Picky Eating vs. Selective Eating Disorder

It weighs heavy on my mind, the negative comments from those who don’t live with Selective Eating Disorder (SED). One would think that someone who didn’t know anything about the subject might choose to ask questions instead of offering ridiculous suggestions. Unfortunately, logic escapes many who seem to have an uncontrollable urge to wedge their foot firmly into their mouth. Oh, the irony; reading words from someone with a mouthful of shoe about people who can’t eat but only a handful of foods.

A sample of some comments from The Wright Stuff’s Facebook Page

SED is not picky / fussy eating. Picky eating is a temporary childhood phase. SED usually has an underlying cause. There is always a reason that explains why a child refuses food. Despite what the ‘sole’-seeking, armchair critics might like to think, shipping a child or adult with autism or a digestive disorder to a third world country isn’t going to fix their diet any more than it will change the qualities of the food they cannot eat.

Trying to explain that SED is not just picky eating is hard. Not everyone shares the same medical history. Not everyone eats the same foods. Not everyone answers “yes” to all the points on the chart that follows this paragraph. There is, however, a distinct difference between picky eating as a typical phase of childhood development and someone with SED.

sed vs picky

image © Mealtime Hostage, 2012

The shoe chewing crowd could argue that SED is not really an eating disorder, after all, it’s not in the current version of the DSM. I say, “Keep munching away on that sneaker.” I have yet to speak with anyone who has SED that doesn’t struggle with eating socially to some degree. At a restaurant, the garnish (often an offensive pickle) is leaking juice onto their food; a repulsive sauce has contaminated part or all of their meal. Family gatherings are often dreaded for the overwhelming smells, and the food that is expected to be eaten. Adults with SED learn creative ways to bear the relentless teasing, and the remarks about what isn’t on their plate.

Any event that creates a pattern of behavior that significantly impacts social interaction and/or creates distress for the individual experiencing these symptoms meets the criteria for a disorder. Just because it has not been added to current or previous editions of the DSM or any other medical textbook, does not make Selective Eating Disorder any less real. What it does mean, sadly, is that those with this particular eating disorder have a great deal of difficulty finding treatment for it. Parents, like me, depend on advice and suggestions from other parents of kids with SED, and adults who have grown up with it. Many adults with SED never had anyone take their disordered eating seriously. They have just learned to live with it, a strategy that often involves hiding their limited diets from others by avoiding situations that involve eating socially.

For all the quirks that make it so difficult to describe, there is one unifying truth among people with SED. All of them … Every. Last. One… would, if they were able, willingly choose to eat normally.

UPDATE Added July 5, 2013

Selective eating disorder was officially added to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders in May 2013, and renamed Avoidant/Restrictive Food Intake Disorder.

At the time of the original post, the group of parents and adults that collaborated to create the above chart were aggravated and incensed by the lack of available information on selective eating. Parents, like myself, were fed up with being placated and dismissed with “he’ll grow out of it” while Duke University’s adult picky eating study had heard from over 30,000 respondents. This post continues to attract adults who had no idea there are others who also struggle with eating socially, avoid entire food groups, and often live off a diet that often consists of 30 items or less.

This same post has also attracted knowledgeable feeding professionals who have contributed significantly to the conversation about selective eating.

Speech Language Pathologist, Jennifer Hatfield from Therapy and Learning Services in Indiana describes picky eating as a spectrum, rather than a comparison between extremes.

“A selective eater will NOT “eat when they get hungry.” If you implement a technique designed to “wait them out” or “exert your parental control,” if you alter one of their 10-20 foods, you risk having that food drop out of their food list forever. That. Can’t. Happen. because that would mean lower intake which then would translate into weight loss, nutritional concerns etc..and MORE stress for the child and family.”

Ellyn Satter, Registered Dietitian Nutritionist, Family Therapist and internationally recognized authority on eating and feeding describes eating in general as a spectrum. Developing eating competence is a progression of sequentially satisfying one’s food needs at one level before addressing the needs at the next.

