Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2025 Jul 16.
Published in final edited form as: Int J Eat Disord. 2025 Mar 19;58(6):1001–1007. doi: 10.1002/eat.24418

Advancing the Science of Avoidant/Restrictive Food Intake Disorder (ARFID): Six Key Questions

P Evelyna Kambanis 1,2,3, Jennifer J Thomas 1,2,3
PMCID: PMC12264816  NIHMSID: NIHMS2091393  PMID: 40108823

Abstract

Avoidant/restrictive food intake disorder (ARFID) has rapidly emerged as a substantial focus of research and clinical attention since its introduction in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5). This special issue brings together over 30 articles that answer six of the field’s most compelling current research questions about ARFID. Specifically, key contributions explore (1) whether the diagnostic criteria for ARFID should be revised; (2) how well our current self-report measures assess ARFID symptoms; (3) candidate psychological mechanisms that may maintain ARFID symptoms; (4) whether common medical comorbidities may provide clues to etiology; (5) how close we are to identifying evidence-based treatments; and (6) how cultural context may shape ARFID phenotypic presentation. A critical gap remains in understanding ARFID across diverse cultural contexts, with most research still centered in North America and Europe. Expanding global research and refining transdiagnostic and personalized treatment approaches—including combining existing interventions into a comprehensive model of stepped or adaptive care—will be essential next steps in the field. In sum, this issue reflects the rapid evolution of ARFID research and lays the groundwork for future advancements in diagnosis, treatment, and intervention.

It is with great enthusiasm that we introduce this special issue dedicated to avoidant/restrictive food intake disorder (ARFID), a feeding/eating disorder that has garnered increasing attention in clinical and research settings since the 2013 publication of the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5; American Psychiatric Association [APA], 2013). We were delighted to receive an exceptionally strong number of submissions from researchers worldwide, reflecting the rapid growth of scientific inquiry into ARFID. This special issue brings together >30 articles, including empirical studies, reviews, and commentaries. As we describe below, these contributions provide intriguing answers to six of the field’s most compelling current research questions:

  1. Should the diagnostic criteria for ARFID be revised?

  2. How well do our current self-report measures assess ARFID symptoms?

  3. What are the psychological maintaining mechanisms of ARFID psychopathology?

  4. What might the most common medical comorbidities tell us about ARFID etiology?

  5. How close are we to identifying evidence-based treatments for ARFID?

  6. How does cultural context shape ARFID symptom presentation?

Should the diagnostic criteria for ARFID be revised?

A substantial portion of this special issue explores the challenges surrounding the diagnosis of ARFID. In a compelling contribution, Zickgraf and colleagues (in press) propose a revised set of diagnostic criteria for ARFID. In turn, three insightful commentaries (Attia & Walsh, in press; Eddy & Negi, in press; Sharp & Pederson, in press) each offer a unique perspective on the proposed revisions. Zickgraf et al. (in press) propose to divide DSM-5 ARFID Criterion A into two parts – a new Criterion A, which describes avoidant/restrictive eating motivations (i.e., sensory sensitivities, fear of aversive consequences, lack of interest) and a new Criterion B, which specifies associated impairments (i.e., weight loss, nutritional deficiency, supplemental feeding dependence, psychosocial impairment). This separation, as supported by Attia & Walsh (in press), enhances diagnostic clarity and aligns ARFID more closely with the structure of other eating disorders. We also found Zickgraf & colleagues’ refinement of Criterion A particularly valuable, especially their phrasing “the expected outcome maintaining avoidant/restrictive eating is …” for each ARFID profile, which we believe would facilitate differential diagnosis between ARFID and anorexia nervosa.

On the topic of differential diagnosis, Zickgraf and colleagues’ proposed Criterion D acknowledges the potential overlap between ARFID and other eating disorder symptoms, allowing for ARFID to be diagnosed in the context of subclinical body image disturbance. Our own work has extensively examined the intersection between ARFID and other eating disorders (Kambanis et al., 2024a, 2024b), and evidence suggests that prospective crossover from ARFID to anorexia nervosa is rare (Breithaupt et al., 2022; Kambanis et al., 2024c). Additionally, research indicates that shape/weight concerns are lower in individuals with ARFID than in the general population, with only 2% of adults with ARFID in one study reporting clinically significant shape/weight concerns (Kambanis et al., in press). Notably, in this study, body mass index emerged as the sole unique predictor of increased shape/weight concerns among individuals with ARFID. Given that ARFID occurs across the weight spectrum, further research is needed to better understand potential differences in clinical presentation, maintaining mechanisms, and treatment needs across body sizes.

Giving the infrequent overlap between ARFID and other eating disorder symptoms, we support Attia and Walsh’s (in press) position that maintaining the DSM-5 trumping scheme – where anorexia nervosa takes precedence when both disorders appear to be present – remains clinically valuable. This hierarchy helps ensure that ARFID is not misdiagnosed in cases where body image disturbance and weight control behaviors are the primary drivers of food avoidance. In our experience, when ARFID and anorexia nervosa co-occur, the latter is typically the more salient diagnosis due to its egosyntonicity. If future DSM iterations retain the diagnostic hierarchy, it may be necessary to refine the criteria for anorexia nervosa to more clearly distinguish it from ARIFD.

