Understanding Selective Eating Disorder: What it is and How it Affects Individuals

By Ivana Smith April 24, 2023

Are you or is someone you know a picky eater? Some extremely picky eaters may have an eating disorder called Selective Eating Disorder or SED, also known as Avoidant/Restrictive Food Intake Disorder (ARFID). This relatively new mental health condition is still not widely known or understood. This condition affects an individual’s relationship with food, causing extreme anxiety and fear of trying new foods or textures. But what is SED, and how does it affect individuals’ lives?

Often, picky eating does not interfere with weight status, growth, or daily functioning. However, people who experience consequences such as these due to extremely picky eating may need treatment.

Defining Selective Eating Disorder

SED is a condition where an individual’s ability to eat is limited by a set of restrictions they have set for themselves. These constraints include specific food textures, colors, tastes, and nutritional value. Those individuals with SED often have a limited diet, leading to a risk of malnutrition and other medical complications.

SED is not the same as picky eating or simply avoiding certain foods due to personal preference. Instead, SED individuals tend to have an irrational fear of trying new foods, leading them to stick to familiar options, often above their nutritional needs, as they offer an illusion of safety and control.

What is Food Selectivity?

Food selectivity is the consumption of an abnormally limited variety of food. Technically, any child who eats fewer foods than normal and who avoids any foods could be called food selective. However, we usually reserve this term for children who avoid one or more entire food groups.

The four food groups as we define them are:

1) Cereals, grains, and starches

2) Protein foods (meats, eggs, cheese, legumes)

3) Fruits and vegetables

4) Dairy products.

What is the difference between a “Picky” Eater and a “Selective” Eater?

Picky eaters may eat a limited number of foods but eat at least one or two from each food group. They have more balanced diets than selective eaters.

Selective eaters have aversions to many more foods or have unusual dislikes. For example, selective eaters may avoid all cereals, all meats, all cold foods, all foods with red color, all crunchy foods, all fruits, and vegetables, etc.

A child who eats no more than five foods would also be considered a selective eater. A typical food-selective diet might include pizza, chicken nuggets, milk, and nothing else.

Symptoms of SED

The symptoms of SED may vary from one individual to another, with some people experiencing mild to moderate issues while others may have severe symptoms. Some common symptoms of SED include:

Refusing to try new foods or textures
Restricting food intake to a few specific options
Avoiding whole food groups, such as fruits or vegetables
Being highly sensitive to textures, smells, or flavors
Feeling anxious or upset when presented with new foods

What Is ARFID?

Avoidant restrictive food intake disorder (ARFID) is an eating disorder similar to anorexia. Both conditions involve intense restrictions on the amount and types of food you eat. But unlike anorexia, people with ARFID aren’t worried about their body image, shape, or size.

Many children will have phases of picky eating. But ARFID (which doctors used to call selective eating disorder) is different. Someone with ARFID doesn’t eat enough calories for their bodies to work properly. In kids, this can lead to delayed weight gain and growth. In adults, ARFID can not only cause dangerous weight loss, but it could also keep them from being able to maintain basic body functions.

Causes

Doctors don’t know what causes ARFID. Some experts believe that people who get it might have extreme sensitivity to taste or texture. They might have had a bad experience with food — like choking or vomiting — that makes them fearful or anxious about food.

People most likely to get ARFID include:

Children who never outgrow picky eating
People on the autism spectrum
Those with ADHD

Kids with ARFID often have anxiety disorders. They also have a greater chance of other psychiatric issues.

Symptoms

Some of the physical signs of ARFID are like those of anorexia. They include:

Severe weight loss
Lack of appetite
Abnormal menstrual periods
Stomach cramps and pain
Constipation
Trouble concentrating
Low iron or thyroid levels
Slow heart rate
Dizziness or fainting
Feeling cold all the time
Dry hair, skin, and nails
Fine body hair growth
Thinning of hair on the head
Muscle weakness
Weakened immune system
Poor wound healing
Cold hands and feet
Swollen feet

People with ARFID might have behavioral or psychological symptoms, as well. For example:

The need to dress in layers to hide weight loss or stay warm
Drastic restriction in the types or amount of food they’ll eat
Difficulty eating with others
Fear of vomiting or choking

It’s worth noting that SED can affect anyone, regardless of age or gender. Therefore, seeking help from a qualified health professional is essential if you have concerns about your eating behavior.

Causes of SED

The exact cause of SED is unknown, although several factors could contribute to its development. Some of these factors include:

Genetics: there is evidence that SED has a genetic component that predisposes some individuals to the condition
Trauma: SED can develop after a traumatic event or experience with food, such as choking, food poisoning, or a severe allergic reaction.
Sensory processing issues: those with SED can have difficulty processing sensory input, making foods with strong or unfamiliar flavors or textures uncomfortable or even painful to eat.
Medical condition: History or tendency toward digestive problems such as reflux or complex medical history that affected interest in or ability to eat, like chronic constipation.

How to diagnose selective eating disorders

To determine if you have ARFID, your doctor will ask questions about your eating habits. They’ll want to know if you:

Have a lack of interest in eating
Avoid food based on things like texture or how it looks or smells
Are very concerned about things that can happen to you while you eat, like choking
Take a lot of nutritional supplements
Use a feeding tube
Only have eating trouble during bouts of anorexia or bulimia

They’ll also check to see if you have the following:

Very low weight or major weight loss
Malnutrition
The trouble with daily tasks
Another medical condition or mental disorder that better explains the problem

Treatment Options for SED

SED is a highly treatable condition but requires a comprehensive treatment approach addressing the underlying causes and symptoms. Here are some treatment options for SED:

Nutritional counseling: a registered dietitian can help individuals with SED develop a balanced and varied diet that meets their nutritional needs. This personalized meal plan is focused on enhancing your nutrition and dealing with your feelings about food.
Cognitive-behavioral therapy: a type of therapy that addresses the thoughts, emotions, and behaviors that contribute to SED. This therapy can help individuals learn new coping mechanisms and techniques for managing anxiety.
Exposure therapy: gradually introducing individuals to new foods and textures in a controlled and supportive environment.
Medications: Sometimes, medication may be prescribed to manage symptoms or underlying conditions contributing to SED.
Therapy: Meetings with a psychiatrist or psychologist to treat other mental health conditions that could affect your ARFID

Conclusion

SED is a challenging and highly misunderstood condition affecting individuals of all ages and genders. Understanding the symptoms and seeking help from a qualified healthcare professional if you suspect you may have SED is essential. With the right treatment and support, learning to manage your symptoms and developing a healthy relationship with food is possible.