ARFID – A Misunderstood Eating Disorder and Why It Deserves Better
- Brainz Magazine
- 5 days ago
- 9 min read
Updated: 3 days ago
Blending innovation with compassion, Kylie Gallaher brings cutting-edge expertise in clinical hypnotherapy to empower lasting change. Grounded in evidence-based practice, her professional journey is dedicated to helping clients overcome challenges and thrive with confidence.
For years, Avoidant Restrictive Food Intake Disorder (ARFID) has lived in the shadows of the eating disorder landscape. It is often described as “picky eating,” dismissed as a childhood phase, or misunderstood as a behavioural choice. Yet ARFID is none of these things. It is a complex, trauma informed, anxiety driven, neurologically rooted experience. And the consequences ripple across mental health, physical health, and social wellbeing.
Despite its impact, ARFID remains one of the least understood and least adequately treated eating disorders. And the people living with it deserve much more.
What ARFID really is, hint, it is not what people think it is
ARFID involves a deeply ingrained relationship between anxiety, post traumatic stress responses, phobic reactions, and sensory sensitivities focused on food and eating.
These processes combine to create a lived experience far beyond “limited eating.”
In fact, a person with ARFID may experience extreme fear, sensory overload, or physiological distress around the thought, smell, taste, or texture of certain foods. Their experience is that eating is not something that may be pleasurable, eagerly anticipated, or even neutral. It is interpreted by the nervous system as threatening and something to be endured.
Social situations involving food often amplify this response, layering self consciousness, anxiety, and avoidance onto an already overwhelmed system. Over time, these repeated mealtime experiences make visible a consistent and unmistakable pattern of fear without choice and avoidance without defiance. This can feel difficult, or even impossible, to articulate for the person living it, and deeply frustrating and hard to make sense of for those witnessing or sharing it.
What this gradual revealing exposes is a cavernous gap between how ARFID is lived and how it is commonly described, interpreted, and responded to in clinical and social contexts. While the individual is navigating a neurological survival response organised around safety, the external world often views the same behaviours through a behavioural, motivational, or compliance based lens. This misalignment does more than misunderstand ARFID. It actively shapes how support is offered, often prioritising behavioural change over nervous system safety.
When treatment approaches fail to recognise this neurological reality, they do not simply miss the mark. They can inadvertently intensify the very survival responses they are attempting to extinguish. This exposes a further and often uncomfortable reality, that well intentioned, behaviour first interventions may unintentionally reinforce fear, anxiety, and overwhelm rather than relieve them.
It was in response to this gap that the seeds of my ARFID treatment framework were planted. Long before I had formal language for what I was observing, I was trying to make sense of my own son’s experience. The patterns of fear, overwhelm, and the absence of choice beneath the behaviour became increasingly evident.
That early, intuitive understanding became the foundation for years of study, clinical training, and applied work, evolving into a dynamic, trauma informed approach within my practice at Newcastle Clinical Hypnotherapy. It integrates neuroscience, cognitive pattern work, sensory processing insight, and clinical hypnosis. At its core is a simple, non negotiable principle, meaningful change can only occur when the nervous system feels safe. Throughout my experience, I have watched this shift towards safety offer opportunities to reshape not only relationships with food and eating, but family relationships and, most hearteningly, self trust and confidence.
Understanding ARFID through this lens changes how we interpret avoidance, resistance, and distress around food, social relationships, and sense of self. Because this isn’t fussiness. This is a survival response.
A neurological survival response, not a choice
ARFID is fundamentally a safety seeking disorder.
The body and brain learn that food is dangerous, unpredictable, or overwhelming through a range of experiences, sometimes sudden and intense, such as an illness, and sometimes more subtle and cumulative, shaped by ongoing stress and discomfort. Importantly, these experiences do not need to be objectively or overtly traumatic to have a lasting impact on the nervous system. Regardless of how this learning begins, it is reinforced through repeated daily experiences, giving rise to patterns of:
avoidance
rigid rules
extreme discomfort
hypervigilance
panic responses
dependency on “safe” foods
breakdown of social participation
It is not about the presence or absence of any single pattern, but how relentlessly they reinforce one another. And because eating happens multiple times daily, the nervous system remains caught in a repeated cycle of activation and overwhelm.
