Tips from a Washington DC Psychotherapist on Body Image, ARFID, & Eating Disorders

 

Caroline stared at the meal on their plate. The meat was stringy. It might have been one of those strings that made them gag and if they gagged, they knew they would be unable to eat the rest. The pasta would dissolve into a mushy ball at the back of their throat.  They could feel the acid of the tomato sauce that often rose up in their throat for hours if they could even manage a few bites of this meal.

But try as they might, they lacked the words to describe the horror that lived on the plate in front of them and the fear that rang though their body. So, Caroline mumbled the one statement that they could muster:

“I can’t eat that”.

 

Sensory issues often go hand-in-hand with disordered eating. We don’t know how someone else experiences food (the thoughts, the feelings, and/or the sensations that are associated with eating). Often, we do not have the language to explain our experience, so we start to use other people’s words that barely scratch the surface of our experience.

As friends asked if Caroline was a vegetarian, they started to answer “yes”. It meant they didn’t have to deal with the unpredictable texture and chewiness of meat. When Caroline’s roommate proudly said that she also didn’t eat carbs like pasta, Caroline just nodded. It was just easier to agree than to explain that it was not that simple for Caroline. Caroline ate a lot of carbs, but not this type of pasta. They often felt weird because they did not like a lot of common foods. When people talked about how much they liked food, Caroline often did not know what to say.  At least by blaming it on a fear
of carbs, they had a chance to connect.

“Picky Eater”

Caroline had always been a “picky eater” but their whole family was, so it wasn’t really an issue when they lived at home. When Caroline went to college, their main option for food was the school’s massive dining hall. It was a giant, noisy place that seemed to serve everything that Caroline hated.

Caroline existed on a few staples, until their friends started to laugh at their weird combinations of food. Caroline started avoiding eating with others and often avoiding the cafeteria all together.  Even thinking about that place launched a giant knot in their stomach.

Eating is often a way we connect to others.  When we don’t eat what other people eat, we may be labeled as different or weird. Noise sensitivities often can co-occur with food sensitivities. The overstimulation of a loud restaurant may make it challenging to imagine any more stimulation with eating.

How ARFID can Mimic Anorexia, Binge Eating Disorder or Bulimia

Without intending to do so, Caroline lost weight. People noticed. Caroline had never been particularly small before. They liked how their body looked and felt when they were smaller. Lots of Caroline’s friends and relatives liked it too. There were a lot of positive comments about Caroline’s weight loss.

ARFID (Avoidant Restrictive Food Intake Disorder) is often defined as limited food intake that presents without body image disturbance or fear of weight gain. However, it is hard to live in a fatphobic society obsessed with appearance and not have concerns about body image or a fear of weight gain!

Eventually, Caroline’s body seemed to rebel out of the desperation for food. To avoid social rejection, they often ate very little during the day and found themselves binging at night, usually on safe foods. Sometimes it was on anything they could get their hands on in a flurry of rapid swallowing. Caroline’s weight climbed. People noticed.

The clinical definition of ARFID is often defined as failure to maintain weight or appropriate growth. But food sensory issues don’t always result in a person being underweight. People in all sizes of bodies have ARFID. Food aversions and sensitivities may result in weight loss, weight gain, or weight stabilization. It may manifest differently throughout various points in someone’s life. When faced with food deprivation, it is not uncommon for the body to trigger a binge response. Your body is trying to make sure you get the sustenance that you need to help keep you alive.

In response to Caroline’s body size, people jumped in to “help” Caroline with nutrition ideas. When Caroline managed to eat with others, it seemed like everyone had a thought on what Caroline should or should not eat. But Caroline couldn’t imagine eating a lot of the “healthy” foods that people recommended. The foods were too mushy, too unpredictable, too slimy, etc. Caroline tried a few diets, but always ended up binging again. They hated their body and their “lack of willpower”. They avoided eating with people whenever they could. Their eating became more isolated, more shameful, and
more secretive.

If you resonate with parts of Caroline’s story, you are not alone. There might be different food textures that you despise, such as gummy, crunchy, squishy, etc. The fear associated with food might come from a variety of reasons such as feeling ill, being gassy in public, a fear of choking on food or a particular type of food, or public ridicule at your food choices. And the worst part is, you might not have the words to explain your food inconsistencies. One day, you can eat a certain meal  with no issues, and the next day, the same meal can seem utterly repulsive and impossible.