Alternatively, if the field shifts toward a more dimensional classification system, as proposed by Eddy & Negi (in press), a framework such as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017) could provide an alternative approach to capture shared traits across eating disorders (e.g., anxiety-driven food avoidance), without imposing rigid diagnostic boundaries (Forbush et al., 2017). This system may enhance diagnostic precision, reduce longitudinal diagnostic crossover, and allow for tailored treatment approaches. In the end, these debates must be resolved empirically, and Richson et al. (2024) propose promising statistical approaches – such as latent class analysis and factor mixture modeling – that could help empirically define boundaries and clarify areas of overlap.

A key consideration in refining ARFID’s diagnostic framework involves clarifying its distinction from pediatric feeding disorder (PFD). Estrem et al. (2024) explore the historical roots of ARFID within PFD and clarify key distinctions between the two diagnoses. As both Estrem (2024) and Sharp and Pederson (in press) note, DSM-5’s expansion of ARFID to a lifespan diagnosis inadvertently blurred some boundaries between PFD and ARFID. The current diagnostic text provides little guidance on how ARFID may differ in presentation and trajectory across developmental stages, leading to challenges in differentiating it from PFD – particularly in infants and young children. We agree with Sharp and Pederson’s (in press) recommendation that the feeding skill and medical problems characteristic of PFD should be explicitly delineated within DSM criteria for ARFID, ensuring that pediatric ARFID is not diagnosed solely on the basis of a feeding skill deficit or medical condition that thwarts the development of age-appropriate feeding behavior.

How well do our current self-report measures assess ARFID symptoms?

Advancing empirical work on ARFID requires a robust set of measures capable of accurately assessing its psychopathology. When ARFID was introduced as a formal diagnosis in 2013, no standardized measures existed to assess its core features. Since then, several validated instruments have been developed. In this issue, two of the most extensively evaluated measures – the Nine Item ARFID Screen (NIAS; Zickgraf & Ellis, 2018) and the Pica, ARFID, and Rumination Disorder Interview–ARFID Questionnaire (PARDI-AR-Q; Bryant-Waugh et al., 2022) underwent in-depth psychometric examination. Ortiz et al. (2025) highlight the distinct strengths of these measures and emphasize that the choice between the NIAS and PARDI-AR-Q should align with research and clinical objectives. The NIAS, with its stronger correlations with the Pica, ARFID, and Rumination Disorder Interview (PARDI; Bryant-Waugh et al., 2019) subscales and better convergent validity, appears well-suited for assessing symptom dimensions. By contrast, the PARDI-AR-Q offers appears to offer greater specificity for screening and identifying individuals with possible ARFID (Ortiz et al., 2025). These findings underscore the importance of selecting measures based on whether the primary aim is to evaluate continuous symptom severity (e.g., Carmody et al., 2025) or categorically identify individuals who may have the disorder (e.g., Melisse et al., in press).

Another recurring theme across multiple studies in this special issue was the discrepancy between caregiver and child reports of child ARFID symptoms (Carmody et al., 2025; Barnhart et al., 2025; Gianneschi et al., 2024). While discrepancies between self- and collateral reports are common in eating disorders more broadly (e.g., Accurso & Waller, 2021), this discordance is particularly salient for ARFID, given its earlier age of onset compared to other eating disorders (e.g., Aulinas et al., 2020) and the high likelihood that pediatric patients present for treatment with caregivers. Findings from Barnhart et al. (2025) and Carmody et al. (2025) suggest that parents/caregivers consistently report that their children have higher levels of ARFID psychopathology than self-reported by the children themselves, particularly in relation to low appetite concerns. One possible explanation for this discrepancy is that caregivers bear the brunt of impairment, experiencing significant distress and engaging in parental accommodation that results in seamless eating opportunities for the child who is then shielded from experiencing distress. Interestingly, however, when it comes to fear and anxieties related to eating, children reported concerns that were not always discernible by their parents (Gianneschi et al., 2024). This is consistent with research on parent-child agreement for internalizing versus externalizing disorders, where concordance is typically lowest for subjective internal states and strongest for observable behaviors (Yeh & Weisz, 2001). Findings from Carmody et al. (2025), Barnhart et al., (2025) and Gianneschi et al. (2024) provide at least partial support for Zickgraf et al.’s (in press) proposed revisions to ARFID criteria allow for caregiver-reported impairment to be considered when conferring a diagnosis, given that parent-reported functional impairment is often more pronounced than self-reported impairment in pediatric ARFID.

