When People Are Afraid of Eating

For many people, eating is a source of comfort, connection, and routine. But for individuals living with Avoidant Restrictive Food Intake Disorder, or ARFID, eating can provoke intense fear, anxiety, and distress. Rather than being a pleasurable or neutral activity, food becomes something to avoid. Despite being officially recognized as an eating disorder, ARFID remains poorly understood and is frequently dismissed as simple picky eating. Mental health professionals warn that this misunderstanding has serious consequences for diagnosis, treatment, and long-term well-being.

Beyond Picky Eating

ARFID is characterized by restrictive eating that leads to nutritional deficiencies, weight loss, dependence on supplements, or significant interference in daily functioning. Unlike anorexia nervosa or bulimia, ARFID is not driven by concerns about body image, weight, or shape. Instead, avoidance is rooted in fear and anxiety related to eating itself. Sensory sensitivities, fear of choking or vomiting, gastrointestinal discomfort, or a lack of appetite cues can all play a role. This distinction is crucial, yet it is often overlooked, delaying appropriate care for those affected.

Role of Anxiety

Mental health experts emphasize that anxiety is not just a side effect of ARFID but often a central driver of the disorder. Dhara Ghuntla, psychologist and psychotherapist affiliated with Sujay Hospital, 7 Hills Hospital, and Criticare Hospital, explains that anxiety frequently precedes eating in individuals with ARFID. “In ARFID, anxiety often precedes eating and is linked to fears of choking, vomiting, gastrointestinal discomfort, or sensory overload,” she says. “This anticipatory anxiety leads to avoidance, which temporarily reduces distress and thereby reinforces restrictive patterns.”

This cycle of fear and avoidance becomes deeply ingrained. When avoiding food reduces anxiety, the brain learns to associate food with danger rather than nourishment. Over time, this pattern becomes automatic, making recovery increasingly challenging without professional intervention.

Food For Thought

Dr. Pavitra Shankar, Associate Consultant in Psychiatry at Aakash Healthcare describes fear as both a precipitating and maintaining factor in ARFID. “The fears experienced by individuals are not irrational to them,” she notes. “They are perceived as direct dangers that trigger the body’s anxiety mechanism.” According to Dr. Shankar, repeated avoidance teaches the brain to react to certain foods, textures, smells, or eating situations as threats.

While avoidance may reduce anxiety in the short term, it prevents individuals from learning that eating can be safe. “Although avoidance does decrease anxiety temporarily, it tends to strengthen the fear inadvertently,” she explains. This process locks individuals into a self-perpetuating loop where anxiety fuels restriction, and restriction, in turn, heightens anxiety.

Physical & Emotional Toll

As ARFID progresses, anxiety can begin long before a meal starts. Even the thought of eating may trigger nausea, gagging, or panic. Social situations involving food can become overwhelming, leading to isolation and further distress. Dr. Shankar highlights that nutritional deficiencies resulting from restricted intake can worsen mood, concentration, and emotional regulation. “The cycle of anxiety and restriction becomes a vicious circle,” she says, warning that without intervention, ARFID can become a chronic condition rather than a temporary phase.

Misconceptions

One of the biggest barriers to effective treatment is the widespread misconception that ARFID is merely extreme picky eating. Ghuntla explains that this belief often leads to symptoms being minimized or blamed on stubbornness, immaturity, or poor parenting. “As a result, diagnosis and appropriate intervention are delayed,” she says. “This mislabelling increases shame, invalidation, and family conflict, while untreated anxiety and nutritional deficits worsen overall mental health.”

Dr. Shankar adds that another common misunderstanding is that all eating disorders involve body image concerns. Because many individuals with ARFID do not appear underweight, their struggles are frequently overlooked or misattributed to gastrointestinal issues or general anxiety. These diagno-stic delays can result in long-term health complications and worsening mental health outcomes.

Diagnosis Matters

Experts stress that distinguishing ARFID from other eating disorders is essential for effective treatment. Ghuntla explains that ARFID requires anxiety-focused and exposure-based interventions rather than therapies centred on body image. “This distinction is clinically essential,” she notes, as using the wrong treatment approach can leave the core problem unaddressed.

When ARFID is properly recognized, individuals can receive coordinated care that addresses both nutritional needs and underlying anxiety. Early intervention not only improves physical health but also reduces shame and self-blame, paving the way for recovery.

As awareness grows, mental health professionals hope that ARFID will no longer be dismissed as a minor or temporary issue. By recognizing ARFID as a serious mental health condition, families, clinicians, and society can move toward earlier diagnosis, compassionate care, and better outcomes for those whose relationship with food is shaped by fear rather than choice.