Avoidant/Restrictive Food Intake Disorder (ARFID) is characterised by restrictive eating that results in nutritional, psychosocial, or functional impairment. However, distinguishing ARFID from medically necessary dietary restriction can be challenging in conditions such as coeliac disease, where lifelong avoidance of gluten is essential for health. Increasingly, research has reported elevated rates of ARFID symptoms among people with coeliac disease, raising important questions about how restrictive eating should be understood and assessed within this population.
This presentation will draw on recent research examining dietary hypervigilance, food avoidance, and eating-related burden in coeliac disease. Findings from qualitative and quantitative studies suggest that many behaviours associated with ARFID screening measures, including avoidance of unfamiliar foods, heightened concern about contamination, extensive dietary planning, and restriction of eating in social settings, may also represent understandable responses to managing a genuine and ongoing health threat. At the same time, for some individuals these behaviours can become increasingly rigid, generalised, and associated with reduced quality of life.
The presentation will explore the overlap between adaptive dietary self-management, dietary hypervigilance, and clinically significant avoidant/restrictive eating. Practical implications for clinicians will be discussed, including the importance of considering functional impact, flexibility, and psychosocial burden when evaluating restrictive eating in coeliac disease. The talk will highlight the need for nuanced assessment approaches that avoid pathologising necessary dietary management while identifying individuals who may benefit from additional psychological or multidisciplinary support.