Selective Eating Disorder: Symptoms, Causes, & Treatment

What Is an Eating Disorder?

An eating disorder is a mental health condition characterized by persistent disturbances in eating habits and related behaviors.¹ Eating disorders often involve a preoccupation with food, body weight, and shape, leading to harmful physical and emotional consequences.

Eating disorders can manifest in various forms, such as anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder (ARFID). The complexity of these disorders underscores the need for early recognition and comprehensive treatment approaches to address the condition’s physical and psychological aspects.

What Is Selective Eating Disorder (SED)?

Selective Eating Disorder, now known as Avoidant Restrictive Food Intake Disorder (ARFID), is characterized by limited food preferences, textures, or aversions that impact an individual’s ability to maintain a balanced diet.^{1, 2, 3, 4} Unlike some of the other eating disorders, ARFID is not driven by concerns about body image or weight.^{1, 2, 3}

ARFID focuses on the avoidance of certain foods due to sensory sensitivities, fear of negative consequences, or traumatic experiences related to eating. ARFID can lead to nutritional deficiencies and interfere with daily functioning.

The Difference Between Picky Eating and SED

While picky eating is a common behavior in children, Selective Eating Disorder, or ARFID, goes beyond typical fussiness. ARFID involves severe food restrictions, potentially leading to nutritional deficiencies and impairing daily functioning. The severe symptoms and effects of ARFID need specialized attention and intervention, distinguishing it from transient picky eating habits in children.

Signs & Symptoms of Selective Eating Disorder

Individuals with Selective Eating Disorder, or ARFID, often display specific signs and symptoms. These may include a limited range of preferred foods, avoidance of entire food groups, heightened sensitivity to sensory aspects of food, and resistance to trying new foods. ARFID can lead to nutritional deficiencies, impaired social functioning, and anxiety or distress related to eating situations.

Individuals with ARFID might exhibit challenges in the quantity and variety of foods consumed. Complications of the condition, when it affects children, include leading to potential weight loss or failure to achieve expected developmental milestones. The persistent avoidance of certain foods or food groups often goes beyond age-appropriate picky eating, impacting overall physical and emotional well-being.

Limited Food Choices

Individuals with Selective Eating Disorder, or ARFID, often exhibit a limited range of preferred foods.^{2, 3} They may be reluctant to try new foods, experiencing anxiety or distress at the mere thought of consuming non-preferred items.

Selective Eating Disorder goes beyond simple preferences, as those with ARFID may have strong aversions to certain colors, textures, or smells associated with specific foods, further restricting their dietary choices. The impact of limited food choices can extend to nutritional deficiencies and challenges in social and daily functioning.

Physical & Nutritional Consequences

Selective Eating Disorder, or ARFID, can pose significant health risks due to the restricted nature of the individual’s diet. Limited food choices may result in insufficient intake of essential nutrients, leading to nutritional deficiencies.² This can affect various aspects of physical health, including compromised immune function, developmental delays, and disrupted hormonal balance.²

In extreme cases, individuals with ARFID may experience weight loss and failure to thrive, impacting their overall growth and well-being. The restricted diet associated with ARFID can contribute to a range of health issues.²

Avoiding Social Situations Where Food is Present

Individuals with Selective Eating Disorder can avoid social situations involving food. The fear of being exposed to unfamiliar or non-preferred foods can lead to social isolation, as individuals may decline invitations to gatherings, parties, or meals with friends and family. This avoidance is driven by the anxiety and distress associated with the prospect of encountering foods outside their comfort zone.

The impact of Selective Eating Disorder on social interactions can affect relationships and the ability to engage in shared cultural or social experiences centered around food.¹ The avoidance of these situations may result in feelings of isolation and difficulty forming connections with others.

Heightened Sensitivity to Sensory Aspects of Food

Individuals with Selective Eating Disorder often display heightened sensitivity to sensory aspects of food, such as taste, smell, texture, and the appearance of certain dishes.^{2, 4} These sensory sensitivities can trigger intense aversions. The fear and discomfort associated with certain sensory experiences can contribute to the reluctance to try new foods or engage with a broader variety of textures and flavors.

This heightened sensitivity to sensory stimuli can also involve various other aspects of daily life. Individuals with Selective Eating Disorder may also exhibit sensitivities to other sensory inputs, such as sensitivity to bright lights, loud sounds, or certain textures in their environment.

Anxiety or Distress in Eating Situations

Individuals with Selective Eating Disorder often experience heightened anxiety or distress in eating situations.^{1, 4} The prospect of unfamiliar foods or pressure to try new dishes can evoke significant discomfort and may manifest as a strong aversion to social events involving food. Distress associated with eating situations can further contribute to limited food choices, perpetuating the cycle of selective eating disorder.

In social contexts where food is a central element, individuals with Selective Eating Disorder may navigate their anxiety by adopting coping mechanisms, such as avoiding events altogether, eating before attending, or bringing their preferred foods. This coping strategy aims to manage the distress and maintain a sense of control over the eating experience.