This explains why traditional “just try it” approaches, pressure based feeding, exposure therapy, or behaviour first interventions often fail. They collide directly with a nervous system organised around survival and, in doing so, can inadvertently strengthen the very response they are attempting to override.
My experience has guided me to create a dynamic treatment model that prioritises establishing a neurologically safe environment before any exploration of new foods can begin.
Safety first. Progress second. Force never.
In practice, this is an evolving exploratory exercise grounded in restoring safety in ways that people might not expect. Families often find this approach relieves pressure they felt but did not even recognise, and reframes years of struggle in an entirely new light.
Why ARFID is misunderstood
Three core issues drive the widespread misunderstanding of ARFID.
1. It does not look like other eating disorders
There are no body image concerns, no dieting behaviours, and no weight preoccupations. Because ARFID does not fit the stereotypical picture of an eating disorder, professionals and families often misinterpret it as fussiness, stubbornness, or a developmental phase, rather than recognising it as a nervous system driven safety response. This makes it easy for ARFID to be missed entirely.
2. It overlaps with anxiety, sensory processing, and may be interpreted as behavioural
People with ARFID often present with anxiety disorders, complex medical histories, sensory processing differences, neurodivergence, and gastrointestinal issues. Because many of the outward signs involve avoidance, distress, and resistance around food, these responses are frequently interpreted as behavioural rather than neurological.
When symptoms span so many domains, ARFID often “falls through the cracks” or is addressed through behaviour focused frameworks, with the assumption that the person will eventually grow out of it.
3. It is hidden in plain sight
Many people with ARFID appear “stable” because they can maintain routine around their safe foods. This surface level stability can mask deeper impacts and delay appropriate recognition or support.
Beneath that routine lie significant and often cumulative risks, including:
Nutritional deficiency
Cognitive impacts
Digestive dysfunction
Impaired immune function
Social withdrawal, isolation, or dysfunction
Emotional dysregulation
Over time, the effects of ARFID extend far beyond immediate nutrition or eating behaviour. Chronic stress around food can influence neurological development, learning, and emotional regulation, shape self concept and identity, strain relationships, and limit social participation and life opportunities. These impacts are particularly significant during childhood and adolescence, but continue to shape wellbeing across the lifespan.
What is often missed is that these effects do not occur in isolation. They interact, reinforce, and compound one another over time. Nutritional deficiency affects neurological development and cognitive function. Cognitive strain increases psychological stress. Chronic stress disrupts gut function, sleep, and immune function. These physiological impacts, in turn, intensify anxiety, avoidance, and social withdrawal.
ARFID is not a single problem with multiple consequences. It is a dynamic, interconnected system that shapes how a person develops, relates, and functions in the world. ARFID does not simply affect what someone eats. It affects how they live. Often in ways that remain unseen until the costs are significant.
The cognitive patterns behind ARFID
At the heart of ARFID is not simply avoidance of food, but a pattern of learned predictions organised around safety and threat. Over time, repeated experiences of distress around eating shape how the mind anticipates, interprets, and responds to food related situations. These cognitive patterns are not chosen. They are adaptive responses developed in service of survival.
Through my lived experience and clinical work, the dynamic treatment framework I have developed recognises recurring cognitive patterns such as:
a negative orientation, with an expectation that outcomes will be unpleasant or unsafe
a future focused fear or anxiety orientation, anticipating that something will go wrong
internal prediction errors, such as “what if I don’t like it” or “I know this will be bad”
low tolerance for discomfort and uncertainty
heightened vigilance to bodily sensations and perceived threat cues
globalisation, where all foods outside a narrow safe range are perceived as dangerous
stable attributions, such as “I can’t change” or “this is just how I am”
learned helplessness or hopelessness following repeated failed attempts
These patterns do not exist in isolation. They reinforce one another and are continually strengthened by a nervous system that has learned to prioritise safety above all else. As a result, change can feel not just difficult, but actively threatening, even when the desire to change is present.
This is why behavioural change alone is rarely sustainable. Unless these cognitive patterns shift alongside nervous system regulation, attempts to push through eating difficulties often deepen fear, reinforce avoidance, and confirm the belief that change itself is unsafe or impossible.
