Brave Steps: Facing Eating Fears and Finding Strength
When avoidant/restrictive food intake disorder and eating disorders intersect
Posted February 6, 2026 | Reviewed by Davia Sills
When Dani was a small child, she became afraid of choking on chunky food. Pills were difficult to swallow and often regurgitated. Dani was afraid of feeling hard things in the back of her throat and often complained she felt an uncomfortable lump in her throat.
Dani’s pediatrician and a pediatric gastroenterologist evaluated Dani for the causes of her intolerance to hard food items in her throat. The results suggested it was unlikely that there was an underlying physical cause. At home, the family accommodated Dani’s food preferences so that she could eat and grow.
As the years passed, Dani began to fall off her growth chart as her food avoidance increased. She developed a fear of choking and not being able to breathe when eating lumpy foods, and gradually became intolerant of foods with any texture or chunks. By the time she was 10 years old, the range of foods she found acceptable had narrowed significantly.
Dani’s mother was frustrated that Dani’s physical growth was not on track and knew it was because Dani wasn’t eating the wide variety of foods she needed to be healthy. Meat was impossible—too fibrous. Vegetables had to be boiled until mushy. Some fruit products were acceptable because they were soft and smooth, like applesauce. Puddings, ice cream, and soups were well-tolerated when smooth, creamy, and free of chunks.
Dani’s mother didn’t want to resort to puréeing foods to help her eat well. She was already regularly accommodating Dani’s fears by preparing special meals. Social problems then developed for Dani because she brought unusual lunches to school and couldn’t eat many of the foods her peers ate—chips, pizza, bagels, and cake. Dani began avoiding social situations involving typical kid snacks.
It would have been simple if Dani had been reassured that she wouldn’t choke or stop breathing if she swallowed food with chunks or a grainy texture. However, Dani’s fears began when she was very young. The few times she briefly choked on foods early in life—a common experience for most children—were enough to snowball into increasing fears over time. Dani was not easily reassured, any more than a child learning to swim can be reassured that they won’t drown if they let go of the pool edge.
To complicate matters, Dani, like most little girls, was not immune to social pressure to be thinner and smaller. Her already petite, undernourished stature earned her compliments from other girls. She valued her smaller frame and grew protective of her self-image as a small person. She was already vulnerable to needing peer approval because she had experienced negative peer judgment about her unusual eating habits. Like most of her peer group, she wanted to be admired. Being small had an unhelpful value.
Recommendations from Dani’s pediatrician to eat more healthfully were met with Dani’s anxious resistance on two fronts. She remained intolerant of hard and eventually grainy foods, and she prized her underweight status. When progress stalled, additional treatment professionals were added to the treatment team.
Behavioral health and nutrition were addressed by professionals in these fields. The question of how to diagnose Dani’s condition was debated. Criteria for a restrictive eating disorder were met, but so were criteria for ARFID, or avoidant/restrictive food intake disorder.
Current diagnostic criteria suggest that the eating disorder diagnosis should take precedence over the ARFID diagnosis. However, it was clear that Dani’s fear of hard food and related picky eating were causing nutritional deficiency as much as avoiding foods she thought would jeopardize her petite stature by causing weight gain. The decision was made to treat both the ARFID and the eating disorder, where treatment goals could overlap.
There is an ongoing debate about the existence of overlapping ARFID and eating disorders. Researchers continue to report cases like Dani’s, where symptoms of eating disorders, e.g., distorted body image , coexist with symptoms of ARFID, e.g., non-body-image-related fears surrounding eating.
Nutrition restoration is central to recovery from both ARFID and other eating disorders. Although some treatment goals were specific to each diagnosis and required distinct, specialized approaches, Dani’s treatment team initially prioritized goals that supported her ability to tolerate three balanced meals per day, regular snacks, and a wider variety of foods.
An occupational therapist helped Dani tolerate sensations in her mouth that she had previously found uncomfortable by teaching sensory desensitization and oral-motor skills. The occupational therapist’s role was to help Dani better manage eating, chewing, and swallowing foods that had previously felt unsafe and uncomfortable in her mouth.
The mental health professional teamed up with the nutrition expert to gradually expose Dani to increasingly chunky, hard foods. It was a marathon, not a sprint. Dani found this work difficult. Her mom became her chief cheerleader. It took the special skills of these professionals to help Dani and her mother choose what to work on and how to work on it.
Dani’s mom’s recovery work was also challenging. She had customarily accommodated Dani’s picky food choices in an effort to help her eat. It was hard to shift Dani to many normal, everyday chunky foods one step at a time. Mom was used to preparing separate meals for Dani without question. Now, once a food was introduced, she was advised to continue providing it so Dani would maintain her gains. Old anxieties might return if practice facing them wasn’t continued.
The eating disorder aspect of Dani’s care was supported by necessary re-nourishment. Issues around body image were addressed more effectively by Dani’s care team once improved eating was achieved. The motivation and commitment of Dani’s family to treatment were key.
Dani learned to tolerate the changes in her body image that accompanied the expected weight gain from re-nourishment. Years of fear responses to eating—initially related to sensory intolerance of certain foods and later to fear of weight gain—were addressed and gradually improved over time.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.) Washington D.C.
Eddy, K. T., & Negi, S. (2025). Avoidant/Restrictive Food Intake Disorder Plus Eating Disorder Comorbidity: Are Two Diagnoses Better Than One?. International Journal of Eating Disorders , 58 (6), 1025-1028.
Kambanis, P. E., & Thomas, J. J. (2023). Assessment and treatment of avoidant/restrictive food intake disorder. Current Psychiatry Reports , 25 (2), 53-64.
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Cris E. Haltom, Ph.D., CEDS is a Certified Eating Disorders Specialist, clinical psychologist, workshop presenter, and author of two books and research articles on eating disorder treatment.
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