If you feel like sensory issues are interfering with your relationship with food or complicating treatment from an eating disorder, here are a few things you could try:

1- Develop an understanding of your particular sensory sensitivities.

These may be tastes, textures, visual, etc. It’s not uncommon to find that you don’t mind the initial taste or texture of a food item but find that you are repulsed as the texture/taste morphs during the chewing process (or vice versa). It’s also not uncommon for foods to conflict with one another (i.e., you like the taste but struggle with the texture). Developing language around your food preferences is powerful. It helps you voice concerns and preferences in a way that is more specific than “I don’t like that”.

Understanding your specific sensitivities and preferences is also helpful in reclaiming foods with confidence. It is not uncommon for folks with food sensitivities to eliminate large categories of foods after a few bad experiences. Understanding your food preferences can help you adjust your food to your liking. For instance, perhaps you are
repulsed by breads that easily dissolve into mush, but you find that you are able to tolerate coarser breads or bread toasted to a crunchier consistency.

2- Understand that inconsistency is part of the ARFID complexity.

“But you ate it last week!”

 

Yup, that’s part of the battle. When food sensitivities are part of broader challenges with stimulation, you might find that it’s easier to eat variety on some days and not others. You can think about it like video game life points. Let’s say your tolerance for stimulation is about “50 points” per day. If you are in a space where it takes 80 points to survive your surrounding space, you are way over capacity.

It may feel next to impossible to eat anything that will result in more stimulation. But if the situation is only taking 20 points to survive then maybe you can allocate 15 to eat the food that’s only moderately repulsive. The problem is that your capacity of points likely shifts from day to day based off your nervous system. And some days, when your body is well-regulated and not overstimulated, the creative, adventurous side of you might be excited to try something new. This is life with food sensitivities, and it doesn’t make your struggle any less valid.

3-Limit or control external stimulation

If you are sensitive to noise or visual stimulation, try to limit stimulation while eating. If it’s too much pressure or challenge to focus on mindful eating, try positive stimulation like a favorite book, video, music, or social media.

4- Practice regulating your nervous system through deep breathing, humming, stimming, etc.

It may be easier to take on sensory challenges when your body is calmer.

5- Chew.

To avoid yucky sensations, people with food sensitivities develop a habit of swallowing food with minimal chewing. You may even have issues chewing due to jaw tension.Poor chewing and gulping down extra air lead to digestive issues,  especially bloating, gas, and stomach discomfort/pain. This is cyclical. Negative associations with food may cause a fear that food makes you ill.  The assumption that the food caused discomfort may lead to unnecessarily cutting out more foods.

6- Get evaluated by an RD who specializes in ARFID and/or gastrointestinal (GI) issues.

GI issues and sensory issues often go hand in hand. If you wonder if digestive issues could be complicating your experience with food, see an RD that specializes in digestive disorders. You will likely need more specific tests than simply a colonoscopy/endoscopy. A GIMAP test may be helpful to uncover digestive challenges/imbalances that may have
gone undetected for years.

7- Identify safe foods based on your specific sensory needs.

As you identify your sensory food preferences, there will likely be an intersection of reasons of why your go to foods are “safe”. Foods may be easier to access due to sensory reasons, limited food prep/decision making, and fears regarding nutrition/health/diet culture advice. As you understand your sensory needs better, you can start to pick this reasoning apart and start to reclaim foods.

8- Try to eat regularly.

Oftentimes, parents say “oh, eventually they’ll get hungry enough to eat it”. This statement is often not true for people with sensory issues/ARFID. Waiting longer might make eating feel even more impossible.  Drops in blood sugar make your body more dysregulated, so you may be less able to handle stimulation. Keep safe foods on hand. Carry them with you if you are out and about. That way, you can keep your body regulated. One idea is to carry a bag with multiple foods that represent a variety of safe textures and flavors. Then, you have options if you need it. Sometimes, starting with a safe food at a meal can make it easier to eat progressively more challenging ones.

9- Be gentle with yourself.

Food is a psychosocial experience. It’s hard to feel weird or feel left out. It’s hard to feel terror about food when others around seem to enjoy it. It’s really hard when you don’t have words to explain or are not believed by others. You are not alone in your struggle. Your struggle is real and valid. Celebrate small victories and keep moving forward. One bite at a time.

Chris Sherman is an eating disorders therapist at Monarch Wellness & Psychotherapy.  They specialize in eating disorders. 

They also have particular interest and expertise in questions about neurodiversity and gender and they way that these issues intersect with food and body concerns.  Reach out to book a consultation.