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Fending Off Food Phobias

April 18, 2003

Heather Heilman

hheilman@tulane.edu

He was a 23-year-old graduate student subsisting on a diet of pancakes for breakfast and French fries for lunch and dinner. Sometimes he might eat a piece of bacon or a slice of bread, substitute a waffle for the pancakes, or indulge in sweets. It wasn't that he didn't want to eat a more varied diet, or that he didn't have access to other foods.

The idea of eating, say, a green vegetable was overwhelmingly frightening and disgusting. He was sure he would choke if he tried. He'd tried psychotherapy and had taken drugs for anxiety and depression, but nothing seemed to help. Finally he ended up at the Tulane Eating Disorders Clinic, where he was treated by Deborah Marcontell Michel, clinical assistant professor of psychiatry. She realized that this was more than a control issue for him--it was a real phobia.

"Once we conceptualized this as a phobia, the treatment fell into place," Michel said.

Michel had never encountered a person with this condition before, or even read about such a case, but in a short period of time three people whose diets were severely limited by a debilitating fear of unfamiliar foods walked through the doors of the clinic. They were all able to trace their food neophobia to early childhood.

It's a disorder that has received some attention in children. Yet no one had looked ator developed a treatment forpeople who had reached adulthood without overcoming their fear of trying new foods. None of the patients were malnourished, although their limited diets would certainly seem to be setting them up for health problems in the future. Their more immediate problems were emotional and social. It was hard for them to negotiate a business lunch or a dinner date when they were afraid of items on the menu. Their self-esteem suffered. Of the three, two successfully completed treatment, transforming their lives in the process. The other never began treatment because it was too frightening.

"They have to confront the food they fear," Michel said. "They have to be pretty motivated to go through with it, because it's difficult work."

Patients worked with a psychologist to develop a list of food they wanted to learn to eat, starting with foods they only feared slightly and ending with those they found the most terrifying. The psychologist taught each patient muscle relaxation, deep breathing and cognitive techniques to help them face their fears.

"They had all kinds of negative associations with different colors and textures. Crunchiness was 'gross,' anything green was 'slimy.'"

The psychologist would help the patient replace those thoughts with positive or neutral statements, like "green is just a color, it doesn't make a food good or bad." Nutritionist Jan Johnson coached the patients on how to go to the grocery store to shop for the new food item, then helped them prepare it in the clinic's kitchen.

"They had questions about how to properly eat something, how to prepare foods, how to use utensils, even how to peel a banana or an orange," Michel said.

After successfully eating a food in the clinic, the patients would have to prepare and eat it by themselves as a homework assignment. Both patients who finished treatment were able to eat more than 20 new foods each. And they were able to maintain a less fearful attitude toward food. Michel doesn't know how many people may suffer from this disorder, but since publishing her findings in The Journal of Anxiety Disorders last fall, she has been contacted by colleagues all over the world who have had patients like those described in her paper.

"One of the things I'd like to do in the future is to take a look at how prevalent this problem is and learn more about its development and treatment, because so little has been written about it."

Heather Heilman can be reached at hheilman@tulane.edu.

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