More Than Just Picky Eating: How ARFID Presents in Adults

You're at a work lunch. The server places your plate in front of you. Someone across the table smiles at you.

"You look like you've never eaten anything like that before."

They have no idea what a comment like that means to someone living with an eating disorder. Maybe they're just teasing. A social gesture, they think.

But your stomach tightens. You can barely lift your fork. You're not thinking about how good the food looks — you're running a risk assessment. How obvious would it be if you didn't eat? Could you move the food around your plate convincingly enough? Or should you just laugh it off, say you're not really that hungry?

Meanwhile, inside, your nervous system is screaming contradictory commands at itself.

For many adults, this experience has a name: Avoidant/Restrictive Food Intake Disorder, or ARFID.

And it has nothing to do with being picky.

After writing this post, we went looking for an illustration and quickly realized we simply couldn't find a single image showing a person with ARFID eating with a group where any of the tension or anxiety they experience would be visible to an outside observer. Eating is so fundamentally a communal experience that every image centers exactly that — the shared laughter, the conversation, the connection. The scene you see here is not real; it was AI-generated. You may have noticed it's slightly surreal, the way the group cheerfully eats on while completely ignoring one person's discomfort. Perhaps it helps to imagine just how hard it is, as someone with ARFID, to break that general good mood and draw attention to yourself because you don't eat the way everyone else does.

ARFID can affect anyone regardless of age. Many children who struggle with ARFID grow into adults living with those same struggles, and for some people symptoms first appear in adulthood — following a traumatic event involving swallowing or choking, or in the wake of persistent digestive problems.

Despite this, many people still think of ARFID as a "childhood condition," partly because it didn't exist as an official diagnosis until 2013. Before then, the term used was "feeding disorder of infancy or early childhood," which applied exclusively to young children and required symptoms to have appeared before age six.

Because the diagnosis is relatively new and still not widely known, the old perception that this can only affect children persists in many people's minds. The professional consensus today, however, is unambiguous: ARFID can occur at any age.

Unlike other eating disorders, body image plays no role in ARFID. The anxiety isn't about calories. It's about the food itself — its texture, its unpredictability, the feared consequences of eating it, or simply an apparent absence of interest in food altogether.

Adults living with ARFID are often highly motivated to get better: they want to eat, they want to participate fully in their lives without anxiety and shame. For many adults, the challenge isn't just finding the courage to seek help. It's finding treatment specifically designed for how ARFID presents in adulthood.

What's happening behind the scenes is invisible to others

Because ARFID was only recognized as an official diagnosis in 2013, a significant proportion of clinicians are still not equipped to recognize or work with it — especially when it presents in adults. This means you can easily find yourself labeled as picky, dramatic, or childish rather than actually being heard.

It's even possible that those around you will minimize your symptoms, even when you're trying to ask for help.

People still widely assume that those with eating disorders have weight problems — when in reality an eating disorder can affect anyone, regardless of age, gender, or body size.

This is equally true of ARFID. Higher body weight absolutely does not rule out serious nutritional deficiency, and when body weight is used as the primary diagnostic criterion, people living with ARFID are easily misdiagnosed — suspected of having anorexia, or having their symptoms attributed to OCD — or not diagnosed at all.

When we struggle with something others don't understand, misread, or simply dismiss, the result is often an intense sense of shame. Which drives us to learn to hide it, to mask it. We develop coping strategies that rely entirely on our own resources — strategies which, in the end, make it even harder for clinicians to recognize and diagnose what's actually happening. And the longer those coping strategies are repeated and reinforced over years, the more prolonged the path to recovery or improvement becomes.

The particular challenges adults face

• Because of the misconceptions surrounding ARFID and years of masking symptoms, diagnosis is often delayed or never happens at all. By the time someone reaches a clinician, their coping strategies are often so deeply embedded that the real symptoms are difficult to see — from the outside, or from the inside.
  

• Adult life is full of situations where eating is an unavoidable expectation — work lunches, team building events, dates, family gatherings, holidays. Declining to participate in shared meals or signaling special needs invites explanation, and sometimes awkwardness. This creates constant, difficult-to-avoid pressure.
  

• As an adult, you generally navigate the healthcare system alone — often having to educate your own doctor about ARFID while simultaneously fighting to be taken seriously. There's no parent to research options, organize therapy, or advocate on your behalf. The entire responsibility for recovery rests on your own shoulders — while you may be struggling with the very daily challenges that make treatment necessary in the first place.
  

• Many people by adulthood have fully identified with the condition — they see it as part of their personality, a character flaw, rather than an unrecognized disorder. The years of accumulated criticism, embarrassing situations, and failed attempts at eating leave a deep mark. This can easily turn into self-blame and carry significant shame — which itself makes it harder to reach out for help.
  

