Some children avoid food for reasons that have nothing to do with fussiness. Certain textures, smells, or the thought of choking can be genuinely frightening. That pattern is recognised as avoidant/restrictive food intake disorder, or ARFID.
A recent study tested a cognitive behavioural therapy designed specifically for it, CBT-AR, with young people aged 10 to 17. Participants received 20 to 30 sessions, delivered either with their family or individually. The results were encouraging. Clinicians rated 85% of the young people as much or very much improved. Participants tried an average of nearly 17 new foods. Those who had been underweight gained weight, and 70% no longer met the criteria for ARFID by the end of treatment.
The relevance to OCD lies in the mechanism. Both conditions involve fear and avoidance becoming self-sustaining, whether what is avoided is a food or a thought. Structured, graded exposure can change those patterns in either case. ARFID care usually involves a team, with medical and dietetic support alongside psychological therapy.
If avoidance has started to narrow what you or your child can do, it is worth seeking support rather than waiting.
What the study actually tested
Avoidant/restrictive food intake disorder (ARFID) isn't about dieting or vanity — it involves genuine fear or aversion around eating, often tied to sensory sensitivity (texture, smell), fear of choking or vomiting, or simply low interest in food. Because ARFID is a relatively newly defined diagnosis, there's been little research on how to treat it. Thomas et al. developed a manualised (meaning it follows a structured, written treatment protocol) cognitive-behavioural therapy called CBT-AR and tested it in 10 to 17 year olds.
This was a feasibility, acceptability, and proof-of-concept study — an early-stage design used before running a full randomised controlled trial (RCT). Feasibility asks: can this treatment actually be delivered as planned? Acceptability asks: will patients and families engage with it and stick around? Proof-of-concept asks: are there early signs it might actually work? These studies typically don't include a control group, so they can't yet tell us the treatment definitely caused the improvement — that's what RCTs are for.
Participants received 20-30 sessions, delivered either in a family-based format (involving parents/caregivers directly) or individually, depending on what suited them.
What it found
Of 25 eligible young people, 20 started treatment; 17 completed it and 3 dropped out. Using intent-to-treat analysis — a method that includes everyone who started treatment, even dropouts, to avoid overestimating results — clinicians rated 85% of patients as "much improved" or "very much improved."
ARFID severity, measured with a structured clinical interview (the Pica, ARFID, and Rumination Disorder Interview, or PARDI), dropped significantly according to both patients and parents. On average, patients added 16.7 new foods to their diet (with considerable variation between individuals). Among those who were underweight at the start, there was an average weight gain of 11.5 pounds, shifting their body mass index (BMI) from around the 10th to the 20th percentile for their age — meaning they moved from being lighter than about 90% of peers to lighter than about 80%. By the end of treatment, 70% no longer met diagnostic criteria for ARFID at all.
Why it's relevant to OCD
CBT-AR draws on principles similar to those used in OCD treatment — particularly gradual, structured exposure to feared situations (in this case, feared foods) rather than avoidance. The logic is the same: avoidance keeps fear alive, while carefully paced confrontation with the feared thing, supported by a therapist, helps the brain relearn that the feared outcome usually doesn't happen. This study doesn't test OCD directly, but it adds to the broader evidence that exposure-based CBT approaches can be adapted successfully to different fear-and-avoidance conditions.
Limits to keep in mind
This was a small, single-arm study with no control or comparison group, so we can't yet be sure the improvements were caused by CBT-AR specifically rather than other factors. The authors themselves note that randomised controlled trials are the necessary next step.
If fear, avoidance, or anxiety is getting in the way of everyday life for you or someone you care about, it's worth reaching out to a qualified professional for support.