Avoidance of Entire Food Groups

Individuals with selective eating disorder often exhibit avoidance of entire food groups. This selective approach can result in the exclusion of essential nutrients, leading to nutritional deficiencies and potential health risks.² Avoiding entire food groups may stem from aversions to specific textures, tastes, or smells, contributing to the complexity of selective eating disorder.

Potential Weight Loss or Failure to Achieve Expected Developmental Milestones

Individuals with Selective Eating Disorder may experience weight loss or fail to achieve expected developmental milestones due to the restricted nature of their diet.² The limited food choices and avoidance of certain textures or flavors can contribute to inadequate calorie intake, affecting both physical and developmental aspects.³

Gastrointestinal Symptoms

Individuals with Selective Eating Disorder (SED) may experience gastrointestinal symptoms such as upset stomach, abdominal pain, or other digestive issues with no apparent cause.^{2, 3} The restrictive eating patterns characteristic of SED can lead to nutritional deficiencies and challenges in the digestive process, contributing to discomfort and gastrointestinal distress.

What Causes Selective Eating Disorder?

The origins and causes of Selective Eating Disorder, now known as ARFID, can vary. Some individuals may develop this disorder due to sensory sensitivities, making certain textures or tastes aversive. Traumatic experiences related to food, such as choking incidents, can also contribute. Additionally, anxiety and a fear of negative consequences associated with eating may play a role.

Sensory Sensitivities

Heightened sensitivities to textures, tastes, or smells can contribute significantly to Selective Eating Disorder, now recognized as ARFID.^{1, 2} Individuals with Selective Eating Disorder may find certain food characteristics overwhelming or unpleasant. This sensory aversion can impact their ability to explore new tastes and textures, reinforcing a pattern of restricted food choices characteristic of ARFID.

Past Traumatic Experiences

Food trauma, encompassing negative experiences like choking or forced feeding, can significantly contribute to the development of Selective Eating Disorder, now recognized as ARFID.¹ Such traumatic incidents create lasting associations between distressing events and food, leading individuals to develop aversions and anxieties surrounding certain foods or eating situations.

Anxiety & Control

Selective Eating Disorder, now ARFID, may be linked to anxiety and control issues.^{1, 2} Individuals with ARFID often exhibit a strong desire for control over their environment, including their food choices. Anxiety about certain foods or eating situations may lead to a restricted diet, offering a sense of control amidst the discomfort. People might not feel that they have enough autonomy, and this control over eating can help compensate for that.

Selective Eating Disorder Treatment

Individuals with Selective Eating Disorder can benefit from various therapeutic interventions. Cognitive-behavioral therapy (CBT) addresses distorted thoughts around food and gradually expands food acceptance. Exposure therapy exposes individuals to feared foods in a controlled manner, reducing anxiety. Family-based therapy involves families in the treatment process, fostering a supportive environment. These interventions combine with nutritional counseling and collaboration with healthcare professionals.

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy for Eating Disorders (CBT-e) is a valuable intervention for individuals with Selective Eating Disorder. It targets the cognitive aspects of restrictive eating behaviors, helping identify and challenge maladaptive thoughts around food. By fostering a healthier relationship with food, CBT-e facilitates gradual exposure to feared foods and encourages flexible thinking, contributing to a more varied and balanced diet.

Exposure Therapy

Exposure therapy plays a pivotal role in treating Selective Eating Disorder. By systematically introducing previously avoided or feared foods in a controlled and supportive environment, individuals can gradually desensitize and acclimate themselves to these foods. This process allows them to confront and overcome their food-related anxieties, expanding their range of acceptable foods.

Family Therapy

Family therapy is a valuable treatment option for Selective Eating Disorder when the eating patterns significantly impact family dynamics. It helps improve communication, understanding, and support among family members. Involving the family in therapy addresses potential conflicts related to food and encourages a collaborative effort to create a positive eating environment, fostering the individual’s progress in overcoming SED.

Nutritional Counseling

Dietitians or nutritionists play a crucial role in the treatment of Selective Eating Disorder by providing specialized guidance to individuals struggling with restricted food choices. They help create structured meal plans, ensuring nutritional adequacy while addressing the specific preferences and challenges associated with SED.

When to Find Professional Help for Selective Eating Disorder

When selective eating patterns become deeply entrenched or pose significant health concerns, seeking assistance from a therapist or nutritionist is crucial. These professionals can offer specialized support, helping individuals explore and challenge the root causes of their Selective Eating Disorder while guiding them toward healthier relationships with food.

Using an eating disorder app may be appropriate for those seeking additional tools and resources to complement traditional therapy or nutritional guidance. These apps often provide support, meal planning assistance, and community engagement. An online therapist directory can be a valuable resource for connecting with qualified professionals who specialize in treating eating disorders, including SED.