Your friend invites you over for dinner, or perhaps your other half finally wants you to meet their parents at a fancy Chinese restaurant. No big deal, right? Wrong! You desperately Google the restaurant you’re going to, or try to work out what your friend will serve for dinner, and hope that it’s something you like, or at least something you can stomach. You fear hating everything and leaving your dinner untouched. Won’t your hosts be offended? They will assume you don’t like their cooking, or that they wasted money on you in the restaurant. Why did you agree to dinner in the first place?
You may immediately be perceived as a fussy eater, you are basically choosing not to eat. However, take an individual who cannot bring themselves to eat certain types of food even though they are starving. Can that really be classed as just fussy eating also?
Selective Eating Disorder (SED) is a term coined to describe individuals with an avoidance of certain foods based on their colour, smell and/or texture. It is also referred to as picky eating or food neophobia (Strochlic, 2012). When you hear the term eating disorder, your first thoughts might be Anorexia or Bulimia, both of which are triggered by an individual’s self-image and food choices are influenced by calorie content (Reel, 2013).
SED is an under-researched phenomenon that has led to wrongful assumptions by health professionals. One such assumption is that it only occurs in children. This could be due to the fact that children are more than likely to be treated because they are dependent on their parent/guardian who would be monitoring their child’s eating habits. An adult, on the other hand, may never seek help for their limited diet.
Fussy eating can start in childhood, which, if not treated properly, can lead to future dietary and health problems in adulthood. According to Sarah Keogh, a Nutritionist for the Irish Nutrition and Dietetic Institute, ‘There’s a very short window for [children] to get used to different flavours and textures. I think it’s between 6 months and 16 months that if children aren’t exposed to enough textures and flavours they start to refuse them.’
In some cases entire food groups can be avoided, e.g. vegetables. Leaving out a food group means the body is not getting its necessary intake of particular nutrients. Also, the food preferences of someone with SED may not necessarily be healthy. According to Reel (2013), adult selective eaters identified French fries and bacon as their chosen meals.
The lack of research not only leaves the prevalence of the disorder unknown, but it makes treating it a challenge. Felix Economakis, a chartered psychologist and clinical hypnotist from London, has treated approximately 300 people for SED in his clinic. He says he has experienced it in two forms: a phobic form and a sensory processing disorder (SPD). The phobic form, the more common of the two, occurs like most phobias: from a traumatic experience in childhood that creates avoidance of a certain food, e.g. choking on a particular food, or associating a food with an underlying stomach bug.
‘Once in my 20s I drank too much red wine and threw up a few times. I couldn’t even look at red wine for over a year. Now imagine being very little and having intolerance or [an] allergy to dairy or certain proteins, wheat, gluten or whatever, and getting repeated cramps when eating such foods. It’s no wonder the system will go into over-drive and refuse all potentially painful new foods.’
Such a phobia, he insists, can be treated in a one- to two-hour treatment session in his clinic using a mixture of therapies based on systemic therapy, Gestalt therapy, neuro-linguistic programming (NLP) and hypnosis.
SPD, on the other hand, is rare, and results from a sensory processing problem. Felix has encountered difficulty trying to treat ‘pure’ SPD in one session. ‘However, it should also be pointed out that I haven’t had the chance to see if I can change SPD over several sessions using hypnosis to change the focus of attention, stimulation or sensitivity.’
It is very possible for individuals to think they have SPD, when it is actually SED. ‘Many people I have successfully treated who made remarks about texture or smell at the start of the session assumed they had the SPD version,’ Felix continues, insisting that an individual’s perception is influenced by fear. ‘Once the underlying fear was removed, their perception was ‘uncontaminated’ by fear and they could assess food more objectively and problems with texture and taste simply cleared up.’
To make matters even more complicated, the disorder is constantly misdiagnosed by health professionals who have never heard of it. ‘SED often gets overlooked and misdiagnosed by doctors and therapists, as they confuse one with the other. Sometimes they diagnose SED/OCD/autism when it is extreme fussy eating and other times they diagnose fussy eating/OCD/autism when it is SED.’
Untreated SED can lead to physical and emotional problems, both in the long- and short-term. Physical long-term problems of selective eaters may include low energy, lethargy, irritable mood swings, poorer concentration, more frequent colds/coughs, sleeping issues, overweight/underweight, etc. However, emotional problems can also cause great distress; these include exclusion, sadness, guilt, self-esteem issues, self-consciousness, shame, problems keeping relationships, etc.
It clear that more research is needed on this disorder, something Felix agrees with based on the feedback he has received: ‘Most UK and US doctors and health professionals are clueless and recommend unhelpful approaches such as starving. They do not realise the difference between SED and fussy eating.’
In Ireland, it is a challenge to find a nutritionist or a dietician who has treated SED. Sarah Keogh admits that she has never treated an individual who has been officially diagnosed with this disorder, but has treated individuals who were classed (usually by the individuals themselves) as fussy eaters. ‘You would occasionally have an adult come in to be helped with their fussy eating and it’s almost always the feel of the food, whether it’s the texture, that it’s crunchy, or it’s difficult.’
As of May 2013, SED has been recognised by the fifth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-V), however, it is now called Avoidant/Restrictive Food Intake Disorder (ARFID). A diagnosis of this disorder is made if an individual does not show signs of ‘traditional’ eating disorders, such as anorexia or bulimia, but experiences significant disturbances with eating and food (eatingdisorder.org, 2013). Whether or not this acknowledgement by the manual will create better awareness of SED, among the public and/or health professionals, remains to be seen.