De Young (in press) provides an accessible overview of key measurement-related terms and critically examines whether discrepancies in ARFID symptom reports between children and caregivers reflect true differences in symptom experience or are instead artifacts of measurement limitations. He challenges the assumption that diverging reports necessarily indicate disagreement, instead raising the possibility that caregivers and children may be reporting on related but distinct constructs — such as observable impairment versus internal distress. He concludes by offering a much-needed roadmap for refining ARFID assessment and strengthening the psychometric foundation of our field. One particularly important recommendation is the need to prioritize discriminant validity alongside convergent validity – arguing that demonstrating what a measure does not assess is just as essential as confirming what it does. We strongly agree, and this issue is exemplified in Presseller et al. (2024), who describe a study in which individuals with non-ARFID eating disorders score unexpectedly high on measures of ARFID psychopathology. Of individuals with non-ARFID eating disorders, those with anorexia nervosa had the highest mean NIAS scores and the greatest proportion scoring above the clinical cutoff on at least one NIAS scale, whereas individuals with bulimia nervosa also demonstrated elevated NIAS scores compared to those with no lifetime history of an eating disorder. Although the field has made significant strides in differentiating ARFID from healthy controls (Kambanis et el., in press), distinguishing ARFID from anorexia nervosa using-self report measures clearly remains a substantial hurdle, given that both diagnoses center around restrictive eating.

What are the psychological maintaining mechanisms of ARFID psychopathology?

A growing body of research highlights the psychological mechanisms that may maintain ARFID symptoms, providing important avenues for both conceptualization and treatment. Several studies in this special issue call for further investigation into cognitive and emotional processes that contribute to persistent food avoidance/restriction, including executive function deficits (e.g., cognitive flexibility, working memory, inhibitory control; Richson et al., 2024), emotion regulation difficulties (Stern et al., 2024), and sensory perception abnormalities (e.g., heightened self-reported sensitivity to taste and smell stimuli; Gydus et al., 2025). These factors may reinforce restrictive eating behaviors, making it critical to identify how they interact with core ARFID psychopathology and could be targeted in treatment. For example, Gydus et al.’s (2025) paradoxical finding that individuals with ARFID perceive themselves to have heightened sensitivity to taste and smell that is not corroborated by performance-based measures may be leveraged to maximize inhibitory learning in exposure-based interventions.

In addition to maintaining mechanisms, ARFID frequently co-occurs with neurodevelopmental and anxiety disorders. Several studies in this special issue further support this comorbidity, with findings demonstrating elevated rates of neurodevelopmental conditions among individuals with ARFID compared to individuals with non-ARFID eating disorders (Richson et al., 2024). Notably, Sader et al. (2025) report a 16% prevalence of autism spectrum disorder (ASD) in individuals with ARFID—a number significantly higher than the general population but still suggesting that most individuals with ARFID do not have ASD. As proposed in Zickgraf et al.’s (in press) revision to Criterion E, ARFID should be recognized as a distinct clinical entity even when it occurs alongside other conditions, provided that avoidant/restrictive eating behaviors exceed what would be expected based on the presence of a related comorbidity (e.g., ASD) alone.

What might the most common medical comorbidities tell us about ARFID etiology?

Several studies in this special issue highlight the complex interplay between ARFID and medical conditions, particularly in relation to gastrointestinal (GI) disorders. While Burton-Murray et al. (2024) reported that individuals with ARFID exhibit an increased prevalence of GI conditions, the reverse is also true; Matherne et al. (2025) highlighted a strikingly high co-occurrence of ARFID in a pediatric disorder of gut-brain interaction (DGBI) sample, with 50% of patients meeting criteria for ARFID. This bidirectional relation raises important questions about shared mechanisms. Fortunately, Schneider et al. (2024) propose a model highlighting that dysregulation of gut microbiota could play a key role in the etiology or maintenance of ARFID. In their model, reduced dietary variety, a hallmark feature of ARFID, is hypothesized to diminish gut microbial diversity, which in turn may disrupt homeostatic signaling, food reward processing, interoception, and sensory sensitivity–maintaining the illness over time. This raises the intriguing hypothesis that interventions targeting gut microbiota could represent a novel treatment avenue for ARFID.

Emerging research suggests that abrupt-onset restrictive eating in children may be especially common in children with pediatric acute-onset neuropsychiatric syndrome (PANS). Kapphahn et al. (in press) found that more than half of children seeking treatment for PANS exhibited sudden-onset restrictive eating, with presentations spanning the three ARFID profiles. Notably, restriction driven by sensory sensitivity, fear of aversive consequences, or lack of interest in food/eating was significantly more common that restriction driven by shape and weight concerns. These findings highlight the need for increased clinical awareness of ARFID in the context of neuroimmune conditions, which may confer increased ARFID risk. In sum, understanding the bidirectional relations between ARFID and its co-occurring medical conditions, including GI disorders, immune dysregulation, and neuropsychiatric syndromes, may provide clues to etiology and open new avenues for intervention.

How close are we to identifying evidence-based treatments for ARFID?

