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About Abigail Natenshon
Over 45 Years of Eating Disorder Specialty Practice

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Questions posted on the Picky Eating web site ( and Abbie’s Responses

TOPIC: Are these neurological problems or can they be healed by the power of will-power?

"I think it is a mixture of both....I think that the neurological guides us to be a certain way and then with things like SID, OCD, the thoughts intensify in our brains and make us fearful of many foods.

In my opinion, taking the stance that we have no control over this because it is neurological doesn't help us. Personally I am not going to wait for a doctor to come up with a cure. Over the last year I have been doing a lot better once I learned about the SID and OCD connection. Once I heard that my body is possibly looking at food as a danger, when in fact the food is not a danger; that is something I can work on. It has really helped change the way I think. This is not to say that I would be willing to try any foods (like seafood for example), just that I have opened my mind to different foods.

People in the group seem to be offended if anyone refers to the idea that we have some control over this food disorder. It is easy to say it is all something out of my control, therefore I won't try to improve. Since we "don't" know the exact reason for our disorder and may never, I would like to encourage people to feel free to speak their opinion regardless whether everyone agrees or not. I think the steps that people need to help themselves depends upon the person. If you find something that works for you....go for it! For me, it is taking small steps to try and help get over my fear....just like anyone else trying to get over a fear.

For those of you who celebrate it, maybe this year at Thanksgiving, try one bite of something you have never tried........? Small steps.....

Abbie's response: Just because a problem is neurologically based does not mean to imply that it is unfixable. Increasingly, holistic approaches to healing food related problems have been shown to have ameliorative effects on body awareness and on neurologically based sensory changes. Challenging ones self to take risks with food, or with new behaviors in other life spheres can be a wonderful way to create new behavioral inroads (and new neuro-pathways.) Small steps ultimately lead to large changes.

TOPIC: Treating PE through hospital programs that focus on anxiety reduction

"Yes, I have taken Jesse, my 13 year old to an OT and yes I finally found one to agree with me that this is a sensory integration disorder.
We had Jesse doing tongue exercises to strengthen his tongue muscle in order to be able to better "sense" his food so that his nervous system doesn't go into "protect" mode (read gag) because it cannot discern enough information from the food. The problem was, as is with all therapies, is that it was once a week, along drive and too difficult to integrate into everyday life. The other therapies were just exposure therapies of odors and looks and nibbles of foods. Again, only once a week.

Cognitive behavioral therapy is also exposure therapy. To some extent, that is what Jesse will be getting on an intensive basis when he goes to Rogers Hospital in the summer. He needs to be physically desensitized and these constant and consistent exposures should do that in a progressive manner. Same as an OT only 24/7

I too was extremely skeptical about John' miraculous seemingly
overnight recovery. Since Jesse has been a picky eater since I introduced solid foods, I have no doubt in my mind that this is a physical problem. So, then why am I sending Jesse, to Rodgers?
There is no doubt in my mind that years of bad experiences with food
creates a psychological component to the ailment. I know that there must be many more foods out there that Jesse should be able to like and some to at least tolerate to be sociable. I don't totally love every food I ever am required to eat on any occasion and Jesse shouldn't expect to love all foods he eats either. He does. If it isn't delicious to him immediately it is not going to be eaten. He needs to free up his mind set and decrease the anxiety to at least increase the likelihood that he can find new foods to eat. That is all I am expecting of Rogers.

In order to accomplish such a thing one needs intensive Cognitive
Behavioral Therapy. Going to a psychiatrist once a week for years, in my mind, makes it almost impossible to succeed. Even if one endeavors to put the CBT into use in their daily lives it is really very difficult to achieve on one's own. 24 hours a day, 7 days a week, one is a picky eater and 1 hour a week from that for therapy, well, I have my doubts. So what John did (in entering a hospital program) is pay an enormous amount of money to surround himself with this therapy or therapeutic environment for 24 hours a day 7 days a week for 30 days. That seems to me a legitimate way to make inroads into a problem.

I have seen and read about countless studies where the mere will to change has brought about changes in a human being that can be scanned and viewed as a physical change in the brain. John certainly had the will. I do not expect Jesse to have as resounding a success as John. My hope is that he will be less reluctant to taste new things and accept that not everything has to be delicious to be eaten. Not all of that gag reflex is physical. Some of it is psychological. Whatever I can chip away, I will be content with.

With Best Regards,
Susan Sorger
Entourage Arts

Abbie's Response: There is something to say for behavioral exposure and flooding as a way to create and reinforce new neuronal pathways in the brain. New neural pathways are created in response to new behaviors, and new behaviors are reinforced through the creation of these pathways.

