Avoidant/Restrictive Food Intake Disorder 335
activities, such as eating with others, or to sustain relationsh ips as a result of the distur-
bance would indicate marked interference wi th psychosocial functioning (Criterion A4).
Avoidant/restrictive food intake disorder does not include avoidance or restriction of
food intake related to lack of availability of food or to cultural practices (e.g., religious fast-
ing or normal dieting) (Criterion B), nor does it include developmentally normal behaviors
(e.g., picky eating in toddlers, reduced intake in older adults). The disturbance is not better
explained by excessive concern about body weight  or shape (Criterion C) or by concurrent
medical factors or mental disorders (Criterion D). 
In some individuals, food av oidance or restriction may be based on the sensory char-
acteristics of qualities of fo od, such as extreme sensitivity to appearance, color, smell,
texture, temperature, or taste. Such behavior  has been described as  “restrictive eating,”
“selective eating,” “choosy eating,” “perseverant eating,” “chronic food refusal,” and
“food neophobia” and may manifest as refusal to  eat particular brands of foods or to tol-
erate the smell of food being eaten by others . Individuals with heightened sensory sensi-
tivities associated with autism  may show similar behaviors. 
Food avoidance or restriction may also repr esent a conditioned negative response as-
sociated with food intake following, or in an ticipation of, an aversive experience, such as
choking; a traumatic investigation, usually invo lving the gastrointestinal tract (e.g., esoph-
agoscopy); or repeated vomiting. The terms functional dysphagia and globus hystericus  have
also been used for such conditions. 
Associated Features Supporting Diagnosis