As Waller (in press) explains in his commentary, our field is still in the early stages of developing and evaluating effective treatments for ARFID. Currently, no single intervention is definitively recommended in international treatment guidelines, though several psychological treatments, such as cognitive-behavioral therapy for ARFID (CBT-AR; Thomas & Eddy, 2019); family-based treatment for ARFID (FBT-ARFID; Lock, 2021); and Supporting Parenting for Anxious Childhood Emotions (SPACE-ARFID; Shimshoni et al., 2020); and Feeling and Body Investigators (Zucker et al., 2019) have been studied. However, Waller (in press) reminds us that we were in a similar place with other eating disorders not long ago, and considerable progress has been made. Supporting this progress, Hellner et al. (2025) found that both youth and adult patients with ARFID showed reliable improvements following virtually delivered treatment including either CBT-AR or FBT-ARFID. These findings provide both initial effectiveness data on these emerging interventions in a real-world setting, and underscore the potential of scalable, evidence-based interventions to enhance access to care.

Also in this issue, two studies present novel treatment approaches for ARFID, both of which have the advantage of being fairly brief. Breiner et al. (2024) evaluated the acceptability and preliminary efficacy of a two-session parent-focused intervention that aimed to teach parents evidence-based strategies (e.g., exposure techniques) to implement at home. This approach highlights the potential for brief interventions to empower caregivers in supporting their children with ARFID. Matheson et al. (2024) examined a slightly longer (though still brief) 14-session psychoeducational and motivational treatment tailored for individuals with low-weight ARFID. While participants showed reductions in ARFID-related psychopathology, weight did not significantly change during treatment, suggesting that this intervention may be better suited for individuals who are not underweight or as an adjunct to other treatments that directly address nutritional rehabilitation.

These new ARFID treatments of varying lengths highlight opportunities for the development of stepped care models that optimize the allocation of scarce healthcare resources. For example, in the future, patients with ARFID could be offered brief treatments first (e.g., Breiner et al., 2024), with longer, more intensive interventions (e.g., Matheson et al., 2024; Palmer et al., 2024) reserved for non-responders. Of course, the development of stepped or adaptive care pathways for ARFID will depend on identifying reliable moderators of treatment outcome. Palmer et al. (2024) took the first step on this path by examining predictors of remission following CBT-AR. Their finding that those with fear of aversive consequences profile had the greatest odds of remission raises important questions about whether the fear profile is particularly well suited to treatment with CBT-AR, or inherently more amenable to treatment in general. Future research should explore whether different ARFID presentations require tailored interventions to optimize outcomes.

Building on Breiner et al.’s (2024), Matheson et al.’s (2024), and Palmer et al.’s (2024) efforts to refine ARFID treatment, research is also beginning to explore how treatment models can be structured to address overlapping features between ARFID and other restrictive eating disorders (namely, anorexia nervosa). In a related study, Abber et al. (2025) found that individuals with ARFID and anorexia nervosa exhibited similar trajectories of improvement in dietary restriction, suggesting that aspects of these two restrictive eating disorders may respond to shared therapeutic mechanisms. This raises important questions about whether integrated treatment models could be beneficial for individuals with restrictive eating disorders more broadly, particularly for those whose symptoms do not fit neatly into a single DSM-5 diagnostic category (e.g., individuals with ARFID-related and shape/weight-driven motivations for dietary restriction; Eddy & Negi, in press; Kambanis et al., 2024a; Zickgraf et al., in press). Given the behavioral similarities between ARFID and anorexia nervosa, future research should examine whether transdiagnostic approaches – such as adaptations of CBT and FBT – could be modified to target both ARFID-specific maintaining mechanisms and those more commonly associated with anorexia nervosa. Additionally, understanding which treatment components are most effective for different presentations could inform stepped-care models, ensuring that individuals receive appropriately matched interventions based on their clinical needs.

As researchers continue to explore how best to tailor treatment for different ARFID presentations and potentially overlapping other eating disorder symptoms, another important consideration is the role of allied professionals such as occupational therapists (OTs) in ARFID treatment. Willman et al. (2024) highlight the unique expertise that OTs bring to intervention, particularly in addressing feeding skill deficits (in younger patients) and enhancing activities of daily living such as food preparation (in older patients). However, research on the efficacy of OT-led interventions remains limited, and it is not yet clear which individuals are most likely to benefit from an OT-focused approach.

Taken together, the studies in this issue reflect the rapid advancement of ARFID treatment research while highlighting the need for further research. Although no single intervention has been universally recommended, promising approaches are emerging, and as Waller (in press) points out, ideally many effective interventions will ultimately be identified. Notably, many ARFID interventions have now been manualized and can be systemically studied, paving the way for future large-scale randomized controlled trials (RCTs) to establish efficacy, moderators, and optimal placement in stepped care models.

How does cultural context shape ARFID symptom presentation?

