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Picky eating is a relatively common problem in early childhood and affects nearly half of children. However, when children refuse to eat enough food that it affects their health, they can be classified as suffering from avoidant/restrictive food intake disorder (ARFID).
The affected children frequently report that they are fearful about eating food because it might cause them to choke, make them feel sick or nauseous, or can have a terrible taste. They typically say they are not hungry, eat very small portion sizes, gag easily with foods they dislike, and sometimes take a very long time to eat.
Health effects of ARFID include inadequate weight, poor growth, electrolyte abnormalities, and delays in physical and mental development (Bourne, 2020). Because of the health effects of ARFID, it is important that patients are under the care of a health care professional who can monitor their physical health while they receive psychological therapy.
ARFID is different from anorexia as affected children do not have a distorted body image. ARFID is often associated with anxiety, obsessive compulsive disorder, attention deficit hyperactivity disorder (ADHD), and autism spectrum disorders.
Causes of ARFID
There are many potential causes of ARFID, including genetic, psychosocial, and psychological factors. The genetic/psychosocial factors become evident in families where several individuals deal with eating difficulties. Psychological factors can include experiencing a choking event or other unpleasant events involving food early in life. For example, one of my patients stopped eating meat after choking on a hamburger, and another patient stopped eating fruit when another child poured a bowl of applesauce on his head.
When patients develop obsessions or compulsions about avoiding certain foods, this can cause great difficulty for them. Some patients with ADHD cannot sit still long enough to eat adequately.
Treatment of ARFID With Hypnosis
Treatment of ARFID often requires the help of a multi-disciplinary team of professionals and sometimes even intensive in-patient therapy. Family therapy is indicated as part of treating a child dealing with ARFID when family dynamics can make or break the situation. For example, parents who insist the child cannot leave the table until the meal is consumed can prompt their child to become defiant.
About half of children referred to me with ARFID have responded well to the use of out-patient therapy with hypnosis and counseling. In my experience, children who require in-patient therapy often have difficult intra-family dynamics that contribute to their persistent symptoms. In such situations, the solution extends beyond what the children can do on their own due to therapy. Most non-ARFID picky eaters respond to the use of hypnosis as long as they are willing to work on their diet.
The first step in planning how to use hypnosis for ARFID is often to identify the original trigger, if possible. If the affected child is of school age, he or she may respond well to a technique involving reimagining the event that triggered their fear of food. The child is instructed to imagine that they knew how to calm themselves with hypnosis at the age when their ARFID began. Then, they imagine reliving the scary event while remaining calm. After that, many children report resolution of their fear and begin eating more readily.
Children who complain that they dislike the taste or texture of their food can be taught to use hypnosis to alter their perception of the food in their mouth. For example, to change their perception of the taste of food, I teach children how to change the flavor of water to that of their favorite drink.
“Take this water and taste it to make sure it tastes like water,” I tell them after giving them a filled glass. “Now, close your eyes and imagine that the water is the color of your favorite drink. Now smell the water and make sure it smells like your favorite drink. Now taste it.” The majority of children will say it tastes like their favorite drink, and some of them then drink it greedily. I suggest they use the same technique for food.
If children complain that they might choke or have difficulty swallowing, I suggest they imagine their throats as large as an Olympic-sized swimming pool. Or, they can simply trigger a hypnotic relaxation response while eating, which helps ease their anxiety about choking.
Children can be taught to imagine eating different foods while in hypnosis as a form of gentle desensitization. Another form of desensitization is to have the children calm themselves with hypnotic relaxation while manipulating their food, such as preparing it for cooking or blending.
Finally, making a game of expanding their diet, increasing their food intake, or decreasing the time required to eat often goes over well with 5-12-year-olds. I promise to reward children with Pokemon cards, candy, or small toys in exchange for each new food they eat or for eating everything they serve on their plates.
Ironically, one family whose 8-year-old with ARFID responded very well to being given candy in exchange for expanding his diet chose to discontinue therapy with me because they did not like the idea of a candy (eg, a mini piece of chocolate) reward. In that circumstance, I wondered if the child’s eating issues were related to his parents’ controlling ideas about food.
Children with avoidant/restrictive eating disorders sometimes respond very well to hypnosis and counseling directed at the underlying cause(s) of their eating issues.
Copyright Ran D. Anbar
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