Understanding ARFID: Why Traditional Exposure Therapy May Cause Harm and Neuro-Affirming Alternatives

Avoidant Restrictive Food Intake Disorder (ARFID) is a complex eating challenge that is often misunderstood and misrepresented. For neurodivergent people, ARFID is not simply about "picky eating"; it is a deeply personal and nuanced experience shaped by sensory sensitivities, trauma, and the need for safety and control around food. While Cognitive Behavioural Therapy (CBT) and exposure therapy are commonly recommended treatments, these approaches can sometimes cause harm when they fail to honour the individual’s unique needs and lived experiences.

This blog explores why traditional approaches may not work for ARFID and offers neuro-affirming, compassionate strategies to support clients in their journey toward a healthier relationship with food.

What is ARFID?

ARFID is characterized by restrictive eating patterns that are not primarily driven by body image concerns (though it can be a piece of the puzzle considering how ingrained diet culture is), but by sensory sensitivities, fear of adverse consequences (e.g., choking, vomiting), or a lack of interest in eating. For many, ARFID intersects with neurodivergence, such as being Autistic or ADHD, and is often influenced by trauma, chronic illness, or other disabilities.

Why CBT and Traditional Exposure Therapy May Cause Harm

CBT and exposure therapy often rely on rigid frameworks that prioritize compliance over safety and autonomy. While these methods may work for other conditions, they can inadvertently harm individuals with ARFID by disregarding their lived experiences and the reasons behind their food challenges.

1. Overemphasis on Compliance

Traditional exposure therapy often pushes individuals to confront "fear foods" in a controlled environment, sometimes without adequately addressing the root causes of their food aversions. For someone with ARFID, this can feel coercive and retraumatizing, especially if they are not emotionally or physically ready.

2. Ignoring Nutritional Deficiencies

For individuals with ARFID who are already undernourished or struggling with nutrient deficiencies, exposure therapy can feel overwhelming and counterproductive. Without a foundation of safety and adequate nourishment, exposure work can worsen anxiety and resistance.

3. Overlooking Sensory Needs

ARFID is often rooted in sensory processing differences. Traditional approaches may fail to account for the sensory overwhelm certain foods cause, reinforcing feelings of unsafety around eating.

4. Lack of Intersectionality

Rigid protocols do not consider the intersection of neurodivergence, trauma, and other identities or experiences (e.g., chronic illness, disability). This lack of nuance can alienate clients and make therapy feel inaccessible.

Neuro-Affirming Suggestions for Supporting Clients with ARFID

A neuro-affirming approach respects the client’s autonomy, sensory needs, and lived experiences. Here are some compassionate strategies to support clients:

1. Build Safety First

Before addressing food aversions, focus on creating a sense of safety in therapy and around eating. This includes:

• Validating the client’s feelings and experiences without judgment.

• Ensuring they have access to enough safe foods to meet their nutritional needs.

• Avoiding pressure to "perform" or meet specific food goals.

💡 Tip: Ask the client what feels safe for them. For example, they may prefer to eat alone, with a trusted person, or in a familiar environment.

2. Honour Autonomy

Let the client take the lead in deciding when, where, and how to explore new foods. Empower them to choose:

• Which foods to try.

• Whether anyone will be present during exposures.

• The timing and location of food exposures.

💡 Tip: Collaboratively create a list of foods they feel curious about or willing to explore when ready.

3. Address Sensory Needs

ARFID is often tied to sensory sensitivities. Work with the client to identify and accommodate their sensory preferences:

• Experiment with textures, temperatures, and flavours that feel safe.

• Deconstruct meals to allow for more control (e.g., serving components separately).

• Encourage them to use sensory tools like weighted blankets or noise-cancelling headphones during meals if it helps reduce anxiety.

💡 Tip: Introduce new foods in ways that align with their sensory preferences, such as blending, cutting into smaller pieces, or pairing with a safe food.

4. Focus on Gradual, Collaborative Exploration

Instead of traditional exposures, try a gentler approach:

• Use food play or non-eating interactions (e.g., smelling, touching, or cooking with the food) to build familiarity and reduce fear.

• Celebrate small wins, such as sitting near a food they are uncomfortable with or tasting a tiny amount.

💡 Tip: Normalize the idea that progress is non-linear and unique to each individual.

5. Address Underlying Trauma

For many with ARFID, food-related trauma plays a significant role. Incorporate trauma-informed practices, such as:

• Exploring how past experiences influence current feelings about food.

• Using somatic techniques to reduce anxiety and re-establish a sense of safety in the body.

💡 Tip: Work with the client to identify grounding techniques they can use during mealtimes.

6. Collaborate with a Multidisciplinary Team

ARFID often requires a team approach. Collaborate with dietitians, occupational therapists, or other specialists who use neurodiversity-affirming practices.

💡 Tip: Ensure all professionals involved are aligned in their approach to avoid sending mixed messages to the client.

Final Thoughts

ARFID is not about stubbornness or defiance. It’s about safety, sensory needs, and lived experiences. By shifting away from rigid frameworks like traditional CBT and exposure therapy, we can create a compassionate, neuro-affirming approach that empowers clients to build a healthier relationship with food on their own terms.