorder online. He also started working with a food therapist, who has helped him slightly expand his diet to include some types of noodles and smoothies.

“Even after doing all that, I’m still put off by most foods,” says Pascarelli, who directed and produced the 2023 documentary called Not Just a Picky Eater about ARFID. “I am very happy with eating my safe foods every day. My brain is wired very differently when it comes to food.”

One approach to treating ARFID that’s been gaining traction is cognitive behavioral therapy for ARFID (CBT-AR), which was developed by Thomas’s team at Massachusetts General Hospital. It uses an exposure-based approach to help people confront specific foods or sensory properties they tend to avoid.

Treatment at the newly opened Emily Program includes CBT-AR as well as dialectical behavior therapy (DBT), a form of talk therapy that focuses on promoting mindfulness, distress tolerance, emotion regulation, and improving communication skills; and somatic therapy, which uses breathing exercises, body scanning, and other techniques to help people become aware of physical sensations and tension patterns they experience with eating. The program also includes mindfulness practices, nutrition education, and therapeutic meals, explains Warechowski. “The main goal is to understand the primary barriers to eating and moving people toward where they want to be.”

Family therapy also can be helpful for children. A study in a 2026 issue of the Journal of the American Academy of Child & Adolescent Psychiatry found that family-based treatment for ARFID was more effective than individual therapy for promoting weight gain in underweight kids ages six to 12.

 “The earlier the intervention, the better,” says Richmond. “Patterns can get laid down and become harder to reverse.” But it’s important for people to know that ARFID can be treated and the right approaches can lead to improvements in their symptoms, experts say.

In some instances, drugs may also help manage people’s anxiety, depression, or gastrointestinal symptoms or stimulate appetite in those who lack it. Because Dionisos had major depression, she began taking antidepressants while at the Emily Program; the first four she tried didn’t work but then she found one that did.

By the time Dionisos left the Emily Program in May, she had gained a sense of control over her food choices and increased her calorie intake to at least 2,000 calories a day. “I want to eat but I still don’t enjoy eating—I force myself to eat, usually with a distraction like music or a movie, to stay healthy and survive,” says Dionisos, who now weighs 113 pounds. “I feel very proud of myself for what I’ve accomplished.”