In closing, it is important to acknowledge the geographical concentration of ARFID research in North America and Europe. A notable exception is the valuable contribution by Melisse et al. (in press), which examined the frequency of ARFID symptoms in the Gulf Cooperation Council (an alliance of Middle Eastern countries), offering insights into how ARFID may manifest outside of Western contexts. Research on ARFID remains largely absent from many parts of the world – including Africa and Asia (with the work of Nakai et al., 2016 being a notable exception) – limiting our understanding of the disorder’s global prevalence, presentation, and cultural influences. Given the growing literature on eating disorders in underrepresented regions – particularly studies exploring the impact of food insecurity and dietary availability – it would be valuable to investigate how these factors shape ARFID presentation. Both Mulkens (in press) and Trujillo (in press) highlight the need to explore whether ARFID presents differently across cultures, just as anorexia nervosa has been shown to have distinct phenotypic variations, such as the non-fat-phobic phenotype observed in some Asian countries (e.g., Tareen et al., 2005). For example, while the strong preference for grain and dairy foods among individuals with ARFID originally observed in Western cultures (Harshman et al., 2019) may be fairly universal across cultures, the specific foods within these categories that come to be viewed as “safe” by individuals with ARFID can vary by cultural context, ranging from macaroni and cheese in the United States, to beans and rice in Mexico (Trujillo, in press), to hagelslag bread in the Netherlands (Mulkens, in press). Broadening the scope of ARFID research to include more diverse populations is crucial for developing a more comprehensive understanding of the disorder.

Conclusion

This special issue highlights the remarkable progress that has been made in ARFID research over the past decade, while underscoring the critical gaps that remain. Each of the six key questions answered in this special issue has yielded important insights, while also pointing toward critical next steps:

  1. Should the diagnostic criteria for ARFID be revised? Yes, revisions appear warranted to improve diagnostic clarity and differential diagnosis both with other eating disorders and PFD. Future research is needed to understand how to best refine diagnostic criteria to improve specificity, sensitivity, and construct validity.

  2. How well do our current self-report measures assess ARFID symptoms? Current self-report measures, such as the NIAS and PARDI-AR-Q, show promise, but have limitations. Discrepancies between caregiver and child reports of child ARFID symptoms remain a challenge, with caregivers typically reporting more impairment than children themselves. Improving discriminant validity and ensuring measures accurately capture ARFID’s unique features are critical next steps.

  3. What are the psychological maintaining mechanisms of ARFID psychopathology? Compared to healthy controls, individuals with ARFID exhibit executive functioning deficits, heightened sensory sensitivities, emotion regulation difficulties, and a higher-than-expected prevalence of autism spectrum disorder. Determining whether these associated factors are mere correlates (versus potential mechanisms that could be targeted in treatment) is an essential next step.

  4. What might the most common medical comorbidities tell us about ARFID etiology? ARFID is strongly linked to gastrointestinal disorders and neuroimmune conditions, such as PANS. Future prospective research should evaluate whether childhood viral illness or early alterations in the gut microbiome following the onset of picky eating may contribute to later development of ARFID.

  5. How close are we to identifying evidence-based treatments for ARFID? While no single intervention is universally recommended, promising treatment approaches are emerging. CBT-AR and FBT-ARFID have demonstrated scalable outcomes, and several brief interventions are being explored. However, large-scale randomized controlled trials are now needed to establish the efficacy of these treatments against comparators, and moderator analyses are crucial to determining how to match specific treatments to patients.

  6. How does cultural context shape ARFID symptom presentation? ARFID research remains largely concentrated in North America and Europe. Clinical and community-based studies have now identified the presence of ARFID and its symptoms across several continents, and clinical observations suggest that cultural context may shape symptom presentation. Moving forward, research that integrates diverse perspectives and examines underrepresented populations will be essential for advancing the field.

In sum, this issue reflects the rapid evolution of ARFID research and lays the groundwork for future advancements in diagnosis, maintenance, etiology, and treatment.

Funding:

Funding from K24MH135189 (Thomas). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency.

Footnotes

Competing Interests: Dr. Thomas receives royalties from Cambridge University Press for her books on avoidant/restrictive food intake disorder, and from Oxford University press for her book on rumination disorder. Drs. Thomas and Kambanis both receive consulting fees from Equip Health.

Declarations

Ethics Approval and Consent to Participate: Not applicable.

Consent for Publication: The authors consent for this manuscript to be published. There are no other parties involved in the decision to publish.

Availability of Data and Materials:

Not applicable.