Satter hierarchy of food needs

The foundation of Satter’s Hierarchy of Food Needs rest on getting enough food to eat (extreme poverty), followed by having access to acceptable food (unspoiled food, food you are not allergic to). Only after achieving reliable access to food (able to acquire a food stash, and plan for subsequent meals) can people start to consider food selection in terms of taste and appearance.

How does this work with adult picky eating? Consider popular parenting techniques of the 1960s, 70s and 80s and how a parent would be advised, even encouraged to respond to a picky eater. A child who is repeatedly sent to bed hungry for not touching anything on their plate, declining the vegetable, or gagging on the chicken is not learning that there is a constant and reliable access to food. Despite the full pantry, this particular child is growing up with food acceptance skills at the very bottom on the food needs hierarchy. As a result, the need to satisfy hunger is commonly met with energy dense, low nutrient carbohydrates.

Once people learn they can readily access enough, acceptable, reliable, and good-tasting food, only then are they able to comfortably consider novel food and finally, choosing what to eat for instrumental purposes (calories, specialty diets, etc).

It’s common for the adult picky eater to refer to eating as “a chore.” Adult PEs at the lowest levels of food acceptance tend to see food in terms of “edible” and “repulsive”, often wishing all their caloric and nutritional requirements could be met with a supplement to avoid eating all together. With this in mind, adult picky eating is less about being stubborn and hard-to-please and more about living in a food-focused society with under-developed food acceptance skills.

In terms of helping the adult picky eater embrace or expand what they can eat, Satter offers:

“To help yourself, begin by addressing your attitudes about eating. You are entitled to like what you like and to feel good about eating what you eat. Once you learn to be kind to yourself about eating, work on protecting yourself from food pressure. Be matter-of-fact and unapologetic about saying ”yes, please,” and ”no thank you.” Don’t complain and don’t explain.”

What anyone eats is nobody else’s business. If someone else is offended by what is or isn’t on your plate, that is their problem, not yours. It is, and always has been, the eater’s responsibility to choose how much to eat, and that includes the right to say “no thanks” to offerings of anything you don’t want, especially when it’s served with judgement, ridicule, stress, pressure and guilt.

Please continue to add to the conversation.

232 thoughts on “Picky Eating vs. Selective Eating Disorder

    • “Healthy” is a subjective term. What’s considered healthy changes from decade to decade, from food guide to food guide, and from nation to nation.

      What matters is how you feel about eating, not so much what you eat. If you approach food with shame about what you eat, the stress experienced is far more unhealthy than anything you do or don’t eat.

      If dietary change is what you hope for, start by accepting that you are doing the best you can with what you enjoy eating right now, and focus on enjoying the act of eating. Progress looks like being able to be calm in the presence of unfamiliar food, then being able to take some without tasting it, to taste a little bit without eating it, to eat a small piece and not like it (or maybe you do!) – throughout this process, you always have the right to say ‘No’.

      Even the most reprehensible meal is still better than not eating at all.

  1. How do I defiantly know I have this because I’m 16 and I’m always told that I’m just being fussy with my food?? Xx

    • Rachel, SED (now known as Avoidant Restrictive Food Intake Disorder ARFID) is an avoidance of certain food or food groups based on their sensory qualities (sight, smell, texture). While that would apply to everybody on the planet, the disorder component applies if this causes you significant discomfort so as to impair your quality of life. For example, finding eating in the presence of others so uncomfortable, that you actively seek to avoid social eating occasions.

      A diagnosis may help you feel validated, but what to do about it and how to help you come to terms with what you do eat have yet to be embraced by the mainstream medical community.

      If you’re on Facebook, join the Picky Eating Adults group and the Mealtime Hostage parent support group. You can also get in touch with me using the Contact form on the blog for more personal coaching.

  2. Thank you! I recognise myself in this. Being labelled as a ‘fussy eater’ all my life has been so so unhelpful in making positive changes. Only when I moved out when I was 18 and started being completely in control of my own diet (no one around to criticise, no one telling me to eat more or eat less, stop playing with my food, don’t be so ridiculous, just eat it it doesn’t matter) was I able to address these issues (and some still persist).

