Thirteen-year-old Sandhya, (name changed) was a very quiet child who studied well in school. At the age of 10, Sandhya had experienced a fever and severe bouts of vomiting, and she had to be admitted to hospital and needed to be given drips, as she had become dehydrated. Following this experience, she was frightened of vomiting and started avoiding certain foods. Gradually, the list of food she avoided started growing: within a year, she was only eating biscuits and milk.
Mealtimes became difficult and she would become distressed, crying and would leave the table if she was forced to try new foods. Her parents started worrying. Relatives told them that parents have to be strict at mealtimes. Her parents felt guilty, believing they were doing something wrong. Sandhya started to lose weight, she was feeling tired and she could not focus in school. She made excuses to not attend birthday parties of her friends. Eventually, she was taken to see a doctor who recognised ARFID.
What is ARFID?
Many Indian families have the experience of children being choosy with food. Parents try very hard to make the children eat, and often hear others reassure them that this is a ‘passing phase’ and that the child will ‘grow out of it’. ARFID (Avoidant/ Restrictive Food Intake Disorder), however, is a mental health disorder which may look similar to picky eating in the beginning, but it can become serious, if not treated, due to the consequences of restrictive eating. ARFID can affect both children and adults.
ARFID is a type of eating disorder that is being increasingly recognised in the global arena as a growing but treatable disorder. It is not the same as merely being picky about food: there is a significant weight reduction, leading to physical complications such as growth restrictions in children, and problems in functioning at school, work,etc. Mealtimes become difficult including at family functions, eating out and lunches in school. The restrictive eating is not part of religious fasting, food insecurity or underlying medical issues and it is not caused by body image issues or the fear of weight gain.
What causes ARFID?
While the exact cause of this disorder is unknown, research suggests it may be the result of an aversion to certain texture of foods, along with fear of a harmful effect of the food on the body, alongside genetic (family history of eating disorders), social, cultural and environmental influences or traumatic experiences such as food insecurity, choking, force feeding,etc. It is not caused by bad parenting.
As awareness about this disorder is gradually increasing in India, there are reports of many cases of ARFID. Young children and adolescents have been seen to restrict their eating for fear of choking, and others have an onset of ARFID following a viral illness with vomiting, with the fear of subsequent vomiting making them avoid certain foods including solids, leading to weight loss, complications and psychosocial functioning impairment.
How is it treated?
The good news is that ARFID is treatable with appropriate professional support. While it does take time, individuals can get better with a gradual expansion in the range of foods they eat, improving their nutrition. A team of mental health professionals, doctors and nutritionists/dietitians have to work together to help the individual become better and then sustain the improvement.
Psychological therapies, particularly cognitive behavioural approaches, help individuals slowly and safely try new foods, manage anxiety, and build positive eating experiences. Families can play an important role in helping the individual with ARFID. The family should remain calm and supportive. It is important not to force the individual to eat or punish the person for not eating. New foods should be gradually introduced without pressure. Regular mealtime routines that are positive and low in stress can make a difference to the recovery. Families can help provide modelling around food for the affected individual as well.
In the case of Sandhya, the doctor educated the child and her parents and referred her to a psychiatrist. She was given a formal diagnosis, and a referral was made to a psychologist who worked with her to help her with her anxiety, including relaxation and breathing exercises. Her parents were trained to provide a supportive environment at mealtimes. They were trained to praise the effort Sandhya put in, rather than praising her only when she ate food. Whilst the progress was slow, Sandhya slowly started to put on weight and started trying new food, and grew confident that she could eat without vomiting. She became more energetic and her performance at school also became better.
It is essential to remember that ARFID is a real health problem. It is not stubbornness, attention-seeking or a passing problem. With the right support, people with ARFID can make a successful recovery from the disorder and lead a healthy confident life, and maintain a good relationship with food.
(Dr. Lakshmi Venkatraman is assistant director of psychosocial rehabilitation services at the Schizophrenia Research Foundation, Chennai. lakmesridhar@scarfindia.org)
Published – February 27, 2026 06:30 am IST