Most children go through phases of picky or fussy eating at some point. To the frustration of their parents, kiddos will suddenly refuse foods they once excitedly ate while turning their noses up at pretty much anything new or different that is placed before them. In most cases, this is normal and often doesn’t last that long. For that matter, many primary care providers and pediatric specialists will tell you that it’s OK. If your child is only willing to eat chicken nuggets or mac and cheese, feed them chicken nuggets or mac and cheese. At some point, the fussiness will begin to ease, and their diet will become substantially more varied. Most children start to grow out of the “fussy eating” stage around the age of six, except for those children who don’t. 

In some notably more severe cases, selective eating does not subside. In these cases, the picky eating continues well beyond typical fussiness that can be attributed to toddlers and adolescents. For these children, typical methodologies of dealing with fussy eating such as refusing to give them the foods they demand can sometimes lead to starvation, illness, and the need for urgent medical and mental health treatment such as that provided at Meadowglade. 

What is Selective Eating Disorder?

Selective eating disorder falls under the umbrella of Avoidant Restrictive Food Intake Disorder or ARFID. This particular category of disordered eating is common. More than fifty percent of eating disorders do not meet the diagnostic criteria for better-known eating disorders such as binge eating disorder, bulimia, or anorexia and therefore fall under the Avoidant Restrictive Food Intake Disorder category. Far more severe than simply being a fussy or picky eater, someone with a selective eating disorder may have a phobia of certain foods, follow an extremely restrictive diet, have sensory aversions to specific tastes, textures, or smells, or fear or aversion to swallowing.

Before being included in the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (5th edition) in 2013, few medical or mental health practitioners knew about or understood the severity of Avoidant Restrictive Food Intake Disorder. Before being renamed in 2013,  Avoidant Restrictive Food Intake Disorder was previously referred to as “Feeding Disorder of Infancy or Early Childhood.” In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the definition of the disorder was broadened to include adults who intentionally limit eating and are affected by psychological or physical problems but who do not fall under the definition of another eating disorder. Unfortunately, in the eight years that have elapsed since the broadening of diagnostic criteria,  one may still be hard-pressed to find a doctor or mental health provider who knows how to treat the symptoms of this illness. 

What Causes Selective Eating Disorder (ARFID)?

Unlike other, commonly known eating disorders, Avoidant Restrictive Food Intake Disorder does not have anything to do with body image or the desire to lose or maintain weight. Instead, Avoidant Restrictive Food Intake Disorder is often based on trauma. The development of this particular eating disorder often results from an incident early on in childhood that convinces the individual that eating specific foods they are afraid of might actually kill them. 

The traumatic incident can be anything from an experience with choking to, in some cases, repressed memories from infants who were born prematurely and spent several months in the NICU with tubes running in and out of their mouths and noses. Unlike other eating disorders, Selective Eating Disorder is a sensory condition, and therefore it is based on fear.

For individuals who struggle with this condition, the fear of even having specific foods deemed “unsafe” in their mouth can be debilitating. Regardless of age, kids and adults who suffer from a selective eating disorder have a deeply rooted belief that if they eat specific foods, they will die, and therefore, comprehensive mental health treatment (and often medical treatment) are vital to helping them overcome their fears and develop a healthy pattern of eating. 

What are the Symptoms of Selective Eating Disorder?

Although the condition often develops in childhood, selective eating disorders can affect teens and adults as well. The symptoms of a selective eating disorder can be psychological and physical. Psychological symptoms that are commonly seen include anxiety and depression, as well as social impairments. Someone with a selective eating disorder will eat only foods they consider safe or acceptable and go out of their way to avoid foods with particular tastes, colors, textures, or smells. 

For some, the idea of specific foods brings about such aversion that they cannot bear to touch or be in the same room as those foods. As a result, children and adults with selective eating disorders struggle to eat or be around groups of people eating as it is likely a particular food they struggle with may be present. Also, someone with a selective eating disorder may become distressed or anxious when they are encouraged (or forced) to try different foods. This anxiety can arise from phobias related to food, fear of choking or vomiting from eating the food, or memories related to a food or food group that bring about anxiety. 