Why ARFID deserves better treatment options
Ten years after ARFID was formally recognised in the DSM 5, the treatment landscape still falls short of what individuals and families genuinely need. A 2023 review by Fisher, Zimmerman, Bucher, and Yadlosky highlights that while awareness has increased, clinical pathways remain inconsistent, fragmented, and poorly aligned with ARFID’s complex presentation.
ARFID is not simply a variation of other eating disorders, nor does it reliably respond to exposure based feeding programs, cognitive only interventions, or behavioural models developed for anorexia or anxiety disorders. It exists at the intersection of safety driven survival responses, sensory processing differences, neurodivergence, gastrointestinal stress, and deeply ingrained threat based predictions around food. No single discipline or symptom focused model can adequately address that complexity.
The stakes are high. Without appropriate support, individuals may experience nutritional compromise, cognitive and emotional strain, chronic digestive and immune disruption, social withdrawal, and entrenched avoidance that quietly shapes development, relationships, identity, and quality of life over time.
ARFID deserves better because it demands better. Effective treatment must begin with nervous system safety, integrate contemporary understanding of trauma and sensory processing, and work with the cognitive patterns shaped by survival learning. Traditional approaches were never designed for this level of nuance, and expecting them to succeed without adaptation places an unfair burden on those seeking help.
Treatment for ARFID must evolve. Contributing to that evolution is not about replacing existing models, but about expanding our understanding of what ARFID truly requires.
The role of family and relational systems
ARFID does not exist in isolation. Whether it affects a child, adolescent, or adult, it inevitably shapes the relational systems around it, including parents, partners, children, and shared households. Mealtimes, routines, social events, travel, stress levels, and emotional wellbeing are all influenced by the ongoing presence of food related threat and avoidance.
For families of children with ARFID, parents are often navigating intense pressure, conflicting advice, and repeated experiences of feeling blamed or misunderstood. For adults living with ARFID, partners and family members may struggle to understand the invisible stress beneath eating patterns, while adults themselves may carry deep exhaustion or shame after years of managing food within relationships.
It is essential to state clearly that families and partners are not the cause of ARFID. They are affected by it, and they are part of the context in which change becomes possible.
Effective support must recognise the importance of relational systems, co regulation, and reducing pressure around food. When those closest to the individual understand the nervous system dynamics at play, the focus can shift away from control and compliance and toward safety, trust, and connection. These conditions are what allow meaningful and sustainable change to occur.
A compassionate, holistic, trauma informed approach is not optional
ARFID treatment must honour the role of the nervous system, the subconscious patterns that maintain fear, and the cognitive frameworks shaping perception and expectation. It must be collaborative, paced, and grounded in safety rather than force.
For someone with ARFID, food is not simply food. It is perceived as threat. Until that survival logic changes, no amount of pressure, reasoning, or exposure will create lasting freedom. When safety is restored, the world expands. New foods become possible. Social connection becomes less fraught. Confidence and autonomy grow. This is not about doing more. It is about doing differently.
ARFID is not picky eating, not a behavioural choice, and not something resolved through pressure. It is a deeply human, neurological, and emotional experience that responds to safety, understanding, and care. And for people living with ARFID, that difference matters. Because this is where freedom begins.
A thoughtful next step
If this article has helped you recognise ARFID in a new way, consider sharing it with a partner, family member, or clinician who is supporting you. Over the holiday season, reducing pressure around food and prioritising safety and connection can make a meaningful difference. If you are living with ARFID or supporting someone who is, seek out practitioners who understand nervous system safety, sensory sensitivity, and survival based avoidance, not just behaviour change.
Read more from Kylie Gallaher
Kylie Gallaher, Clinical Hypnotherapist, Strategic Psychotherapist
Kylie Gallaher leads Newcastle Clinical Hypnotherapy, the region’s only specialised hypnotherapy team, offering comprehensive support in all areas where hypnotherapy is beneficial. With advanced qualifications and a focus on evidence-based methods, she has established herself as a leader in the field. Kylie specialises in ARFID, eating disorders, trauma, anxiety, and related conditions including gastrointestinal disorders, and is committed to reshaping treatment approaches in Australia. Her professional journey reflects a dedication to blending science with compassion, delivering measurable results and raising the standard of clinical hypnotherapy nationwide.
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