Treating ARFID in the UK: What’s Working While We Wait for NICE?

There’s still no one-size-fits-all treatment for ARFID. And if you’re struggling with it, or supporting someone who is,that uncertainty can feel frustrating, even disorienting. Because ARFID is a relatively new diagnosis, the research base is still catching up. We don’t yet have a single, clear, evidence-based treatment that works across all presentations.

But here’s the important part:

That doesn’t mean nothing works.

In fact, in the therapy room, we’re already seeing what does help, when we move beyond rigid models and actually respond to the person in front of us.

What people often assume ARFID treatment looks like

Most people expect a structured, protocol-driven approach:

• A standardised therapy model

• A clear set of steps

• A predictable outcome

And while that works for some conditions…

ARFID rarely fits neatly into that kind of box.

Because underneath restrictive eating, we’re often not just dealing with “food issues.”

We’re looking at:

• Sensory sensitivity

• Fear-based avoidance

• Past experiences (sometimes traumatic, sometimes subtle but powerful)

• Neurodivergent processing styles

• A nervous system that doesn’t feel safe

What’s actually working in practice

In reality, effective ARFID treatment tends to be integrative and responsive.

1. CBT-AR (Cognitive Behavioural Therapy for ARFID)

This is currently one of the most supported approaches.

It focuses on:

• Gradual exposure to avoided foods

• Understanding and shifting beliefs around eating

• Reducing avoidance patterns

I’ve trained in and used the CBT-AR model, and it can be incredibly helpful, particularly when adapted properly for neurodivergent clients. But on its own, it doesn’t always go far enough.

2. Addressing the underlying drivers (this is often the missing piece)

What I see again and again is that avoidance isn’t random.

There’s usually something underneath:

• A specific memory

• A felt sense of threat

• A moment where the body learned: this isn’t safe

This is where I integrate EMDR.

We’re not just talking about food.

We’re working with:

• The images

• The body responses

• The emotional imprint

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Particularly where there’s a clear incident (e.g. choking, vomiting, illness, or even something less obvious but impactful), this work can shift things in a way that behavioural approaches alone often can’t.

I’ll be sharing case studies on this soon, because the changes I’ve seen here are significant.

3. Nutritional rehabilitation (done properly, not forcefully)

A registered dietitian plays a key role in:

• Increasing food variety and intake

• Supporting nutritional needs

• Creating structure around meals

But this only works when it’s done alongside psychological safety. If the nervous system still perceives food as a threat, pushing intake too quickly can actually reinforce avoidance.

4. Sensory-based work

For many people with ARFID, especially those who are neurodivergent, sensory sensitivity is central.

This might involve:

• Texture

• Smell

• Temperature

• Appearance

Gradual, supported exposure (sometimes through sensory integration approaches) can help build tolerance over time.

5. Family or systemic support (particularly for younger clients)

Approaches like Family-Based Therapy can be helpful, especially where family support is key to maintaining structure and consistency.

Why a multidisciplinary approach matters

ARFID rarely sits in just one domain.

That’s why effective support often involves:

• Therapist

• Dietitian

• Medical input (where needed)

If I think you need additional or different support, I’ll be direct about that, and help you access the right people. I have a network of clinicians I work alongside to make sure you’re properly supported.

A slightly uncomfortable truth (but an important one)

Some of what shows up in ARFID, especially in adults, isn’t just about food.

It can also link to:

• Control

• Safety

• Identity

• Getting it “right”

  
  

Sometimes even a quiet version of:

“If I just do this properly, I’ll be okay.”

That’s where this starts to overlap with what I call the Good Person Trap™ where behaviour becomes tied to safety, certainty, or worth. Not in a dramatic way. But in a very human one.

And if we don’t address that layer, progress can stall, even when everything looks “right” on the surface.

So what does help?

What I’ve found most effective is:

• Adapting structured approaches (like CBT-AR), not rigidly applying them

• Working directly with the nervous system and underlying experiences (e.g. EMDR)

• Respecting neurodivergent needs, not overriding them

• Building safety first, not forcing change

Because when the system feels safer…

Eating becomes more possible.

Working with me

My work brings these together, because in reality, they’re rarely separate.

If you’re looking for support, the best place to start is with:

• A Clarity & Direction session

• Or an assessment to understand what’s actually driving things for you

From there, we decide on the right next step, whether that’s therapy with me or a broader support plan.

Book a Call

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Hi, I’m Becky Grace Irwing.

I’m a BABCP-accredited CBT and EMDR therapist, and a registered Mental Health Nurse with over 15 years’ experience across NHS and private settings — including acute, forensic, CAMHS, and university mental health services.

My work sits at the intersection of eating disorders, neurodiversity, and complex trauma — because in practice, these rarely exist in isolation.

I specialise in working with deep thinkers and sensitive, often neurodivergent clients who feel stuck in patterns that don’t fully make sense on the surface — whether that’s around food, anxiety, identity, or a persistent sense of not quite feeling safe in themselves.

My approach integrates:

• Cognitive Behavioural Therapy (CBT)

• EMDR (trauma processing)

• Nervous system-informed work

— always adapted to the individual, rather than applied as a rigid model.

Alongside my clinical training, I bring lived experience of long-term binge eating (now recovered), as well as ADHD and autistic traits. This means I don’t just understand these patterns professionally, I understand them from the inside.

Before retraining in mental health, I spent a decade working in the fitness and yoga industry, which continues to inform how I think about the body, regulation, and sustainable change.

At the core of my work is a focus on helping people move out of survival mode, and into a way of living that actually feels spacious, sustainable, and fully theirs.

Outside of work, I’m usually with my two dachshunds, somewhere cosy, or knitting.