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 restrictive eating represents
"healthful," discerning 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
consider these conditions to be problematic for the patient or to consider
this category of eating dysfunction pathological. In addition, most doctors
fail to assess the quality of the patient's eating lifestyle in evaluating
general health during the typical physical examination. Compounding these
problems, picky eaters tend not to recognize their condition as
"dysfunctional" though they see themselves as misfits…nor do they recognize
that help and remediation 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 and of normal
socialization, generally leading to overweight in adult years, and
diminishing the individual's self-esteem and well-being. These problems
deserve to be recognized, addressed and treated as early in life as possible
to insure successful treatment outcomes.
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 by themselves.
Instead, they are carried with the individual as a legacy into adult life
and function, interfering with intimate relationships, employment
relationships, parenting quality, etc.
In almost 100 percent of cases that I am aware of, pediatricians who see
these problems in children reassure parents that if the child continues to
grow normally and stay anywhere near a weight that the growth charts show to
be normal, they can rest assured that these problems will prove to be
nothing more than passing phases, or random food preferences soon be
outgrown. These views are myopic, mistaken and misleading to parents who, in
the face of tenacious problems, are made to feel out of control of the
situation, the health of their child, and themselves as effective parents in
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 mealtimes, letting the child go hungry on
occasion in response to the emotional tension in the home during meals.
Children who do not function normally around food tend to act out in
restaurants, may be denied access to after-school programs because of their
refusal to nourish themselves, are teased and shunned by peers, being made
to feel shame and disgrace.
Picky or selective eating in children and adults are not representative of
simple food preferences, but of 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 typical responses to certain tastes, smells and
textures in the mouth. Picky eating is also, in many instances, an indicator
of obsessive compulsive disorder, phobias or other extreme forms of anxiety.
In some instances, these conditions may follow premature birth and early
intubation, or other trauma around eating, digestion, and the function of
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 with
repeated bouts with strep. In many cases, less pronounced OCD symptoms
persist even in the absence of strep infections. It is important to note
that in the case of severe anxiety, food phobias, OCD, the use of
psychotropic medications can be of great use to ameliorating a brain
chemistry condition that exacerbates, and is exacerbated by, these
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, along with holistic therapists, deal successfully with brain
retraining and behaviors as well. It is my belief that picky eating adults
also benefit from 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.
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. The
problem occurs not only within individuals, but also within family systems.
Picky eaters need to come to better know themselves, their strengths and
their weaknesses, to trust their capacities to change and grow, and to feel
motivated to exercise themselves emotionally to improve their condition.
Professionals who diagnose and treat these disorders must be
integrationists, seeing, respecting, and treating all sides of a highly
charged and multi-faceted problem simultaneously.
When parents are also picky eaters
It is not unusual to find that picky eating syndrome runs in families,
partly because the condition is genetically and biologically determined, and
partly because the condition can be exacerbated by environmental triggers in
the home around food and eating behaviors. 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 might have a greater tendency 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 because of what women ate (or did not
eat) during their pregnancy.
A foremost expert in the treatment of eating disorders, Abigail H.
Natenshon, MA, LCSW, GCFP is a psychotherapist who has specialized in the
treatment of children, young adults and their families for the past 40
years. The author of When Your
Child Has An Eating Disorder: A Step-by-Step Workbook for Parents and Other
Caregivers and Doing
What Works: an Integrative System for the Treatment of Eating Disorders from
Diagnosis to Recovery, Natenshon is the founder and director of Eating
Disorder Specialists of Illinois: A Clinic Without Walls. She hosts three
informative, interactive web sites, including www.empoweredparents.com,(for
patients and parents) www.empoweredkidZ.com, (a wholesome alternative to the
pro-anorexic web sites), and www.treatingeatingdisorders.com, (an educative
site for mental health professionals.) She has appeared on national
television as an eating disorder expert for The Oprah Winfrey Show and The
John Walsh Show, as well as for MSNBC and National Public Radio.
Her latest book, Doing What
Works: an Integrative System for the Treatment of Eating Disorders from
Diagnosis to Recovery (NASW
2009) devotes an entire chapter to understanding picky eating syndrome in
children and adults, as well as other childhood feeding dysfunctions.
Abigail is also a Guild Certified Feldenkrais Practitioner with a Masters
certification in the Anat Baniel Method based on the work of Dr. Moshe
Feldenkrais. She has become an innovative leader in using these Methods to
augment more traditional approaches to treating patients with eating
dysfunctions and body image disturbances. Having served as a field
supervisor for several graduate schools of social work, Ms. Natenshon has
recently joined the teaching faculty of Lesley University's Self-Designed
Masters Degree Program in Boston and Cambridge, MA.
Abigail maintains a private practice in Highland Park, Illinois where she
resides with her husband.