Selective Eating Disorder
What is selective eating? Selective eating comes under the umbrella of Avoidant Restrictive Food Intake Disorder (ARFID). More than 50% of eating disorders fall below the threshold for diagnosis as Anorexia or Bulimia or Binge Eating Disorder and fall into this spectrum of diagnoses. It is far more than just being a fussy eater; people with ARFID may have a phobia about certain foods, a very restricted diet, sensory aversions to certain tastes, textures or even swallowing.
The Diagnostic Manual version 5 (DMS5) introduced ARFID to describe patients who struggle with impaired and distressing eating behaviours and symptoms but who don’t have the weight and body image-related concerns associated with anorexia and bulimia.The lack of nutrition caused by the condition could have serious implications for the person’s future health.
How do I know if I have selective eating?
Selective eating disorders can affect adults as well as children.
The psychological symptoms of selective eating include anxiety and depression, as well as social impairment. A person with selective eating will only eat foods they consider to be safe or acceptable, avoiding foods with a particular taste, texture or colour. Some may dread the thought of certain foods, and cannot bear to touch or even be near them.
Selective eaters frequently have an aversion to entire food groups such as fruits, vegetables or pulses.
People with selective eating often become distressed when they are encouraged to try different foods, either because of a phobia, or fear of choking or vomiting as a result of eating it.
The majority of selective eaters do not have weight issues, and are generally within the normal BMI range.
What are the causes and effects of selective eating?
Trauma can often be the cause of selective eating which is brought on by something as simple as an unpleasant experience with a particular food, such as choking or having witnessed someone choking. If your system associates certain food with danger, it will try and protect the body by provoking anxiety whenever there is contact with it.
Childhood events can also trigger the problem, such as a divorce or moving house. Selective eating becomes a way of people trying to exert control over their lives.
Selective eating problems can also be caused by sensory processing, and is down to the texture or feel of food in the mouth.
If the condition is severe enough, the person may suffer from malnutrition with consequent physical problems such as digestive problems, electrolyte imbalances, low blood pressure and a slower heart rate.
Selective eating treatment
Ellern Mede follows NICE guidelines which suggests Cognitive Behavioural Therapy and Family Based Therapy are treatments of choice for people with eating disorders. We also employ a range of psychological approaches including motivational enhancement therapy and cognitive remediation therapy. For young people with restrictive types of eating disorder, family based therapy is an effective intervention. For people with avoidant/aversive eating disorders there is evidence from the eating recovery centre in the United States, that a treatment called Exposure and Response Prevention (ERP), formerly used to treat addictions or anxiety, is useful for selective eating disorder when used in combination with CBT. ERP used in combination with CBT is said to be delivering longer-term cessation of eating disorder behaviours.
ERP helps patients engage in recovery-focused behaviours even when they feel least like doing so. It challenges their avoidance behaviour.
Ellern Mede’s patient-centred approach is tailored to each person’s life circumstances and health needs.
Selective eating recovery
Selective Eating is a relatively new diagnosis within eating disorders and research of treatment outcomes is needed, however, anecdotal evidence suggests that treatments can be extremely effective.
For more information from a recent research study published by Norris, Spettigue and Katzman (2016) in Journal: Neuropsychiatric Disease and Treatment ‘Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth’. Click here to read more.
Dr Hind, thank you for saving my life. I used to think it was food that made my tummy ache but you helped me understand that it was anxiety that gave me that pain. My family are all so pleased that we worked with Colette and Nina in therapy. I may still have my moments but I am no longer afraid.
Ellern Mede has provided specialist Tier 4 eating disorder services to the NHS since 2000. We respond to referrals within 24 hours.
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