  3. Your article mentions weight-loss as a symptom of SED, but I am more worried about weight-gain: I’ve grown up as a picky eater and I find that I identify with quite a lot of the symptoms except for weight-loss. Sure, in my childhood I was small but I’m 18 now and I fear my metabolism will run out eventually! I eat barely any fruits and vegetables and I hate dairy products; my diet consists of lots of grains and pasta, meat, granola bars, crackers, chips and mainly lots of unhealthy options! I wish it were “just a phase” that I could grow out of so I could start eating healthier, but the texture of fruits and vegetables simply repulse me! What options are there for eating healthier in my case?

    • According the preliminary results of the Duke study, adult picky eaters vary in weight just like the variety eating population. Everyone’s metabolism slows down after adolescence, because the need to fuel growth is complete. The thing to keep in mind, though, is a large percentage of the variety eating population do not eat ‘normally’. The success of the diet industry speaks to the high level of disordered eating in society, and society considers chronic dieting as normal.

      Health is a multi-dimensional construct. What we eat plays a small role compared to activity and exercise, as well as our attitudes toward body satisfaction and how we approach food. Just as an example, in the US about 70% of the population does not meet the recommended daily requirements for fruit and vegetable intake, and despite the widely publicized claims that F&V prevent disease, the CDC reports that heart disease and most cancers have been on the decline for the past 3 decades. Given the negative role stress has on health, worrying about all the healthy stuff you don’t eat will likely do more damage than not eating these foods ever will.

      If variety is what you seek, look at the way you prefer your food – crunchy? Soft? Salty? Sweet? Look for ways to prepare new food in appealing and palatable ways. Potatoes are incredibly under rated as a nutritious vegetable. Dried fruit is still fruit. Smoothies are a texture friendly way to introduce new food and nutrients to your diet. Food is not a punishment to suffer through. Take your time finding foods you enjoy eating, and enjoy eating them.

  4. OK so my boyfriend basically only eats pizza and fast food and a few other foods. He refuses to eat any cooked vegetables or any thing touching or near them. He will occasionally try new foods but in the 2 years i have been with him i have never gotten him to eat it a second time and he usually wont even finish the first meal with a new food. He often goes to bed with out eating because there is no pizza in the house and i often resort to cooking french fries just to get him to eat something. though he eats hamburgers he refuses lettuce, tomatoes and onions unless they are diced this is the only way he will eat them and he will often refuse a burger with whole onions entirely, there is no removing the onion. He wont eat seafood at all and avoids all food with corn as an ingredient. He will often reject food just by looking at it. I am concerned for his health and i do not know how to get him to eat better/try new foods is it possible he has this disorder?

    • Surprising as it may sound, the majority of adult picky eaters are in excellent health. There appears to be no higher incidence of illness among picky eaters than there is among those who eat a varied diet. I hope that much is at least reassuring.

      Trying to get your boyfriend to try new foods sounds logical, but is actually adding to the already existing anxiety he experiences with eating. “Get” is a control word – you want him to do something he doesn’t want to. The desire to change has to come from within him. In the meantime, his plate is his business.

      If he is content with what he can and cannot eat, the best thing you can do is accept his eating for what it is, and defend him from outside sources of pressure to eat. There are many very informative articles at http://ellynsatterinstitute.org/hte/adultseatingandweightindex.php – and some wonderful peer support on Facebook’s Picky Eating Adults.

  5. Where have you been all my life!?

    Growing up, my diet consisted of mostly cold cereal, grilled cheese, and quesadillas. However, I wouldn’t eat cheese on anything else. I could eat some vegetables (potatoes, corn, green beans, broccoli, and raw carrots), chicken or ground beef, rice/pasta sans sauce, and apples. I didn’t even like pizza as a kid! I was often worried about attending sleepovers or birthday parties because I was afraid that I was going to have to eat something I didn’t like. As an adolescent, I was able to eat more entrees, but again, to a limited extent. At this same point in my life though, I developed anorexia, which led to bulimia that I actively battled for ten years. Needless to say, eating and food are a large source of stress and negativity for me.

