Are you a picky eater or is your aversion to certain foods so strong, you’re physically unable to eat them?
Medically reviewed by Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP and words by Natalie Healey
If your kid refuses to eat their five-a-day in favour of Turkey Twizzlers, you may be worried that their health is at risk. But while dinner time might feel like a battleground right now, don’t lose hope. The good news is most youngsters do grow out of their picky ways and start to explore a more varied diet as they develop. But what happens if they don’t?
Psychologist Felix Economakis says there could be a medical condition at play that can lead to problems with all aspects of life, from health to work and relationships. He believes the condition, called selective eating disorder (SED), is a serious, life-changing illness which is often dismissed by health professionals.
What is selective eating disorder?
SED is an aversion to certain foods that is so strong, it can seriously limit sufferers nutritional options. ‘I often say fussy eating is when a person won’t eat a food because there’s something imperfect about it,’ says Economakis. ‘They only want pure white chicken breast, for example. But selective eating is very different. There’s a lot of people who would like to eat these foods but they’re physically unable to do it.’
Those with selective eating disorder can end up eating the same kinds of things and nothing else well into adulthood.
How selective it is depends on the individual. Many of Economakis’ patients can’t even put the offending foods near their mouths. Some can’t even be in the same room as certain foods. And no bribe or incentive will do the trick. SED varies in severity but generally results in people that can eat, but consume very few different things.
Sufferers tend to be able to eat white bread, potatoes and plain pasta. Occasionally breaded chicken is also acceptable. Such foods are commonly referred to as a ‘toddler diet’. But those with selective eating disorder can end up eating the same kinds of things (and nothing else) well into adulthood. And even they believe that they’re just being silly.
Selective eating disorder and the brain
But why can’t they just snap out of it? Economakis explains that sometimes the brain is just dead set against eating certain foods. It truly believes that if you eat that food, you will be harmed.
‘The system gets it wrong,’ he says. ‘It’s an imperfect defence system. I’ve seen no end of people with different phobias – some of them quite understandable. But that also includes puppies and kittens and a fear of balloons. So sometimes the brain has a difficulty understanding danger threat levels.’
Is selective eating disorder picky eating?
Economakis says he’s seen more than 2000 patients who had previously been dismissed as ‘picky eaters’ and for the vast majority their condition really does seem to be a sort of food post traumatic stress disorder.
He also believes children are super-tasters and generally find vegetables far more bitter than adults do, which is why you might struggle to get them to eat a varied diet. ‘The government’s trying to give us five-a-day, and I think some children’s taste buds are simply not ready,’ he suggests.
Economakis has seen more than 2000 patients who had previously been dismissed as ‘picky eaters’.
But many of Economakis’ patients also tell him that in hindsight their problem probably has nothing to do with the food itself. Perhaps they had glandular fever or tonsillitis or norovirus and SED developed after that.
‘The brain doesn’t understand bacteria or viruses when you’re a little child. All it knows is – I feel lousy so it must be food. What else could be making me sick. So it blames food. What’s the food I trust? So instinctively these are safe foods because they’re simple – they’re unthreatening, they taste nice, so we go for potatoes and bread and we avoid the crunchy vegetables because it’s more of a stretch compared to toast,’ he explains.
The impact of selective eating disorder
SED can be more problematic in adults than children, and people can suffer very real distress because they’re unable to eat things. Economakis runs a forum of over 2000 people with the condition. He’s lost count of the emails he’s received from sufferers blaming the disorder for a relationship breakup or the fact they’ve lost out on a promotion because a dinner with a client is simply out of the question. And of course, their health suffers too.
‘A lot of people will have some fairly severe illness from this,’ explains Economakis. ‘A lot of them will say they get tired very quickly. But people also tell me that they have to go to hospital and get injections for this and be force-fed with tubes. I mean, shoving a tube down your throat is pretty unpleasant. You’d think they can’t be fussy because if it’s a choice between eating something and going to hospital to be fed with a tube, it’s a no-brainer.’
Selective eating disorder cure
Can SED be cured? The solution, Economakis believes, is to treat the disorder like a phobia, rather than a clear-cut eating disorder. He has developed an online video training treatment which can be accessed by anyone for a fee. He also does a lot of work over Skype.
Peer support can make a huge difference too – there are lots of forums and blogs dedicated to SED which could be a good starting point for finding support and feeling less alone.
The solution is to treat the disorder like a phobia, rather than a clear-cut eating disorder.
Economakis also stresses that if you’re a parent at the end of your tether with a child who will only eat a handful of foods, you must not blame yourself. ‘It’s not the parent’s fault,’ he says. ‘A lot of mental health professionals who should know better look to the parent for the problem. And 90 per cent of the time, the parent is absolutely blameless.’
Is selective eating a genuine disorder?
Some doctors are sceptical and not every medical professional is convinced about SED. But in 2013, it was acknowledged as a category of eating disorder in the DSM – the US manual of mental disorders used by clinicians and psychiatrists to diagnose psychiatric illness. But many mental health professionals feel uncomfortable with its addition over here in the UK.
In the US classification SED comes under the umbrella of ‘Avoidant Restrictive Food Intake Disorder’. It can lead in some cases to nutritional deficiency, weight loss (not all cases) and mental and emotional distress. Studies have shown some overlap with anorexia nervosa, but sufferers are not motivated by weight loss or change in size. As is understandable, suffering as an adult leads to great anxiety around social events centred on food and just general ‘everyday eating’ in public. Work lunch scenarios can be feared.
Selective eating disorder treatment
Various treatment types have been documented in the US as helping – Cognitive Behavioural Therapy (especially that focussed on the emotional side of symptoms) which may deal with exposure to certain foods and methods to deal with the resulting anxiety.
Learning mindful techniques to deal with that ‘moment with food’ can help and group therapies and group meals have been tried in a supportive setting. Group work may also focus around the act of grocery shopping itself as well as public eating.
There is obviously a huge spectrum between simply being a slightly ‘picky eater’ and suffering more severe symptoms such as this as a child or adult. Discuss serious symptoms with a health professional.
Further help and support
There are lots of places you can find additional help, advice and support for people of all ages suffering from eating disorders:
- Beat:charity offering support and advice to sufferers and their loved ones.
- Sane:this UK charity runs a helpline, which you can call for support and advice.
- Young Minds: charity fighting for children’s and young people’s mental health.
- Anorexia & Bulimia Care: national UK eating disorders organisation.