ARFID Treatment

If eating feels like a daily struggle, filled with dread, rigidity, or avoidance, you’re not alone, and it’s not just being a picky eater. Avoidant/Restrictive Food Intake Disorder (ARFID) is a serious, often misunderstood eating disorder that can affect children, teens, and adults. It’s not about weight or body image, it’s about fear, discomfort, or disinterest in eating itself. Left untreated, ARFID can impact physical health, emotional well-being, and quality of life.

At Cognitive Behavioral Therapy & Assessment Associates (CBTAA), we specialize in treating ARFID using evidence-based therapies like Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and exposure-based techniques. Whether you’re seeking help for yourself or a loved one, we meet you where you are, offering care that is collaborative, structured, and rooted in both compassion and science.

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What Is ARFID

Avoidant/Restrictive Food Intake Disorder (ARFID) is a clinical diagnosis that involves persistent avoidance of certain foods or eating experiences, leading to nutritional deficiencies, weight loss or failure to grow, and/or significant interference in daily life. Unlike other eating disorders, ARFID is not about body image or the desire to be thin. Instead, people with ARFID often avoid food due to sensory aversions (such as textures, smells, or colors), fear of negative outcomes (like choking or vomiting), or a general lack of interest in eating.

Some individuals with ARFID may eat only a few “safe” foods and avoid entire categories of food. Others may experience panic, nausea, or gag reflexes when faced with unfamiliar items on their plate. In children, ARFID can delay growth and lead to social withdrawal—especially in school or peer settings that involve shared meals. In adults, it can contribute to fatigue, chronic health issues, and emotional distress.

Signs & Symptoms of ARFID

Recognizing ARFID often requires looking beyond what may seem like food preferences or childhood quirks. Many individuals with ARFID maintain rigid food rituals, avoid meals outside the home, or experience intense anxiety at the idea of trying something new. While symptoms vary, what sets ARFID apart is the level of interference it causes in health, development, or daily life. If eating behavior is limiting growth, disrupting routines, or causing emotional strain, it may be more than just picky eating.

Common signs and symptoms of ARFID include:

• Eating from a very narrow range of preferred or “safe” foods
  
  
• Strong aversions to food based on texture, color, smell, or temperature
  
  
• Refusal to try new foods, sometimes paired with gagging or vomiting
  
  
• Fear of choking, vomiting, or having a negative reaction when eating
  
  
• Weight loss or failure to meet expected growth milestones in children
  
  
• Nutritional deficiencies, such as low iron, vitamin D, or protein
  
  
• Reliance on meal supplements, shakes, or feeding tubes
  
  
• Avoidance of social situations that involve eating, such as school lunch or family gatherings
  
  
• Significant distress, anxiety, or irritability around mealtimes
  
  
• Rituals or “rules” around food preparation and presentation
  
  

These behaviors often persist despite encouragement, rewards, or pressure to eat. Many families try everything, from sneaking vegetables into meals to making separate dishes, only to feel stuck and exhausted. If that sounds familiar, know that support is available and effective.

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What Causes ARFID?

There is no single cause of ARFID, but it often arises from a combination of biological sensitivity, psychological vulnerability, and past experience. For many people, ARFID begins in childhood and is linked to sensory processing challenges or neurodevelopmental conditions like autism or ADHD. A child may experience overwhelming disgust or distress with certain textures, and begin to avoid them entirely. In other cases, ARFID begins after a traumatic incident, such as choking or vomiting, which leads to fear-based avoidance.

Other individuals may not have had a specific event but simply lack hunger cues or find the act of eating unenjoyable. This low interest in food, especially when combined with anxiety or inflexibility, can snowball into a pattern of nutritional restriction. ARFID also tends to overlap with other diagnoses, including generalized anxiety, obsessive-compulsive disorder, and depression.

Understanding what drives someone’s eating avoidance is central to effective treatment. At CBTAA, we always begin with curiosity, not assumptions, about what’s shaping the eating pattern.

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What to Expect in ARFID Treatment

Treatment begins with a comprehensive intake and therapeutic assessment. This early phase includes one to three sessions in which your therapist gathers detailed information about the client’s eating history, current food repertoire, distress triggers, and the emotional and social impacts of restrictive eating. For children and teens, caregivers are integral to this process, we explore not only the child’s experience but also the family dynamics, routines, and past efforts to encourage eating.

