When Picky Eating Becomes An Affliction

When looking at a steak, lightly charred and glistening with fat, most people's brains scream a message: "Yes! Put that in your mouth!" Whether it's a plate of spaghetti or Vietnamese spring rolls, the brain gives the go-ahead, and the body obliges. Thank you, and please pass the peanut sauce.

When Marla Lopez looks at a steak—or a bowl of strawberries, a chunk of brie, a slice of pizza—her brain doesn't send out that excitement, and her salivary glands stay firmly in park. To her, most of the dishes on American tables don't look edible at all.

"It's like asking a colorblind person what color that is," Lopez says. "It doesn't look like food to me."

Lopez, a successful 57-year-old real estate broker from Coeur D'Alene, Idaho, survives on a diet of mostly bread, dry cereal, potato chips, and French fries. What she doesn't eat is, essentially, everything else.

Picky eating might evoke images of frustrated parents exasperated by their child's refusal to try [insert vegetable here]. But for picky-eating adults (called PEAs) it's a mental disorder that goes beyond childhood inflexibilities and follows them well into adulthood. Everyone has ingredients they don't like, but for some PEAs, foods appear totally inedible. In a culture where so much of our socializing revolves around eating, not being able to stomach a burger without gagging can be deeply stigmatizing, causing anxiety, stress, and social withdrawal. Like hoarding, many sufferers keep their conditions hidden even from family or close friends, afraid that others will attribute it to mere stubbornness.

Lopez is a picky-eating adult and a sufferer of avoidant/restrictive food intake disorder (ARFID), a condition that in 2013 was added to the Diagnostic And Statistical Manual Of Mental Disorders—the psychiatrists' handbook that covers everything from gambling addiction to Tourette's syndrome. ARFID is only beginning to be understood by the medical community, but it is a frustrating affliction that manifests itself along a spectrum of intensity. It's defined by a lack of interest in eating or an aversion to foods based on their sensory characteristics. And despite therapy, hypnosis, and gradual conditioning, for people with severe cases such as Lopez, something in their brain still keeps saying, "No."

That's also the case for Bob Krause, another picky eater on the extreme end of the spectrum. "The closest thing to a regular meal I might get is in the morning," he says, "when I might have bacon, toast, cereal, and a glass of milk." The rest of the day, Krause grazes: potato chips (plain only), French fries, toast with a little butter. But when it comes to vegetables, fruit, meat, fish, cheese, or sauce of any kind, Krause stays away.

Krause, 69, is a retired business owner from Florida who says he's eaten this way his entire life. As an infant, he struggled to keep down milk or formula; as a child, his parents and doctors were happy to see him eat anything at all. Like Lopez, many common foods don't look like food to Krause, and despite his best efforts, he's found it nearly impossible to add new items to his menu of acceptable fare. As an experiment, he once tried to eat a fruit cocktail every evening for an entire year. "From day one to the last day, my disgust was just as strong," he says.

Sportswriter Mike Grimala's diet is less restrictive, including a handful of fruits, vegetables, and proteins. But the list of things he's never tasted is long and varied: peaches, pineapple, Chinese and Mexican food, lettuce, broccoli, mustard, mayo, jelly. It's not that he doesn't recognize them as valid, edible options. For the 34-year-old Grimala, every aspect of the food experience—whether it be the smell, texture, taste, or sight—is heightened, and that leads to him being easily turned off.

"Most people think of it as taste, but I guess it's an all-sensory experience," Grimala says. "If it doesn't look right, or if the texture is weird, or if it doesn't smell right—anything can throw it off. If the slightest thing challenges me, I'm not going to do it."

Unlike somebody who might taste a new dish and immediately enjoy it, for Grimala everything is an acquired taste. Learning to eat a new food demands an easing-in process and the mental willpower to keep pushing himself beyond his comfort zone.

"Two years ago I tried a blueberry muffin," he says. "I had never had a blueberry or a muffin." Eventually he warmed to it, but that took months of conditioning, far slower and more complicated than taking a bite and immediately thinking, "Yum!"

While Grimala's diet meets most daily nutrition requirements, health can be a concern for PEAs whose all-carb meals are void of anything green or leafy. "A lot of us are told growing up, 'You're never going to make it to 25,'" Krause says. "Women are always being told, 'You're never going to be able to have healthy children.'" (Lopez says she gets regular checkups but has never had any medical issues related to her eating. She also has two healthy sons in their 20s—one of whom is also a PEA.)

But for many picky-eating adults, the mental burdens of their tense relationship with food far outweigh the physical ones. Social events require advanced strategizing. Dinner parties demand creative excuses. Dating is a minefield full of unexpected culinary encounters like seafood restaurants and barbecues. "Everything in the U.S. focuses around food, and you're not able to participate in it," Lopez says. "It's ostracizing."

For decades, Krause kept his habits closely guarded, even during his 13 years in the U.S. Navy. "I ate only breakfast, lived on one meal a day," he recalls. "It's like having a secret identity. It can be very stressful, because you're constantly on guard."

For a long time, Krause thought he might be the only one. He would read medical texts at the library in search of some clue as to what he had. He scoured the internet for someone else who ate the way he did. And he came up empty, again and again. That is, until finally he found a man named Paul.

This anonymous "Paul" had written a letter to an eating disorder website in which he detailed his extremely limited diet, his secrecy, and his low self-esteem. He wanted to change his habits, but his body simply rejected anything new. The description fit Krause perfectly: "I thought, 'Ah, there's two [of us].'"

Reflecting on that moment, Krause emphasizes its impact. "To find out you're not the only one after hiding it for years and being constantly criticized by family and friends... it's a pretty big deal," he says.

Inspired, he started a website and support group for PEAs in 2003. Over the last 13 years, pickyeatingadults.com has become a beacon to those dealing with the frustrations of an extremely restrictive diet. The site's guestbook is full of messages from people around the world talking about the shame, pain, and anxiety of ordering off the kids' menu or gagging at the sight of salad. The other common thread: an intense sense of relief at knowing they're not alone.

A poll on pickyeatingadults.com asks visitors if they would use a treatment for their condition, were one available. Out of nearly 1,400 respondents, 87 percent say yes. "Absolutely I would change it," Lopez says. "I believe in 'healthy eating.' I wish I ate whatever the latest fad is. All that attracts me, and I believe it. However, I just can't accommodate it."

Because PEA wasn't officially recognized by the medical community until 2013, there have been few advancements in combating the affliction. Most people just find a way to live with it—like Krause, who has grown more philosophical about his diet. He doesn't eat much, but he adores the things he can stomach. Rhapsodizing over his ideal last meal ("Crisp fried bacon slightly burned on the edges, some golden-brown white-bread toast with a little butter, a glass of milk that's almost freezing"), he sounds just as enthralled as a chef describing their signature dish.

If Krause could wave a magic wand and turn his world into an all-you-can-eat buffet, would he do it? Once upon a time, it would've been such a relief, he says. But now? "Probably not," he says. "I think that some part of me would die."