TOPIC: Alerting others to the problem can alleviate the effects of PE problems in some contexts

May I suggest something I found out recently? I am 42 and just found out that my parents buffered many of those food situations for me when I was younger. They would tell other parents ahead of time of my eating habits and sometimes take food that I would eat, but most importantly they told them not to make a big deal of it. Looking back now I am thankful for their effort because, as a kid, it's bad enough when others continue to make a big deal of your eating but if your parents do, it could really make you feel self conscious.

Abbie's Repsonse: This individual describes highly sensitive parents. Keep in mind that parents need to discern the difference between down-playing the condition with others versus pretending that the problem does not exist. They need to know which occasions lend themselves to effective action, and which demand "softer pedaling" in the interest of saving the child's feelings.

TOPIC: Are causes of PE yet to be discovered?

What makes you believe your son might have a disorder that has already been diagnosed in society? This is exactly what doctors and psych people want you to believe. They want to tell you he will grow out of it, it is a control issue, it is a weight issue, or that he has OCD or a sensory problem. They always want to diagnose someone with something that has already been studied and accepted by society.

Maybe our problem is something that is not a result of something that has already been diagnosed today. Maybe it is something that has not been identified and accepted by society. I think we should all start looking at the possibility that it could be something that is not a result of something that is already out there. Many people have tried all the different things that doctors say it could be and tried treatments for them. Most did not benefit from these treatments or they slowly learned to like one or two more things over a very long period of time.

Some people do benefit from treatment of something that is already out there and it helps them with their eating, but many do not. In my case it is about taste. I am not afraid of any foods. Food looks like food to me. I do not have control issues at 41, I do not have a weight problem, I do not have OCD, etc. I'm as normal as any average person. But, for example, I can find a small piece of green lettuce loaded with lots and lots of flavor. Most people would think lettuce is tasteless. If I taste something with a lot of flavor in it, it is overwhelming for me and makes me gag. This makes it very difficult for me to try anything that is not very bland to most people's taste.

Just my thoughts ...

Abbie's Responses: We live in the "era of the brain," where sophisticated brain scans and functional imaging show that holistic treatments bring about real changes in brain function. It is interesting to note that hrough genetic research, scientists have identified a gene (dubbed TAS2R38) that controls a receptor for bitter flavors; those individuals with certain variations of that gene are particularly sensitive tasters. One of my adult eating disordered clients reports "a metallic taste in her mouth" from eating most vegetables, a reflection of the chemical and genetic bases of these problems." (Natenshon, 2009, P 135) (From: Doing What Works: An Integrative System for the Treatment of Eating Disorders from Diagnosis to Recovery, NASW Press, 2009)

Do not stop looking to the brain for solutions, with its marvelous capacity to change and grow through neuro-plasticity. There is every reason to believe that more and more solutions will be found for problems that are neurologically base, and sometimes environmentally triggered and fed.

The following are emails from a behavioral therapist treating a child with picky eating, along with my responses

Dear Abbie,
I am an outpatient therapist working with a 9 year-old boy who is an extremely picky eater. He has been this way since infancy. He only likes a few foods and will go days without eating before he will eat something he doesn't like. He does not like touching certain foods and does not like the texture of certain foods in his mouth. He gags as soon as certain foods are near his mouth and needs to wash his hands after touching certain foods. The doctor has found no physical problems which may cause difficulty eating or swallowing. We have been playing with food, having him hold foods in his mouth, alternating foods that he likes with those he does not, and other similar activities. Do you have any ideas or suggestions for helping him and his parents?

Thank you for your time and consideration.




It sounds to me as though you are doing all the right kinds of things and I am interested to know if your efforts have been productive. Are you seeing changes? How is the child responding?

Can you suggest that this child also work with an occupational therapist, speech therapist and /or Feldenkrais around issues with his mouth? Are you able to make appropriate referrals for the child to accompany the work you are doing with the child and the family?

Have they tried "food chaining" a technique that is described in the feature articles on my site?

Abbie Natenshon


Dear Abbie

We have reached a point where he can put foods in his mouth and hold them there for a few seconds. He is understandably resistant to these changes; however, he is able to gauge when the goal is doable or too much-so he has some input in his goals for the week. His input seems to help in garnering more cooperation from him.

This week his goal is to put 3 different foods in his mouth and chew; he can then spit them out if he needs to. He and dad were also to pick out five vegetables to play with on a large piece of plastic on the floor-touching them, smelling them, smashing them, etc. I don't know how this week has been for him yet.

I will check out the "food chaining" you mentioned.


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