Other common symptoms and warning signs of a selective eating disorder include having a minimal list of foods one is willing to eat, elimination of entire food groups, eating foods with similar characteristics (texture, color, etc.), and becoming visibly emotional or stressed when presented with or being around unfamiliar foods. 

Complications of Selective Eating Disorder

It is important to note that many selective eaters do not have weight issues (as is commonly found with other types of disordered eating) and generally have weights that fall within the normal range. Because of this, it can be hard to visually tell that your child or a loved one struggles with a selective eating disorder. However, long-term selective eating can result in a series of medical conditions, including malnutrition, digestive problems, low blood pressure, electrolyte imbalances, and a slower heart rate when compared to someone without a selective eating disorder. 

In addition to the above, children who developed a selective eating disorder early may experience developmental delays and failure to gain weight. For adults, it can be challenging to use weight as a visual indicator of a selective eating disorder. Some adults may experience significant and sudden weight loss. Whereas in other cases, their weight may be entirely normal and within medically suggested ranges. It is also not uncommon for those who struggle with a selective eating disorder to develop co-occurring mental health disorders such as anxiety and depression.

Treating Selective Eating Disorder

In some cases, the symptoms of Avoidant Resistant Food Intake Disorder may eventually disappear without treatment. However, in others, mental health and medical treatment are needed if the symptoms persist beyond childhood into teen or adult age groups. The most common treatment for adults who struggle with Avoidant Resistant Food Intake Disorder is cognitive-behavioral therapy. The guiding principles behind cognitive behavioral therapy are designed to help individuals struggling with a specific mental health condition examine and reevaluate the ideas behind their thoughts and behaviors. 

By evaluating the root causes of their fears and aversions to food, it is believed that individuals who struggle with Avoidant Resistant Food Intake Disorder may develop healthier, safer coping mechanisms control for managing food phobias. In time, they will begin slowly consuming a more nutritious, more balanced diet. Seeking therapy for selective eating disorders is often significantly more beneficial and successful in changing behaviors than hoping for symptoms to disappear without treatment.

Treatment for younger children often involves treatment with a process known as graduated exposure therapy or systematic desensitization. This is a type of behavioral therapy designed to help people effectively overcome phobias and other anxiety disorders. It includes elements of cognitive-behavioral therapy and applied behavior analysis. 

When used by a trained mental health professional, it helps to “desensitize” an individual so they can better manage phobias and fears. It is a three-step process that involves identifying the anxiety-inducing stimulus or trigger, learning relaxation or coping techniques to employ when faced with that trigger or stimulus, and then, in the third step, using their newly developed skills when faced with a triggering situation. Systematic desensitization aims to provide an individual with healthy or safe tools to address triggering situations.  In the case of someone with a selective eating disorder, to provide tools to better manage food aversions and phobias. During treatment, a child will work through a list of anxiety-producing foods, progressively learning to handle situations that produce increased anxiety levels. It is important to keep track of a child’s progress throughout treatment to ensure that their coping strategies are working and that their condition is improving.

The ability to manage selective eating disorder largely depends on the age one is at when symptoms develop. As an adult, seeking treatment is highly beneficial to learn safer and healthier ways to manage triggering and fear-inducing situations. As a parent, if you believe your child is struggling with a selective eating disorder, it is vital to reach out to their primary care provider or a mental health professional at Meadowglade. 

While their situation may indeed be picky eating, and it may begin to resolve itself, there is also a possibility that their symptoms are related to something more significant such as Avoidant Restrictive Food Intake Disorder or another form of disordered eating. As children grow, it is vital that they consume a well-rounded and balanced diet to ensure adequate growth, property attrition, and healthy development. 

Children who struggle with selective eating for extended periods, such as into their teen years and beyond, may experience new or worsening medical or mental health symptoms. If you would like to learn more about treatment for selective eating disorders, reach out to the admissions team at Meadow glade today. Let our caring and compassionate staff teach you more about how comprehensive therapy in our California treatment center can help. 

Sources

https://www.nationaleatingdisorders.org

https://doi.org/10.1177%2F1359104501006002007

https://www.wsj.com/articles/SB10001424052748704699604575343130457388718