References

  1. Abber SR, Presseller EK, Richson BN, Joiner TE, & Wierenga CE (2025). Latent trajectories of change in dietary restriction during treatment in avoidant/restrictive food intake disorder and anorexia nervosa. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24382 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Accurso EC, & Waller G (2021). Concordance between youth and caregiver report of eating disorder psychopathology: Development and psychometric properties of the Eating Disorder-15 for Parents/Caregivers (ED-15-P). International Journal of Eating Disorders, 54(7), 13021306. 10.1002/eat.23557 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th Ed (DSM-5). American Psychiatric Association. [Google Scholar]
  4. Attia E, & Walsh BT (in press). A useful and timely proposal to amend diagnostic criteria for ARFID: Commentary on Zickgraf et al. (2025). International Journal of Eating Disorders. [DOI] [PubMed] [Google Scholar]
  5. Aulinas A, Marengi DA, Galbiati F, Asanza E, Slattery M, Mancuso CJ, Wons O, Micali N, Bern E, Eddy KT, Thomas JJ, Misra M, & Lawson EA (2020). Medical comorbidities and endocrine dysfunction in low-weight females with avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls. International Journal of Eating Disorders, 53(4), 631–636. 10.1002/eat.23261 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Breithaupt L, Kahn DL, Slattery M, Plessow F, Mancuso C, Izquierdo A, Dreier MJ, Becker K, Franko DL, Thomas JJ, Holsen L, Lawson EA, Misra M, & Eddy KT (2022). Eighteen-month course and outcome of adolescent restrictive eating disorders: Persistence, crossover, and recovery. Journal of Clinical Child and Adolescent Psychology, 51(5), 715–725. 10.1080/15374416.2022.2034634 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Barnhart WR, Hog L, Zickar MJ, Baker JH, Dinkler L, Guintivano J, Johnson JS, MacDermod C, Munn-Chernoff M, Micali N, Ortiz S, Pisetsky EM, White JP, Bulik CM, & Thornton LM (2025). Measurement invariance on the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) by age and reporter Status: Comparing ARFID symptoms among self-reporting adults and adolescents and parent reports of children and adolescents. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24381 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Breiner CE, Miller ML, & Hormes JM (2024). ARFID Parent Training Protocol (“ARFID-PTP”): Results of a randomized pilot trial evaluating a brief, parent-training program for avoidant/restrictive food intake disorder. International Journal of Eating Disorders, 57(11), 2306–2317. 10.1002/eat.24269 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bryant-Waugh R, Micali N, Cooke L, Lawson EA, Eddy KT, & Thomas JJ (2019). Development of the Pica, ARFID, and Rumination Disorder Interview, a multi-informant, semi-structured interview of feeding disorders across the lifespan: A pilot study for ages 10–22. International Journal of Eating Disorders, 52(4), 378–387. 10.1002/eat.22958 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Burton-Murray H, Sella AC, Gydus JE, Atkins M, Palmer LP, Kuhnle MC, Becker KR, Breithaupt LE, Brigham KS, Aulinas A, Staller K, Eddy KT, Misra M, Micali N, Thomas JJ, & Lawson EA (2024). Medical comorbidities, nutritional markers, and cardiovascular risk markers in youth with ARFID. International Journal of Eating Disorders, 57(11), 2167–2175. 10.1002/eat.24243 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Bryant-Waugh R, Stern CM, Dreier MJ, Micali N, Cooke LJ, Kuhnle MC, Burton Murray H, Wang SB, Breithaupt L, Becker KR, Misra M, Lawson EA, Eddy KT, & Thomas JJ (2022). Preliminary validation of the Pica, ARFID and Rumination Disorder Interview ARFID Questionnaire (PARDI-AR-Q). Journal of Eating Disorders, 10(1), 179. 10.1186/s40337-022-00706-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Carmody J, Milliren CE, Richmond TK, Crowley M, Eldredge O, Jhe GB, Freizinger M, & Bern EM (2025). Caregiver-Youth Agreement on the Nine-Item Avoidant/Restrictive Food Intake Disorder Survey. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24384 [DOI] [PubMed] [Google Scholar]
  13. De Young KP (in press). How not to build a house of cards. International Journal of Eating Disorders. [DOI] [PubMed] [Google Scholar]
  14. Eddy KT, & Negi S (in press). Avoidant/restrictive food intake disorder plus eating disorder comorbidity: Are two diagnoses better than one? International Journal of Eating Disorders. [DOI] [PubMed] [Google Scholar]
  15. Estrem HH, Pederson JL, Dodrill P, Romeo C, Thompson K, Thomas JJ, Zucker N, Noel R, Zickgraf H, Menzel J, Lukens CT, Goday PS, MacLaughlin S, & Sharp WG (2024). A US-based consensus on diagnostic overlap and distinction for pediatric feeding disorder and avoidant/restrictive food intake disorder. International Journal of Eating Disorders. 10.1002/eat.24349. Advance online publication. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Forbush KT, Hagan KE, Kite BA, Chapa DAN, Bohrer BK, & Gould SR (2017). Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model. Comprehensive Psychiatry, 79, 40–52. 10.1016/j.comppsych.2017.06.009 [DOI] [PubMed] [Google Scholar]