After the assessment, your clinician will develop a personalized treatment plan that addresses both the behavioral and emotional drivers of food avoidance. For some, treatment involves direct exposure to feared or avoided foods, supported by skills training and coping strategies. For others, especially younger clients, treatment may begin with parent coaching, helping caregivers shift their responses to mealtime stress, reduce unhelpful accommodations, and create a structure that supports gradual progress.

CBTAA uses evidence-based, family-centered approaches to guide parents in becoming confident and effective supports in their child’s recovery. We teach parents how to balance gentle structure with emotional sensitivity. Instead of pressuring or bribing children to eat, we guide parents to create predictable, low-pressure meals where trying is encouraged, but safety and trust come first.

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How CBT Helps ARFID Treatment

ARFID is a relatively new diagnosis, officially recognized only about a decade ago. Because of that, research on treatment is still developing. However, current approaches are informed by evidence from other feeding and eating disorders, as well as anxiety disorders. Based on the best available evidence to date, CBT is recommended as a first-line therapy for ARFID. In CBT, clients work to understand how avoidance behaviors are maintained by unhelpful thoughts or distressing beliefs– and build strategies to interrupt that cycle. For example, someone may fear, “If I try that food, I’ll gag or choke”). CBT provides structured, gradual exposure to test those beliefs, helping reduce anxiety and build confidence in trying new foods.  Clients also learn to recognize “safety behaviors”, like over-reliance on specific utensils, eating rituals, or meal avoidance, and develop healthier ways to cope with discomfort.

For children and adolescents, CBT can involve parallel work with parents. We provide coaching around meal routines, reinforcement systems, and how to avoid inadvertently maintaining avoidance. For adults, CBT can also include cognitive restructuring of long-held food-related fears, mindfulness strategies to manage anxiety at meals, and planning tools to increase flexibility over time.

The goal of CBT is to help clients regain autonomy over their eating, not just to expand food variety, but to reduce fear, shame, and rigidity that have shaped their relationship with food for too long.

Key Evidence-Based Treatment Methods

While Cognitive Behavioral Therapy (CBT) provides the core framework for ARFID treatment at CBTAA, many clients benefit from a more integrative approach. That’s why we draw from additional research-supported therapies. We tailor each treatment plan to the individual’s emotional needs, cognitive style, and co-occurring conditions. Whether we’re working with a child who struggles with sensory overload, a teen navigating social anxiety, or an adult with a long-standing fear of eating, we use every tool available to help build flexibility, confidence, and lasting change.

Exposure Therapy

Exposure therapy is a cornerstone of ARFID treatment. It involves gently and systematically facing foods, textures, or eating situations that have become associated with fear or discomfort. These exposures are never forced. Instead, they’re designed to help retrain the brain’s fear response by gradually increasing tolerance in a safe and supportive setting. Over time, exposure therapy helps reduce anxiety, build trust in the eating experience, and expand dietary variety. Each exposure is customized—starting with manageable steps and advancing only when the client feels ready.

Dialectical Behavior Therapy (DBT) Skills

For clients who experience intense emotions or shutdown during mealtimes, we often integrate skills from Dialectical Behavior Therapy (DBT). Originally developed for individuals with high emotional reactivity, DBT is especially effective for those who feel easily overwhelmed or “flooded” during food exposures.

DBT teaches practical tools for managing strong emotional responses in the moment. These include strategies for distress tolerance (riding out big emotions without shutting down or escaping), emotion regulation (understanding and shifting how we respond to discomfort), and mindfulness (learning to stay present without judgment). For clients who have difficulty with inflexibility, black-and-white thinking, or sensory overload, these skills help build resilience and reduce avoidance behaviors. DBT is particularly valuable in cases where ARFID co-occurs with autism, anxiety disorders, or trauma.

Acceptance and Commitment Therapy (ACT)

In some cases, clients may feel stuck—not just because they’re afraid of food, but because the fear has become deeply ingrained or tied to personal identity. For these individuals, we often use principles from Acceptance and Commitment Therapy (ACT). Rather than focusing on eliminating anxiety or fear, ACT helps clients learn how to move forward even when discomfort is present.

ACT teaches psychological flexibility—the ability to tolerate distress while staying connected to personal values and goals. In the context of ARFID, this might mean trying a new food in order to enjoy a holiday meal with family, or practicing exposures so you can eat at a friend’s house without panic. ACT helps shift the focus from avoidance to alignment: What kind of life do you want to live, and how can we support you in taking steps toward it, even when it feels hard?

