Picky Eating in Adults

Picky eating: It's not just for kids anymore. In fact, just last week, the University of Pittsburgh and Duke University launched the first national registry of picky eating in adults -- a condition now under consideration for inclusion as an officially recognized eating disorder.

But there's a real difference between people who wince at seeing mushrooms on their pizza and those who could be classified as having a clinical condition.

"It has to affect your health or well being," said Marsha Marcus, chief of the Center for Overcoming Problem Eating at the Western Psychiatric Institute and Clinic. "It's not just an embarrassing thing that people talk about at cocktail parties."

Dr. Marcus has heard of cases in which a person's food restrictions are so severe that they need a feeding tube to survive. Other "selective eaters" would rather avoid vacations, restaurants, business luncheons and dinner parties than face an unfamiliar food landscape.

The registry, known as the Food F.A.D. (Finicky Eating in Adults) Study has already drawn nearly 1,000 respondents after being mentioned last week in a Wall Street Journal article. The researchers do not have any outside funding for their registry, said Dr. Marcus, and see it as a "very first step" in laying the groundwork for future studies.

Those interested in participating in the survey must be over 18 and not have a medical condition that affects eating. The survey is online at eatingdisorders.mc.duke.edu at the "Finicky Eating in Adults" link on the right side of the page.

Picky eating usually begins in early childhood when it functions as an evolutionary safeguard, said Nancy Zucker, director of the Duke Center for Eating Disorders. "If you think about it developmentally, it makes sense that when kids are just learning how to walk, and get more mobile, that they should get more scared about putting things in their mouth," she said.

By adolescence, most kids grow out of a picky eating stage, she said.

Children who are extremely picky eaters could be diagnosed with a disease called Feeding Disorder of Infancy or Early Childhood that is recognized in the current edition of the Diagnostic and Statistical Manual of Mental Disorders, said Dr. Marcus, who was on the working group to update definitions for the new edition of the psychiatric reference manual.

The proposed definition for the new DSM, due to be published in 2013, includes adults and is renamed Avoidant/Restrictive Food Intake Disorder. The disease is distinct from anorexia because it is not driven by a concern about weight gain or body image, she said.

As an example of a picky eater who would not be classified as having an eating disorder, Dr. Marcus referenced a woman she spoke on a radio program last week. The woman declared herself as "the pickiest eater I've ever met" and explained that the thought of eating any cooked vegetable made her sick, though she didn't mind them raw.

"That is not a disorder," said Dr. Marcus. "She has plenty of other foods to choose from and it's not affecting her health or well being."

In her practice at Western Psych, Dr. Marcus doesn't see many adults that she would classify as having such a disorder. "I think people don't identify themselves as having an eating disorder and it hasn't been considered an eating disorder," she said. "They don't come to us."

At Duke, Dr. Zucker encounters adult picky eaters mainly as the parents of children that she is treating for picky eating or other eating disorders.

Adults who are picky tend to like bland foods that are comfortable and colorless, said Dr. Marcus, such as plain pasta or french fries.

In both children and adults, picky eating can be caused by "food neophobia," otherwise known as the fear of new foods, by sensory sensitivity to particular textures, or by traumatic experiences such as forced eating.

Still, the vast universe of picky eaters is poorly defined, Dr. Zucker said.

"It's been a pretty poorly operationalized construct -- what it means to be a picky eater," she said. "There's a lot of different definitions floating around. What we'll find is a huge continuum -- we all have food quirks."