  17. Gianneschi JR, Washington KA, Nicholas J, Pilato I, LeMay-Russell S, Rivera-Cancel AM, Mines EV, Jackson JE, Marsan S, Lachman S, Kim YK, Di Martino JM, Pendergast J, Loeb KL, Katzman DK, Marcus MD, Bryant-Waugh R, Sapiro G, & Zucker NL (2024). Assessing fears of negative consequences in children with symptoms of avoidant restrictive food intake disorder. International Journal of Eating Disorders, 57(12), 2329–2340. 10.1002/eat.24303 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Gydus J, Holman K, Harshman S, Stull M, Kuhnle M, Wons O, Asanza E, Hauser K, Stern C, Becker KR, Kambanis PE, Misra M, Eddy KT, Micali N, Lawson EA, & Thomas JJ (2025). Differences in perceived versus acctual sensory perception in avoidant/restrictive food intake disorder. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24358 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Harshman SG, Wons O, Rogers MS, Izquierdo AM, Holmes TM, Pulumo RL, Asanza E, Eddy KT, Misra M, Micali N, Lawson EA, & Thomas JJ (2019). A diet high in processed foods, total carbohydrates and added sugars, and low in vegetables and protein is characteristic of youth with avoidant/restrictive food intake disorder. Nutrients, 11(9), 2013. 10.3390/nu11092013 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Hellner M, Cai K, Freestone D, Baker JH, Menzel J, & Steinberg DM (2025). Clinical outcomes in a large sample of youth and adult patients receiving virtual evidence-based treatment for ARFID: A naturalistic study. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24355 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Kambanis PE, Mancuso CJ, Becker KR, Eddy KT, Thomas JJ, & De Young KP (2024a). Course of avoidant/restrictive food intake disorder: Emergence of overvaluation of shape/weight. Journal of Eating Disorders, 12(1), 54. 10.1186/s40337-024-01001-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Kambanis PE, Palmer LP, Jhe G, McPherson I, Graver H, Dalton AG, Ji C, Asanza E, Shabazian L, Dunford A, Breithaupt L, Freizinger M, Eddy KT, Misra M, Micali N, Holsen L, Lawson EA, Becker KR, & Thomas JJ (in press). Frequency and predictors of shape/weight concerns and objective binge eating in avoidant/restrictive food intake disorder (ARFID). International Journal of Eating Disorders. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kambanis PE, Palmer LP, & Zayas L (2024b). Differential diagnosis between avoidant/restrictive food intake disorder and anorexia nervosa. Psychiatric Annals, 54(2), e37–e41. 10.3928/00485713-20240110-01 [DOI] [Google Scholar]
  24. Kambanis PE, Tabri N, McPherson I, Gydus JE, Kuhnle M, Stern CM, Asanza E, Becker KR, Breithaupt L, Freizinger M, Shrier LA, Bern EM, Eddy KT, Misra M, Micali N, Lawson EA, & Thomas JJ (2024c). Prospective 2-year course and predictors of outcome in avoidant/restrictive food intake disorder. Journal of the American Academy of Child and Adolescent Psychiatry, S0890-8567(24)00238-7. 10.1016/j.jaac.2024.04.010 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Kapphahn C, Peet B, Gao J, Chan A, Farhadian B, Ma M, Silverman M, Tran P, Schlenk N, Thienemann M, & Frankovich J (in press). Sudden onset disordered eating behaviors and appetite issues in a local clinical cohort of children with pediatric acute-onset neuropsychiatric syndrome (PANS). International Journal of Eating Disorders. [DOI] [PubMed] [Google Scholar]
  26. Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby RM, Brown TA, Carpenter WT, Caspi A, Clark LA, Eaton NR, Forbes MK, Forbush KT, Goldberg D, Hasin D, Hyman SE, Ivanova MY, Lynam DR, Markon K, Miller JD, … Zimmerman M (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454–477. 10.1037/abn0000258 [DOI] [PubMed] [Google Scholar]
  27. Matherne CE, Watson HJ, Schmidt R, Zhu L, Pamperin C, van Tilburg M, & Bulik CM (2025). Avoidant/restrictive food intake disorder (ARFID) symptoms in adolescent patients with disorders of gut-brain interaction. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24386 [DOI] [PubMed] [Google Scholar]
  28. Matheson B, Datta N, Van Wye E, Yang HJ, & Lock J (2024). Pilot case series studying a psychoeducational and motivational treatment for children with low-weight avoidant/restrictive food intake disorder. International Journal of Eating Disorders, 57(11), 2176–2180. 10.1002/eat.24273 [DOI] [PubMed] [Google Scholar]
  29. Melisse B, Fakhri H, Kennedy L, Figueiras M, Abu Taha H, Alkazemi DU, & Mulkens S (in press). Prevalence, phenotypes, and correlates of avoidant/restrictive food intake disorder symptoms in the Gulf Cooperation Council: An underserved region. International Journal of Eating Disorders. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Mulkens S (in press). Rethinking screening for avoidant/restrictive food intake disorder (ARFID) and cross-cultural similarities and differences in the clinical presentation of ARFID: A commentary on Presseller et al. (2025). International Journal of Eating Disorders. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Nakai Y, Nin K, Noma S, Teramukai S, & Wonderlich SA (2016). Characteristics of avoidant/restrictive food intake disorder in a cohort of adult patients. European Eating Disorders Review, 24(6), 528–530. 10.1002/erv.2476 [DOI] [PubMed] [Google Scholar]