• Partners, spouses, friends, or even our own children don't always understand what's happening inside us. When we decline food someone has prepared with love, it can easily read as rejection or offense to the other person — even when it's nothing of the sort. Misunderstandings accumulated over years lead to frustration, gradual distance, and ultimately to isolation and conflict.
  

• In childhood, ARFID and its associated conditions generally exist side by side — in adulthood, however, they often layer on top of one another, and in many cases develop precisely as a consequence of unrecognized, untreated ARFID. The shame that builds over years, the exhaustion of constant masking, the cumulative weight of repeated negative experiences, and chronic nutritional deficiency can all contribute to the development of anxiety, depression, or other conditions. This also means that treating only the associated conditions while ignoring the ARFID will produce limited results.
  

• Sourcing safe foods as an adult can be a serious logistical and financial burden — these foods are often expensive, hard to find, or simply discontinued. On top of this come the costs of therapy, dietetic support, and mental health care, which adults generally pay for out of pocket. Shopping, cooking, and cleaning represent a far greater burden in adulthood than in childhood — because all of it falls entirely on the person affected. When an adult living with ADHD, autism, and ARFID finds cooking either too monotonous or too overwhelming, the result is often simply: not eating.
  

What recovery can look like, and how a psychologist and mentor can help

Recovery doesn't necessarily mean someone will eat "normally" — we can't entirely rewire our nervous systems, and sensory sensitivity doesn't simply disappear. Rather, it means the person can arrive, at their own pace and according to their own needs, at a place where eating is less frightening, less limiting, and has less impact on their quality of life.

The psychologist's work includes mapping the sensory profile, identifying any associated conditions (ASD, ADHD, anxiety disorders), and providing psychoeducation about these. In our experience, for adult patients with eating disorders, seeking help is itself extraordinarily difficult — the result of a long illness that has often been met with insufficient empathy — and the support offered needs to be highly personalized, and where appropriate, neuroaffirmative and LGBTQ+ affirming. With ARFID in particular, it is essential to take neurological specificities into account, to work with the nervous system rather than against it. Exposure work is always the product of a collaborative conversation with the patient, in which the psychologist is aware of their sensory sensitivities, priorities, and traumas, attends to them carefully, and never imposes anything the patient themselves doesn't want. Respect for the patient's autonomy is the foundational pillar of this work — one in which a different neurological developmental path is treated not as a flaw to be corrected, but as a territory worth getting to know and explore. It is from this shared, safe foundation that treatment can begin, and depending on the type of condition and the individual's particular needs, it can move in several directions.

This may include:

• the gradual and safe expansion of tolerated foods

• reducing fear and anxiety around eating

• rebuilding confidence in eating situations and social settings

• improving nutritional status and energy levels

• emotional regulation and developing healthier coping strategies
  

We also think it's important to say this: while it's true that we can't entirely rewire our nervous systems, new neural connections and pathways are formed every day, moment by moment. Even as you read these words, new neuronal connections are forming in your brain that will influence existing neural circuits. Thanks to neuroplasticity, a great deal can change — including at the level of the nervous system — and that is precisely what we're working toward. Even in conditions that have persisted for decades, it's possible to reshape a patient's relationship with eating and the experience it represents. Through small, gradual, but kind and consistent steps. The process is something like learning to play a new instrument, or taking up a completely new sport. We don't expect to be good at it immediately — in fact, we all know that the best we can hope for at the start is something terrible coming out of the violin, or spectacular falls on the snowboard. That it's hard in the beginning is natural. All change is hard, especially changes preceded by years or decades of ingrained habit.

And this is where eating disorder recovery coaching comes in. The work of the psychologist and the coach complement each other, because we're able to help clients in different ways. As a psychologist, the work centers on the "whys" — recognizing associated conditions, addressing possible traumas, and easing other psychological burdens, family dynamics, and relationship difficulties. A coach, meanwhile, offers effective support with the "hows." You see a psychologist in scheduled sessions, typically weekly, fortnightly, or even less frequently — whereas coaching means continuous contact. The coach is there with you in everyday life, when you don't feel capable of trying a new food, or when nervous system overwhelm makes it impossible to figure out how to start preparing a meal, or even how to approach the grocery shopping.

A recovery coach can help someone with ARFID by:

• providing a structured framework and personalized recovery plan for lasting change — for those who don't want to go through this alone

• offering continuous text-based support between mentoring sessions

• gently guiding the process of becoming comfortable with new foods through shared meals

• providing emotional support during difficult moments around eating

• helping manage anxiety through developing concrete coping strategies

• supporting the development of sustainable daily routines

• and where needed, collaborating with family members or other professionals — so that support is felt not just during sessions, but in everyday life
  

Explore how eating disorder recovery coaching provides specialized support for ARFID here.

Written by Orsolya Demetrovics (psychologist) and SandorLovas (eating disorder recovery coach)