Eating Disorders or Food Phobias: Complexities and Overlaps
by Libby Lyons, Eating Disorder Hope
November 5, 2017

Eating disorders and food phobias are different in nature and typically are different in treatment modalities. Both can involve having foods that are avoided and restrictive food intake.

Eating Disorders Quickly Explained
Eating Disorders are typically concerned with weight, body size, and shape coupled with a fear of gaining weight or becoming fat.

Food phobias usually fear foods due to fear of the food itself, or because of an associated situational fear (like vomiting) but not concerned with weight.1

Eating Disorders typically include symptoms of being preoccupied with food, counting calories, fear of weight gain, binging, purging, or starving oneself. Many people will eat food in secret, isolate from others, and become obsessed with negative thinking patterns around low self- esteem and body dissatisfaction.

Food Phobias Vary
Those who have food phobias typically have more symptoms that are anxiety based, and fear is centered around having to eat, cook, or be close to specific foods. Symptoms also include dizziness, excessive sweating, nausea, feeling as if they cannot breathe, heart rate increase and shaking, all similar to panic disorder symptoms.

Both disorders can have nutritional and physical consequences. A person can become malnourished with both disorders, and lack essential vitamins and nutrients due to the starvation. Weak and brittle bones can occur within both disorders as well.

With prolonged starvation can come anemia, low blood pressure, hair loss, kidney failure and other medical conditions.1

Not all food phobias are the same within each individual. Some may be fearful of eating perishable foods or won’t eat mayonnaise that will go bad quickly without being refrigerated.2 Other people may have trouble with texture and taste of foods or smells. This can initiate nausea or a sensation of gagging if trying foods that fall into this category.

Young children may also have a fear of trying new foods (neophobia). For some, this may never disappear and may continue through adulthood.

Another food phobia can also be a fear of cooking for others, that the food may be over or under-cooked. It can also include fear of cutting self or burning oneself in the process of cooking.

Types of Food Phobias
With food phobia, there is typically a food aversion. This is important because it may trigger a feeling of revulsion around food rather than anxiety. Aversions can be very strong and last lifelong.3

Adults tend to have aversions to meat or greasy foods, which can protect us from foods that might be life-threatening. This varies though in those with food phobias.

Another type of phobia is the fear of an inability to swallow or fear of choking. It has been linked to extreme sensitivity with the gag reflex.3 The anxiety is maintained with the thought that they will choke and so the food is avoided which releases a 'feel good' thought and emotion, giving the phobia more power.

Similarities and Differences
Both disorders share common characteristics of anxiety based thoughts and symptoms. Food phobia and eating disorders evoke avoidance of certain foods due to fear. Both can have starvation and malnutrition effects with long-term medical complications.

Differences lie in how the individual views themselves and food. Those with eating disorders see themselves as ‘fat’ or needing to lose weight. Often the weight loss is never sufficient, and the person is unhappy with the way they look and are perceived. Frequently compensating behaviors are engaged in to change body shape and size and weight.

With food phobia, individuals are fearful of certain foods due to a fear response. Some individuals may fear vomiting or textures and the smell of foods. Often there was a precipitating event such as eating in the car as a child and then throwing up. They then come to associate all fast foods, or foods with a vague connection to throwing up and will refuse to eat them. There is no concern with weight, body shape, or self-esteem with those that have food phobias. Often the person wants to be able to gain weight and eat similar to their peers.

Treatment Thoughts
Exposure work is essential. Being able to work up slowly from least fear-provoking to most fear-provoking is part of the process.

Individuals work with a clinician to be able to tolerate anxiety at various fear hierarchies to be able to learn distress tolerance and coping skill mastery. This enables individuals to be able to practice in and out of the therapeutic setting.

Steps are typically progressive and logged. The phases are used to raise anxiety at each level and to learn what physical, emotional, and mental symptoms occur as well best practices to manage it, so they stay in control.

Steps become more relaxed as they are worked through, and anxiety may not be 100% reduced from level to level. It is practicing daily on exposures and keeping a written log of process and challenges.

An individual can have an eating disorder and a food phobia at the same time, but treatment approaches are different for the two disorders.

References
  1. The Difference between Eating Disorders and Food Phobias. (2016, April 16). Retrieved September 26, 2017, from The Difference between Eating Disorders and Food Phobias - Maureen Kritzer-Lange Psychotherapy
  2. Expert, P., & Bailey, E. (2017, April 11). Food Phobias: Symptoms, Dangers, and Treatment – Anxiety | HealthCentral. Retrieved September 26, 2017, from Food Phobias: Symptoms, Dangers, and Treatment - Anxiety | HealthCentral
  3. Overcoming Eating Phobias. (n.d.). Retrieved September 26, 2017, from Eating Phobias