    Once I got married and had access to/control over an actual kitchen, things improved dramatically because I could cook and prepare food items to my liking, however, I was still the pickiest eater that I knew.

    Even with all my progress over the last five years, I’ve hit a new barrier. As a professional, I feel like I experience so many business lunch/dinners, or because I travel for work, I eat with my colleagues because we are all sharing the same rental car and I don’t get to dictate where I dine. I hate feeling like a burden when the whole group accommodates my needs, or I am extremely embarrassed when picking certain food items out of my meal among a group of adults that can just eat whatever is placed in front of them. I’ve learned to like Caesar salads (though I am getting rather sick of them) because it is a fairly ubiquitous dish among restaurants, and I typically can’t find anything else edible, by my standards. I dread going to oriental or seafood restaurants.

    I’ve recently started seeing a dietician due to GI problems, and I mentioned to her that I would like to have a healthy relationship with food (physiologically, mentally, and emotionally), and that I wanted to try to expand my palate. I am supposed to try something new each week, and I report back to her at my appointments, but I don’t think she understands how hard it is for me. It can cause me some real anxiety, which in turn exacerbates the GI problems she’s supposed to help me resolve. Are there psychiatrists that specialize with this selective eating disorder? I feel like I need to be able to talk to someone about how I walked around the grocery store with an orange in my basket (my new food item I am supposed to try), only to put it back before checking out because it was, quite literally, freaking me out to think about going home and eating it. I just don’t know what kind of professional to seek out, because I was anticipating my interactions with her to be a bit more useful.

    Anyway, I’d appreciate any insight you have. Thank you for your site, I was enlightened, and relieved to know I’m not the only person experiencing this.

    • Eating socially is really difficult when our own relationship with food is dysfunctional.

      “Once I got married and had access to … an actual kitchen, things improved drastically.” This is significant – you always have control over how much to eat – that means you, and no one else, chooses a lot, a little or none of what’s offered. It’s not any one’s business, or place, to critique what’s on your plate.

      Your dietitian doesn’t get it. Please stop torturing yourself with new foods for her amusement. Put the orange down, and walk away.

      Everybody has food they don’t like, and it is absolutely okay to have a list that is longer than others. You’ve been wise enough to listen to your body say “that doesn’t make me feel good” and avoid that food in response. No one really knows why one person loves a food another doesn’t. And why does it matter? Health? There’s more to health than produce.

      Depending on where you are, I may be able to recommend an RD who can help your GI and eating issues as a package. Get in touch through the Contact page if you’d like to talk privately.

  6. Thank you for this site. It sheds some light on things for me. I hadn’t realized until reading this that my girlfriend might have an eating disorder. Satter’s chart makes sense.
    My girlfriend has distress around eating, and it causes a lot of stress in our relationship. She grew up in poverty where sometimes there wasn’t anything to eat. sometimes she would eat toilet paper just to have something in her stomach. She lived in a ghetto so when there was food, there were only some types of foods available, especially fried. When I met her as an adult, she was not eating enough except some greasy foods late at night, which would make her feel ill in the morning and I thought it was because she was struggling financially. But she has a lot of distress from a traumatic childhood. Now she is in a situation that is somewhat financially secure. She will only eat a very limited selection of foods, and she still doesn’t eat enough at the right times of day and it causes extreme mood swings due to blood sugar imbalances. Her typical pattern is to have a heavy dinner (of only certain select foods), then in the morning she doesn’t feel hungry so she doesn’t eat. She might eat a sugary, caffeine-filled protein bar mid-morning, and then by mid-afternoon, her blood sugar has swung so low that she can become very upset easily. Even then, she won’t eat much besides maybe a pretzel or two. Then at dinner, she will only eat out of one or two choices of favorite foods and only if they are cooked exactly how she likes, and not touching or with any juices merging on the plate.

