The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 2013, introduced Avoidant/Restrictive Food Intake Disorder (ARFID) as a formal diagnosis. It replaced the narrower “Feeding Disorder of Infancy or Early Childhood,” broadening both the applicable age range and clinical scope. The DSM-5 defines ARFID as a persistent eating or feeding disturbance resulting in at least one of four consequences: clinically significant weight loss or, in children, failure to achieve expected growth; nutritional deficiency; dependence on enteral feeding or nutritional supplements; or marked interference with psychosocial functioning. The diagnosis requires that the disturbance not stem from body-image concerns, distinguishing ARFID from anorexia nervosa. Avoidance may instead reflect sensory sensitivity to certain textures or appearances, a lack of interest in eating, or anxiety about aversive consequences such as choking (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. 2013).

Because ARFID was only formally recognized in 2013, clinical awareness among general practitioners has developed unevenly, and families frequently encounter delayed or contradictory guidance before receiving a diagnosis. In Transcription, Max’s account of his daughter Emmie mirrors this pattern. He describes years of inconclusive tests and conflicting advice, progressing from a vague “Failure to Thrive” label to ARFID without any corresponding gain in understanding. Max regards the acronym with open frustration, calling it “just an envelope for ignorance” (90) that repackages a family’s anxieties in clinical language. His skepticism reflects a tension inherent to the diagnosis: ARFID identifies a pattern of avoidance without isolating its cause, leaving families to navigate what Emmie’s specialist acknowledges is “more of an art than a science” (92), an admission that underscores how far the clinical framework remains from offering definitive answers.