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.

Implications
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. 

Causes
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 the mouth. 

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 conditions. 

Solutions
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.

Treatment
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.




About Abigail
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) empoweredkidZ, (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.