What Exactly Is Selective Eating Disorder?

Photo: Alexandra Gavillet
These days, we’re totally obsessed with what we put in our mouths. Whether you’re gluten-free, anti-cows’ milk or completely vegan, there’s probably at least one food that you won’t eat. But what if you literally couldn’t put a certain food in your mouth? What if, no matter how hard you tried, you were so afraid of a food or food groups that to get a morsel of that food past your teeth was a task too mountainous to comprehend? Some people see this as 'picky eating'; others see it as Selective Eating Disorder (SED) or Avoidant/Restrictive Food Intake Disorder (ARFID). SED isn’t widely accepted. In 2013, it was acknowledged as a category of eating disorder in the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5 to its friends) but in the UK, it’s another story. Deanne Jade, founder of the National Centre for Eating Disorders told us that “Selective eating is another word for faddy eating, and is not an eating disorder.” She says that psychologists in the UK are “not comfortable” with the classification “ARFID” and that DSM-5 has “complicated the field by giving eating problems too many descriptions which are not clinically useful.” One man in the UK claims SED is very real indeed, though. Felix Economakis, chartered counselling psychologist and clinical hypnotist, says he first became aware of the disorder when he appeared in a documentary series that aired on British TV back in 2007. In the series, he’d meet people who seemed not only apathetic about certain foods but actually scared of them. Since then, he says he’s treated hundreds of people with phobias of certain foods, or food groups. According to Felix, there is a difference between SED and 'picky eating'. He says that the two often get confused but that SED is a “proper phobia” and describes a person who is unable to eat or swallow certain foods, even if they really want to.

People will say, 'I really like the look of it, or the smell of it, but I physically can't get it past my teeth'

Severity levels differ. Felix has worked with people who literally just eat bread. Nothing else. Just bread. Which – while terribly unhealthy and certainly not something a dietitian would ever recommend – can, in dire circumstances, be a semi-sustainable diet. “In every cell in bread, there is a bit of protein,” explains Felix. “There’s carbohydrates, there’s fats – so it’s not a varied or ideal diet and you’re not going to be the healthiest person in the world but I’ve had people live off just one food for a decade.” More common, he says, are people who will eat three, four, even 15 different types of food which, on the face of it, may sound like a lot, but is actually nowhere near the wide range of foods you probably consume in a normal day. “It gets confused with fussy eating when it’s not, it’s a phobic response to certain foods,” Felix says. “People will say, 'I really like the look of it, or the smell of it, but I physically can’t get it past my teeth.'” So what does Felix think is the most common cause of SED? He offers three reasons (although, as with anything when it comes to the mind, it’s never black and white); the most common is “food PTSD”. This might occur when someone has an unpleasant experience with food – gastroenteritis, for instance, or choking: “The system will get fed up and be like, ‘Ok, what caused this? Ok, food. I can’t handle that food any more.’” For other people, issues with certain foods may arise from a sensory processing problem. “Some textures might feel too crispy, or too wet, or too fuzzy, or whatever the case may be.” The final reason he gives is a shift in family dynamics. “People might be like, ‘My child was eating normally, then we got divorced or moved country and all of a sudden he is really fussy with his food’. If you’re a child especially, you like security and routine and if that’s suddenly taken away from you then you try and overcompensate with things you can control and that often can be food.”
Photo: Alexandra Gavillet
Has he noticed fear of one food or food group in particular come up time and again during his work? According to Felix, any food group can be considered ‘unsafe’ or ‘safe’ but some crop up more than others. “In general, I tend to hear of the ‘toddler’ diet,” says Felix. The toddler diet is bread, chips, chicken nuggets – the kinds of things that people eat when they’re young. The reasoning for this, Felix reckons, is because this food is perceived as 'safe' to the body. It’s easily digestible, it’s familiar, it’s bland. “The first thing to go tends to be vegetables because vegetables come in all shapes and sizes. Some you eat raw, some are squishy, some are hard… you know where you stand with toast and chips – they're predictable.” The day-to-day impact of being unable to eat a wide range of foods – for whatever reason – is undeniably huge. Imagine starting a new job and being incapable of eating in front of your colleagues. Imagine dating and not being able to go for a meal or getting into a relationship and having to explain to your new significant other that no, as a fully-fledged grown-up, you cannot eat green vegetables because, well, you’re scared of them. “It’s so serious to the people I work with,” Felix says. “The other day, someone told me that his fiancée broke up with him because she said that when they first got together she thought she could resolve his selective eating if she cooked for him and he had good food. Now, several years down the line, she’d finally realised she couldn’t and she didn’t want her children growing up with it.” As with most anxiety issues, Felix believes that the longer they are left untreated, the worse they can get. So what is the treatment? When Felix started looking at cases, he assumed he was dealing with sensory processing disorder (a clinical term for individuals who display abnormal behavioural responses to certain sensory inputs) but soon rejudged. “I thought if it acts like a phobia, then it probably is a phobia.” He claims to treat instances of SED with “phobia protocol” and maintains that he experiences a very high success rate. How do you know if you’re affected? Felix says he asks potential patients if there is a food they would like to eat but can't, "regardless of bribes, threats, pushing yourself and willpower". And if the answer is "yes" then he says that person has a "block", an "actual fear" that is stopping them from eating that food. Whether or not SED is recognised by the medical community, it is clear that there are people who are affected by not being able to eat certain foods. The ARFID subreddit makes for a heartbreaking read, as people trade stories, tips and personal wins and losses when it comes to food intake. The top-rated post is from someone sharing their pride at having managed to eat an entire slice of pizza for the first time. And they're not the only ones. There are plenty of other forums and blogs dedicated to SED and ARFID – something which Felix recommends as a good starting point for those that are suffering. “The easiest way to deal with it is to see someone who knows what they’re doing – join forums, support groups and just don’t be alone!" “People say to me, ‘I thought it was just me. I thought I was just being weird at 43 years old.' And then they realised it was a condition that could be helped. You are not alone.” If you are struggling with an eating disorder of any kind, please give Beat a call on 0345 634 1414. Confidential support and information is available 365 days a year.

More from Diet & Nutrition

R29 Original Series