  32. Ortiz SN, White JP, MacDermod CM, Dinkler L, Thornton LM, Johnson J, Guintivano JD, Baker JH, Bulik CM, Micali N, & Pisetsky EM (2025). Validating online parent- and self-report screening methods for avoidant/restrictive food intake disorder. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24376 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Palmer LP, Kambanis PE, Stern CM, Rossman SM, Mancuso CJ, Andrea AM, Burton-Murray H, Becker KR, Breithaupt L, Freid C, Asanza E, Lawson EA, Eddy KT, & Thomas JJ (2024). Predictors of outcome in cognitive-behavioral therapy for avoidant/restrictive food intake disorder. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24345 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Presseller EK, Cooper GE, Thornton LM, Birgegård A, Abbaspour A, Bulik CM, Forsén Mantilla E, & Dinkler L (2024). Assessing avoidant/restrictive food intake disorder (ARFID) symptoms using the Nine Item ARFID Screen in >9000 Swedish adults with and without eating disorders. International Journal of Eating Disorders, 57(11), 2143–2155. 10.1002/eat.24274 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Richson BN, Abber SR, & Wierenga CE (2024). Conceptualizing avoidant/restrictive food intake disorder via an executive functioning lens. International Journal of Eating Disorders, 57(10), 1991–1998. 10.1002/eat.24233 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Richson BN, Schaefer LM, Becker KR, Murray MF, Romano KA, Anderson LM, Wonderlich SA, & Thomas JJ (2024). Empirical approaches to the classification of avoidant/restrictive food intake disorder. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24341 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, & Duffy F (2025). The co-occurrence of autism and avoidant/restrictive food intake disorder (ARFID): A prevalence-based meta-analysis. International Journal of Eating Disorders. Advance online publication. 10.1002/eat.24369 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Schneider E, Schmidt R, Cryan JF, & Hilbert A (2024). A role for the microbiota-gut-brain axis in avoidant/restrictive food intake disorder: A new conceptual model. International Journal of Eating Disorders, 57(12), 2321–2328. 10.1002/eat.24326 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Sharp W, & Pederson J (in press). An important springboard toward establishing diagnostic connection between avoidant/restrictive food intake disorder and pediatric feeding disorder. International Journal of Eating Disorders. [DOI] [PubMed] [Google Scholar]
  40. Shimshoni Y, Silverman WK, & Lebowitz ER (2020). SPACE-ARFID: A pilot trial of a novel parent-based treatment for avoidant/restrictive food intake disorder. International Journal of Eating Disorders, 53(10), 1623–1635. 10.1002/eat.23341 [DOI] [PubMed] [Google Scholar]
  41. Stern CM, Graver H, McPherson I, Gydus J, Kambanis PE, Breithaupt L, Burton-Murray H, Zayas L, Eddy KT, Thomas JJ, & Becker KR (2024). Difficulties in emotion regulation in avoidant/restrictive food intake disorder. International Journal of Eating Disorders, 57(11), 2156–2166. 10.1002/eat.24281 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Tareen A, Hodes M, & Rangel L (2005). Non-fat-phobic anorexia nervosa in British South Asian adolescents. International Journal of Eating Disorders, 37(2), 161–165. 10.1002/eat.20080 [DOI] [PubMed] [Google Scholar]
  43. Thomas JJ, & Eddy KT (2019). Cognitive-behavioral therapy for avoidant/restrictive food intake disorder: children, adolescents, and adults. Cambridge University Press. [Google Scholar]
  44. Trujillo E (in press). Beyond Western frameworks: Rethinking ARFID diagnosis and treatment – lessons from Latin America. International Journal of Eating Disorders. [DOI] [PubMed] [Google Scholar]
  45. Waller G (in press). On the road to somewhere: Commentary on Breiner et al., Matheson et al., and Palmer et al. International Journal of Eating Disorders. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Willman R, Hobbs M, & Thomas JJ (2024). The potential role of occupational therapy in the treatment of avoidant/restrictive food intake disorder. International Journal of Eating Disorders, 57(10), 1985–1990. 10.1002/eat.24199 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Yeh M, & Weisz JR (2001). Why are we here at the clinic? Parent-child (dis)agreement on referral problems at outpatient treatment entry. Journal of Consulting and Clinical Psychology, 69(6), 1018–1025. 10.1037//0022-006x.69.6.1018 [DOI] [PubMed] [Google Scholar]
  48. Zickgraf HF, & Ellis JM (2018). Initial validation of the Nine Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS): A measure of three restrictive eating patterns. Appetite, 123, 32–42. 10.1016/j.appet.2017.11.111 [DOI] [PubMed] [Google Scholar]
  49. Zickgraf H, Cares S, Schwartz R, Breiner C, & Stettler N (in press). Towards a specific and descriptive definition of avoidant/restrictive food intake disorder: A proposal for updated diagnostic criteria. International Journal of Eating Disorders. [DOI] [PubMed] [Google Scholar]
  50. Zucker NL, LaVia MC, Craske MG, Foukal M, Harris AA, Datta N, Savereide E, & Maslow GR (2019). Feeling and Body Investigators (FBI): ARFID division – An acceptance-based interoceptive exposure treatment for children with ARFID. International Journal of Eating Disorders, 52(4), 466–472. 10.1002/eat.22996 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

Not applicable.

RESOURCES