How GI symptoms fuel avoidant eating—and how therapy can interrupt the cycle
Written by Dr. Antonia Repollet
Licensed Clinical Psychologist
Certified School Psychologist
GI Psychology
Understanding ARFID in the Context of GI Health
Avoidant/Restrictive Food Intake Disorder (ARFID) is often misunderstood as “picky eating”, but it is far more complex. ARFID involves an intense avoidance of certain foods or food groups, often due to fear of GI discomfort, choking, or vomiting, or because of sensory sensitivities (e.g., textures, smells). For both children and adults, ARFID can interfere with growth, nutrition, social functioning, and quality of life (Bryant-Waugh, 2019).
One of the most overlooked drivers of ARFID is the gut–brain axis: the two-way communication system between the gastrointestinal (GI) tract and the nervous system. For individuals with sensitive GI systems, eating can trigger uncomfortable sensations like bloating, nausea, pain, or reflux, which then reinforces avoidant eating patterns (Thomas et al., 2017).
How GI Symptoms Fuel Avoidant Eating
Negative associations with food: If eating a certain food consistently leads to discomfort, the brain learns to associate that food with danger.
- Heightened interoception: Many ARFID patients are hyperaware of internal bodily signals. A small amount of fullness may feel overwhelming, which drives restriction.
- Anxiety amplifies symptoms: Worry about food-related discomfort activates the stress response, which makes the gut more sensitive. This creates a feedback loop: anxiety → GI symptoms → avoidance → nutritional compromise (Keefer et al., 2018).
- Social impact: Fear of GI distress can make mealtimes stressful, leading to avoidance of eating with others and reinforcing isolation.
This cycle is not about willpower or stubbornness. It is the result of gut–brain dysregulation, anxiety, and learned avoidance.).
How Therapy Can Interrupt the Cycle
The good news: ARFID is treatable, and therapy plays a central role in helping patients rebuild a safe and flexible relationship with food.
- Cognitive-Behavioral Therapy for ARFID (CBT-AR): A specialized form of CBT that targets avoidant and restrictive eating. CBT-AR combines cognitive restructuring with graduated exposure to feared foods so that patients can challenge catastrophic thoughts, reduce anxiety, and build tolerance over time. This structured approach helps break the cycle of avoidance and allows new, positive food experiences to take root (Bryant-Waugh, 2019).
- Gut-Directed Hypnotherapy: A mind–body therapy that uses imagery, relaxation, and suggestion to reduce gut sensitivity and anxiety around eating, making it easier for patients to try new foods and re-establish trust in their body (Anbar, 2022).
- Family-Based Approaches (for pediatric patients): Equip parents with strategies to support their child without increasing pressure or conflict at mealtimes (Bryant-Waugh, 2019; Shimshoni & Lebowitz, 2020).
Interdisciplinary Care: Collaboration between therapists, dietitians, pediatricians, and GI providers ensures both nutritional needs and gut symptoms are addressed.
Practical Steps for Parents and Adults with ARFID
- Track patterns: Keep a log of GI symptoms and avoided foods to identify triggers and patterns.
- Practice interoceptive awareness: Gentle breathing or mindfulness exercises can reduce reactivity to body signals.
- Start small: Choose low-anxiety foods to expand variety gradually, celebrating each win.
- Seek support early: ARFID is less likely to resolve “on its own” (Eddy, n.d.). Professional help makes a significant difference.
Final Takeaway
ARFID sits at the intersection of gut symptoms, brain processing, and learned avoidance. By addressing both the GI and psychological components, therapy can help children and adults gradually reduce fear, improve nutrition, and reclaim the freedom to eat with confidence and comfort.
If you or your child are looking for support, it may be time to connect with a gut-brain therapist.
- Printable resources and educational support
- Schedule a consultation with our team to see how GI Psychology can support your child and family
- Reach out directly: admin@gipsychology.com
References
Anbar, R. D. (2022, June 11). Hypnosis for avoidant/restrictive food intake disorder. Psychology Today. https://www.psychologytoday.com/us/blog/understanding-hypnosis/202206/hypnosis-for-avoidantrestrictive-food-intake-disorder
Bryant-Waugh R. (2019). Avoidant/Restrictive Food Intake Disorder. Child and adolescent psychiatric clinics of North America, 28(4), 557–565.
Eddy, K. (n.d.). What is Avoidant Restrictive Food Intake Disorder (ARFID)?. National Eating Disorders Association. https://www.nationaleatingdisorders.org/avoidant-restrictive-food-intake-disorder-arfid/
Keefer, L., Palsson, O. S., & Pandolfino, J. E. (2018). Best practice update: Incorporating psychogastroenterology into management of Digestive Disorders. Gastroenterology, 154(5), 1249–1257.
Shimshoni, Y., & Lebowitz, E. R. (2020b). Childhood avoidant/restrictive food intake disorder: Review of treatments and a novel parent-based approach. Journal of Cognitive Psychotherapy, 34(3), 200–224.
Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Current psychiatry reports, 19(8), 54.