Parent Coaching in ARFID Treatment

For children and teens with ARFID, caregiver involvement is one of the most powerful tools in recovery. At CBTAA, we don’t just treat the individual, we work with the entire system surrounding them. That often means equipping parents with the skills, structure, and confidence to support progress at home.

Mealtimes in ARFID households can be stressful. Parents may feel stuck between two extremes, pressuring their child to eat or giving in to rigid preferences. Over time, these well-intentioned efforts can unintentionally reinforce avoidance. Parent coaching helps shift this dynamic with strategies grounded in evidence-based behavioral and cognitive approaches.

In parent coaching sessions, we teach methods that reduce conflict, lower anxiety, and gently encourage food flexibility. These may include:

Supportive Exposure Techniques
Caregivers learn how to scaffold food exposure at home, using a hierarchy of steps, from allowing a non-preferred food on the table to tasting a “learning bite.” We focus on progress, not perfection, and help families build trust before change.

Positive Reinforcement and Reward Systems
We introduce structured reinforcement systems that reward effort (like trying something new or tolerating discomfort) rather than outcome. These tools help increase motivation and foster a sense of achievement.

Reducing Unhelpful Accommodations
Many families adapt their routines to make meals easier, by preparing multiple meals, avoiding triggers, or ending mealtime early. We help parents gradually reduce these accommodations so that avoidance isn’t reinforced, and children are gently guided toward flexibility.

Structuring Mealtime Routines
Parents receive guidance on how to set consistent expectations and boundaries during meals, create predictable routines, and use calm, non-pressuring language. This structure increases a child’s sense of safety while encouraging progress.

Emotional Regulation and Co-Regulation
We coach caregivers in emotion-focused strategies like validating distress, modeling calm behavior, and helping children learn how to manage their own big feelings around food. In families with neurodivergent children, we also address sensory sensitivities and overstimulation.

By empowering parents to become active participants in treatment, we ensure that therapy doesn’t end when the session does. Instead, the skills practiced in session are reinforced every day, in the moments that matter most. The goal is to help families feel more confident, less stuck, and more connected around food and feeding.

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When to Consider ARFID Treatment

You don’t need to wait for a crisis before seeking help. Many people with ARFID go years without a diagnosis, either because their eating habits have been accommodated by family or because the absence of body image concerns makes it harder to identify as an eating disorder. But the impact is real, and often grows over time.

You might consider treatment for ARFID if eating feels like a source of anxiety, conflict, or limitation. This could look like meals filled with tension or dread, a diet restricted to just a handful of foods, or fear-based refusal to eat in public. For children, warning signs may include growth concerns, ongoing meltdowns at meals, or avoidance of social events that involve food. For teens, it may show up as school avoidance, isolation, or shame about their eating habits. And for adults, ARFID can quietly affect everything from energy levels to relationships to overall quality of life.

Whether the concern is relatively new or has been present for years, ARFID treatment is most effective when it’s personalized, compassionate, and grounded in what matters most to the client. If eating, or helping someone else eat, has become a source of stress, avoidance, or confusion, it’s worth exploring support.

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How Long Does ARFID Treatment Take?

Treatment for ARFID is highly individualized. Some clients begin to see change within a few months; others may work with a therapist over a longer period, especially if co-occurring conditions like anxiety, autism, or trauma are present. What matters more than the timeline is the direction: are we moving toward more flexibility, confidence, and reduced avoidance?

In general, many clients attend weekly therapy for several months. Younger children often make steady progress when caregivers are actively involved. For older teens and adults, therapy may focus more on self-driven exposures, cognitive restructuring, and emotion regulation. Throughout treatment, we track progress collaboratively, celebrating small wins, adjusting goals, and making sure therapy continues to feel both manageable and meaningful.

Recovery from ARFID isn’t linear, but it is possible. With the right support, clients can learn to try new foods, reduce distress at meals, and participate in life in ways that once felt out of reach.

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Get Started with CBTAA

ARFID can be overwhelming, but you don’t have to navigate it alone. Whether you're a parent seeking help for your child, a teen who feels stuck and misunderstood, or an adult who’s never been able to expand their eating habits, our team is here to help.

At CBTAA, we provide evidence-based, highly personalized ARFID treatment for clients across New York City, New York, New Jersey, and Connecticut. Our clinicians are deeply trained in CBT, DBT, exposure therapy, and family support, and we approach each case with clinical expertise and human care.

Get started with a free 15-minute consultation with one of our Clinical Coordinators. During that call, we’ll learn more about your needs, answer your questions, and match you with a clinician who’s the right fit for you or your child.