Understanding Picky Eating
By Abigail Natenshon, MA, LCSW, GCFP

 

An elusive disorder

Picky eating is a disorder that is rarely diagnosed as a clinical problem in today’s society where people assume that any form of restrictive eating represents “healthful” and disciplined eating.  Because picky eaters appear not to be afraid to eat certain kinds of foods, because their weight tends to fall in the realm of normal, and because medical and laboratory tests do not indicate atypical behavioral function, medical doctors tend not to note these conditions as problems or to consider this category of eating dysfunction pathological.  In addition, most doctors fail to assess the patient’s eating lifestyle in their evaluation of general health during the typical physical examination.  Compounding these problems, picky eaters tend not to recognize their condition as dysfunctional, other than to see themselves as misfits…nor do they understand that remediation and cure are available to them.

Picky eating will not take lives, as do the more lethal clinical eating disorders, but they do deprive their victims of life quality, of normal socialization, self-esteem and well-being.  They deserve to be recognized and treated.

Implications

Observable as early as birth to several months of age, oftentimes showing themselves in the first three years or in the early and latency years of life, these patterns of behavior do not go away; they are carried with the individual as a legacy into adult life and function, where they interfere with life quality, intimate relationships, employment relationships, parenting quality, etc. In almost 100 percent of cases that I have been aware of, pediatricians who see these problems in children reassure parents that if the child continues to grow normally and stay anywhere near what the growth charts report as normal, they can rest assured that these problems will prove to be nothing more than passing phases, or random food preferences soon be outgrown.  They are mistaken and mislead parents who, in the face of tenacious problems, are made to feel out of control of their child, and inadequate for not being able to accomplish a most basic parenting function… nourishing their child.  Oftentimes, they feel forced to resort to entertaining or punishing the child around food and eating, letting the child go hungry at times in response to the emotional tension in the home at mealtimes.  Children who do not function normally around food tend to act out in restaurants, are denied access to extended programs in school because of refusal to nourish themselves, are teased and shunned by peers, being made to feel shame and disgrace.

Causes

Picky or selective eating in children and adults represent neurological hard wiring problems including autism spectrum syndromes, certain types of non-verbal learning disabilities and sensory integration disorders. Individuals with sensory problems tend to be hypersensitive to smells, sounds, light and dark, textures, taste, etc, with  gagging and vomiting being typical responses to certain tastes, smells and textures in the mouth. Picky eating is also, in many instances, a clear indicator of obsessive compulsive disorder, phobias or other extreme forms of anxiety.  Recent research has pointed to an early childhood condition called PANAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) said to cause obsessive-compulsive disorder, and often accompanied with tics or Tourette's Syndrome, following strep throat. When strep goes undetected or untreated, in some cases the body can build up antibodies to the illness that mistakenly attack the brain, according to the theory. Obsessive-compulsive behaviors in Pandas patients may flare up when a child has repeated bouts with strep. In many cases, less pronounced OCD symptoms persist even when the child doesn't have a strep infection.

Solutions

It is preferable to deal with these problems by addressing them at their source, at the level of neurology and brain function and as early as possible, while the young brain is so fertile and malleable.  For this reason, the work of the Feldenkrais/ Anat Baniel Methods have proven to be particularly successful in reorganizing and creating new neurological pathways in young and newly forming brains.  Occupational and speech therapists deal successfully with brain retraining and behaviors as well.  It is my belief that picky eating adults also do well with brain-retraining through these techniques.  Adults and older children have the advantage, too, of motivational and cognitive capacities for relearning eating patterns through behavioral desensitization… through the extinction of dysfunctional behaviors and reinforcement of new and remediated ones.

Treatment

It is my belief that once picky eating has been diagnosed, the treatment methods must become as integrative as the effects of the disorder on the individual.  Picky eating is a syndrome that tends to fall through the diagnostic and treatment cracks.  Psychologists are sensitive to and treat feelings, not food; medical doctors treat physical disease and are not alarmed unless there is some form of growth disturbances, behaviorists treat behaviors outside the context of emotions and relationship.  Cognitive awareness is not enough; nor is behavioral desensitization when the techniques are performed outside the context of a psychotherapeutic relationship.  Picky eaters are human beings, with many levels of needs.  Picky eaters need to better know themselves, their strengths and their weaknesses, to trust their capacities to change and grow to feel motivated to exercise themselves emotionally to improve their condition.  The professional who diagnoses and treats these disorders must be integrationists who sees, respects, and treats all sides of a highly charged and multi-faceted problem. 

When the picky eater is a parent

It is particularly beneficial for picky eating adults to overcome their problem to whatever extent they can before starting families; children learn largely from a parents’ capacity to role model healthy eating and to prepare, handle and feel comfort with serving varied, healthy and nutritionally dense foods as regular family meals.  A question that would make for fascinating research is whether picky eating adults tend to give birth to children who become picky eaters because of a transfer of their genetic make-up, their own eating patterns and life style, or for women, what they ate (or did not eat) during their pregnancy.