Pathologically picky

If hell is having to do the same thing over and over again, imagine eating chicken nuggets every day. For the rest of your life. Not because you're a connoisseur of processed chicken or you have misguided notions about its nutritive properties, but because you sincerely believe you cannot keep any other foods down. For thousands of adults, picky eating, also known as selective eating or food neophobia, poses a real problem.

In this context, picky eating means more than eschewing the occasional brussels sprout or beet. Adults who suffer from picky eating subsist on an extremely limited range of foods—most often kid-friendly staples like french fries, chicken fingers, or pizza. Psychiatrist Angela Guarda, who directs the Johns Hopkins Eating Disorders Program, says that most of the adult selective eaters she has seen in her practice were also picky eaters as children. Unable to outgrow their fussy habits, they continue to eat bland "kid" foods that often have high-fat, high-sodium, or high-sugar content, avoiding fruits and vegetables altogether. The problem is that not only are picky eating habits unhealthy—contributing to problems such as anemia, diabetes, even scurvy—they can also have severe consequences for one's social life, career, and family relationships. Bob Krause, a self-described picky eater who started PickyEatingAdults.com, an online support group, has said that his condition was partially responsible for the demise of his first two marriages. Other picky eaters describe lying or making excuses to avoid social situations that revolve around eating. The family Thanksgiving meal becomes a source of anxiety for someone who eats only a few foods.

Speculation about potential causes runs the gamut from an extreme sensitivity to food textures or smells—a sensitivity associated with autism or obsessive compulsive disorder—to the "supertasters" theory, which posits that some folks have more taste buds than average and are therefore highly sensitive to certain bitter flavors. For an adult picky eater, a new food might cause gagging, vomiting, or stomach pain.

It's difficult to pin down an exact number of people who suffer from the disorder, Guarda says, because picky eating is tricky to define—the term is often used to describe a heterogeneous group with several subsets. For example, a 2008 study conducted by researchers at Pittsburgh and Duke universities found that among the nearly 7,000 men and women who responded to their online questionnaire for picky eaters, only 28.7 percent of respondents fell into the "picky eating group," meaning they reported high rates of picky eating behaviors but low rates of other disordered eating behaviors. Nearly 50 percent were also found to have symptoms of other eating disorders such as bulimia or anorexia; the remaining 21.4 percent had low rates of any disordered eating symptoms. Guarda says that for adolescents and adults who suffer from picky eating, the condition is usually treatable. With the patients she has seen, Guarda has taken an approach similar to that of treating anorexia. "It's a behavioral treatment approach," she says. "So you don't work on trying to understand why they like french fries. You help them eat other foods."