    She asks me to help her to eat more healthy, and more regularly, but when I suggest things they are most often refused. I try to keep the kitchen stocked with convenient foods that she has accepted. Yesterday was an especially difficult day emotionally, due to blood sugar swings, and after dinner she said that she wanted to eat regular meals today. It’s a holiday so it’s easy for me to be available to cook her anything she wants. But she wouldn’t eat in the morning and the meltdown happened this afternoon, and here I am finding this site because I am looking for help. I can take her to the store and give her her choice, and she’ll only walk out with chips and water, and when we get home, complain that there isn’t anything to eat. She asks for help but I don’t know how to help her if she’s unwilling to help herself. I feel like maybe I should go to Alanon or something. (she’s also a recovered alcoholic, and has an ulcer, which the fried foods are hard on)

    I myself am a recovering bulimic (binge/purge) so I do understand about having distress around food. I’m mostly functional, and I haven’t purged or binged to any extremes for many years now. But when things are hard for her, they are hard for the relationship, and I find myself grabbing the bag of chips and secretly binging to cope. I’m scared to suggest to her that she might have an eating disorder.

    I love her so much. I need help figuring out how to support her in her healing and yet keep myself from being on the rollercoaster with her. I don’t want to be on the rollercoaster.

    • Roller Coaster,

      In addition to Satter’s work on eating competence – http://ellynsatterinstitute.org/hte/adultseatingandweightindex.php – I also recommend investing some time studying Intuitive Eating from a Health At Every Size approach. Both are compatible with each other. This article – http://lindabacon.org/pdf/BaconMatz_Diabetes_EnjoyingFood.pdf – written for a different audience than the scenario you describe, is generous with recommendations that will help.

      Very important for someone with a history of food scarcity is being secure in the ability to find enough to eat, and in your girlfriend’s case, enough to eat that includes foods she enjoys. Structure, not nutrition, is where all the attention needs to be.

      During all this, make sure you don’t neglect your own needs.
      Is it possible we can speak over email? Please get in touch with me through the Contact page.

  7. “Food is not a punishment to suffer through.”

    i’m tearing up after reading this. i’ve never encountered this attitude before – this attitude that what i eat is my business, and that food should be enjoyable.

    i’ve always been a bit of a picky eater, but it started to become a problem with the onset of puberty. i grew vertically, but i didn’t put on much weight to compensate for the growth. i’ve stayed in the 90 – 105 lb range since i was twelve; i’m definitely underweight, and am cold much of the time.

    for many years i have dreaded going to a friend’s house for a sleepover because it means being rude and declining foods i can’t eat.

    for a few months early this year, i was at an all time high of 115 lb, because after getting my wisdom teeth removed my parents forced me to drink protein drinks (even though i literally gagged and spit them up). however, since i got out of high school, i have lost ten pounds. today in particular is a Bad Food Day. i’ve eaten saltines, a couple of taquitos, and a few bites of salisbury steak tv dinners.

    what causes me the most anxiety is the way my parents treat it and the way they don’t buy enough food that i CAN eat. even though multiple doctors have told them that they just need to make sure i eat at all, when i put things on the grocery list half of it is never bought, or they buy the wrong brand or type. and then they have the nerve to get mad at me for not eating.

    maybe once i’m out on my own and have a job and can choose what food to buy, i’ll be able to have a healthy relationship with food. but until then i’m in distress.

    • My heart breaks for your situation. I highly recommend both you and your parents visit

      http://www.ellynsatterinstitute.org/

      Ellyn Satter is a family therapist and registered dietitian, and the website has plenty of evidence-based research and guidance to support your journey toward competent eating.

      I suspect your relationship with food will be just fine once the responsibility to feed yourself is in your own hands. I hope your parents can learn to be more supportive of your needs until then.

      Are you able to cook? As a parent, I certainly appreciate someone else taking over the kitchen. Perhaps it’s a way both sides can meet on middle ground?

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