The Complexities of Treating ARFID: How a Neurodivergent-Affirming, Sensory-Attuned Approach Works

by Marianne Miller, PhD, LMFT, an eating disorder therapist offering ARFID treatment in San Diego, throughout California, and in Texas and Washington D.C.

Understanding ARFID in Neurodivergent Teens and Adults

Avoidant/Restrictive Food Intake Disorder (ARFID) is one of the most misunderstood and often mischaracterized eating disorders, particularly when it presents in neurodivergent individuals. As a neurodivergent therapist specializing in ARFID treatment for both teens and adults in San Diego, Los Angeles, San Francisco, and elsewhere, I’ve seen firsthand how standard treatment approaches often fall short. Models that rely on compliance, exposure, and fixed food goals frequently miss the root causes of food avoidance.

Effective treatment for ARFID requires a complete shift in how we approach care. A neurodivergent-affirming and sensory-attuned framework centers the client’s nervous system, honors their autonomy, and considers how trauma, sensory processing, and neurotype all influence eating behavior.

What Causes ARFID? Key Contributors and Co-Occurring Conditions

Unlike other eating disorders that may be driven by concerns about weight or shape, ARFID often develops from different origins. These might include intense sensory sensitivities to texture or smell, traumatic experiences with food such as choking or vomiting, chronic medical conditions, or difficulty sensing hunger and fullness. ARFID frequently overlaps with autism, ADHD, OCD, sensory processing sensitivity (SPS) and other forms of neurodiversity. Because of these intersecting factors, ARFID care must be flexible, individualized, and deeply attuned to the person’s unique experience of the world.

Why Standard Eating Disorder Treatment Often Fails People with ARFID

Many eating disorder treatment models are designed with anorexia or bulimia in mind. These models often assume that distorted body image or restrictive eating for weight control is the primary concern. But when these approaches are applied to someone with ARFID, they often do more harm than good. People with ARFID may not relate to body image struggles at all. Instead, they may be overwhelmed by the sensory characteristics of food, experience a nervous system shutdown around mealtimes, or freeze when faced with decision-making around eating. Pushing food exposures without adequate regulation or respect for sensory boundaries can lead to shutdown, masking, or complete disengagement from treatment.

What Is a Neurodivergent-Affirming Approach to ARFID Therapy?

A neurodivergent-affirming, or neuroaffirming approach begins by recognizing that behavior is not the problem to be fixed. Instead, it is a form of communication that offers insight into the person’s needs, limits, and capacities. We start by asking what feels safe, not what needs to change. This work includes supporting executive functioning, co-regulating before food exposures, and co-creating treatment goals with the client, not for them. Many clients have been through years of medical trauma, therapy fatigue, or invalidation, so trust-building and autonomy must be at the center of the process.

The Role of Sensory-Attuned Care in ARFID Treatment

The sensory-attuned component of this work is equally essential. Sensory-based food avoidance is a core feature for many individuals with ARFID. A sensory-attuned approach involves mapping sensory preferences and aversions in detail: texture, temperature, color, smell, visual presentation, and more. Instead of rushing into exposure work, we may begin by supporting the client’s overall sensory regulation using tools like compression garments, weighted blankets, or adjustments to lighting and sound. We might explore non-food sensory input first to build awareness and trust. When we do begin to introduce new foods, we use sensory bridges, choosing options that are just one step away from a current safe food in texture or appearance. This approach keeps the process grounded in safety and curiosity rather than urgency or performance.

Case Example: Sensory-Based Food Avoidance in an Autistic Young Adult

Let me share a case example of a young adult called Ray, who had a very limited list of safe foods. They were all beige, crunchy, and highly predictable. Ray is autistic and had previously worked with therapists who pushed food exposures before addressing underlying sensory overwhelm and trauma. In our sessions, we began by mapping Ray’s non-food sensory preferences. We talked about the textures of clothing they found calming, the types of lighting that felt comfortable, and the sensory cues in their everyday life that either soothed or distressed them. Only after building that foundation did we explore a food that visually and texturally matched one of their current safe foods. There was no pressure to eat, just exploration. Over time, Ray tried the new food and accepted it. What made that possible wasn’t exposure. It was safety, regulation, and agency.

Executive Functioning, Trauma, and ARFID: Supporting the Whole Person

Executive functioning is another crucial aspect of ARFID that is often overlooked. Many people with ADHD or autistic traits find it difficult to initiate meals, plan what to eat, or follow through on cooking. Interoceptive difficulties can also make it hard to identify hunger or fullness cues. And for those who associate eating with anxiety or sensory overload, even thinking about food may trigger avoidance. Treatment needs to include tools to support daily functioning, such as visual schedules, task breakdowns, and collaboration with occupational therapists or speech-language pathologists when appropriate. Trauma-informed care is also vital, especially for individuals who have experienced past feeding interventions as coercive or shaming.

How ARFID Recovery Is Possible with Affirming, Sensory-Aware Treatment

Recovery from ARFID is not about rushing through a list of target foods. It is about building a relationship with food, body, and self that feels safe, spacious, and collaborative. When we bring together neurodivergent-affirming principles with sensory-attuned care, we make room for healing that respects the whole person. We validate their reality rather than asking them to override it. We create a path forward that is grounded in autonomy and choice, not pressure.

If you or someone you love is navigating ARFID, or if you are a clinician seeking a better way to support your clients, I invite you to learn more through my self-paced ARFID and Selective Eating Course. This course is designed for parents of neurodivergent children, adults with ARFID, and therapists who want to move beyond compliance-based models. It offers practical guidance on how to work with sensory sensitivities, support executive functioning, and integrate trauma-informed tools into treatment planning. You can learn more or enroll at drmariannemiller.com/arfid.

ARFID Therapy and Virtual Support in California, Texas, and Washington, D.C.

This approach to care reflects the realities of working with ARFID in both teens and adults. Whether you are seeking support in person with an eating disorder therapist in San Diego or looking for virtual ARFID treatment in California, Texas, or Washington, D.C., these strategies can help. Recovery from selective eating, sensory-based food avoidance, or eating challenges connected to autism or ADHD is possible. An affirming, collaborative approach that prioritizes nervous system safety and lived experience can lead to meaningful change.