Selective eating disorder is an under recognized and under studied eating disorder. It is often thought simply to be ‘fussy eating’. It is most common in young children but can persist through adolescence and adulthood. People with selective eating disorder will refuse to eat or even try new foods; foods that are not considered ‘safe’ by them. In extreme cases a person may refuse entire food groups and survive on only a few different foods. Obviously, this pattern of eating if left untreated can lead to malnutrition and other health problems. Therefore, it is important to pursue selective eating disorder treatments as soon as possible, and not to disregard severe ‘fussy eating’ in children as a phase that will be grown out of.
Selective eating disorder is often considered more similar to phobias and obsessive compulsive disorder as opposed to other eating disorders such as anorexia nervosa and bulimia nervosa. This is because the refusal of certain foods in selective eating disorder appears to stem from a fear of the food, often due to a previous experience of choking on the food or because the food is similar in smell, taste or texture to another feared stimulus, or from a fear that the food is in some way dirty. In eating disorders such as anorexia nervosa and bulimia nervosa refusal of certain foods is based on body image and a desire to be thin.
Cognitive Behavioral Therapy for Selective Eating Disorder
Given its similarities to phobias and obsessive compulsive disorder, selective eating disorder can be effectively treated with cognitive behavioral therapy. This is done by challenging the irrational thoughts patients have about the foods they will not eat, in the same way that those suffering from phobias are challenged about their irrational fears. An exposure component, such as systematic desensitization may also be used. This involves encouraging the patient to try new foods in small steps, so as not to overwhelm them, which is especially important in children. A patient may be asked to first smell a food, and then to pick it up, and then to lick it before being asked to actually consume it. Treating children with cognitive behavioral therapy will often also involve a reward system to reinforce the desired behavior. With adults, treatment is usually reward enough.
Family Therapy for Selective Eating Disorder
Family therapy is also an option for selective eating disorder treatments; particularly in conjunction with cognitive behavioral therapy. A child’s selective eating can cause great anxiety in their parents as they worry about their child’s health. This anxiety can lead to increased conflict within the family unit and may be projected onto the child or the other parent. Feelings of depression, anxiety, anger, resentment, guilt and shame may follow which can harm familial relationships and may even lead to the breakdown of the family unit. Family therapy serves to remove blame from any one person and allows family members to strengthen their bonds in order to best cope with the child’s selective eating disorder.
Jaffa, T. & McDermott, B. (2007) Eating disorders in children and adolescents. Cambridge: Cambridge University Press.
Garner, D.M. & Garfinkel, P.E. (1997) Handbook of treatment for eating disorders. Guilford: Guilford Press.