People with food anxiety worry about the consequences of eating a particular food. For example, they may avoid food because they worry about consuming too many calories, being judged by others, or gaining weight. Some have sensory differences and are afraid of or even repulsed by a food’s texture. Other people with food anxiety worry about having allergic reactions or choking.
When this concern about food affects a person’s day-to-day life, it can be limiting or even dangerous to their health.
This article covers the symptoms and causes of food anxiety, as well as how it’s treated. It also provides tips for coping with food anxiety if you or someone you love is dealing with it.
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Characteristics, Traits, and Symptoms of Food Anxiety
Food anxiety can interfere with a person’s health, daily activities, and quality of life. This type of anxiety revolves around the fear of how food will affect the body.
Characteristics of food anxiety include:
Dramatic restriction of food or types of foodOnly eating certain texturesLack of appetite or interest in foodFear of choking or an allergic reactionSelective eating that gets worse over time
Unlike other eating disorders, a person with food anxiety may not have problems with their body image or fear of weight gain.
However, if a person’s food anxiety is rooted in body image distortion or fears of weight gain, they may become overwhelmed by food choices, overly restrict food because they don’t know what to eat, and obsess about their weight or how their body looks.
People with food anxiety get tense when they think about or have to decide what to eat. The mental tension triggers a physical “fight or flight” reaction in the body. They may have a fast heartbeat and breathing, feel “butterflies” in their stomach, and become shaky or clammy.
Fight or Flight Response
When our body thinks it is in danger, survival instincts kick in, and the sympathetic nervous system triggers the “fight or flight” response. When a person is having anxiety, the physiological response happens even though there is no real danger.
If food anxiety leads to not eating or eating very little, a person may experience symptoms like trouble concentrating, dizziness, fainting, and irritability.
Depending on how much a person has reduced their food intake and how long they have been eating less, they may also experience the following:
Significant weight loss
Failure to meet expected growth in children
Symptoms of malnutrition
Food anxiety can also have social consequences. Some people with food anxiety avoid social events because they fear that the food choices will be overwhelming and anxiety-provoking. If a child is afraid to eat new foods, their family may never go out to eat or have dinner at a friend’s house.
Causes of Food Anxiety
Anxiety-based feeding disorders that involve a phobia about what food will do to the body are common in children. This type of anxiety often occurs in kids with sensory differences, including those with autism spectrum disorder.
Kids who have a specific phobia based on a negative experience can also develop food anxiety. For example, a child who is afraid of throwing up (emetophobia) may refuse to eat the food that they ate before they vomited, even if the food had nothing to do with why they got sick.
If food anxiety is related to body image distortion or fear of weight gain, it can lead to restrictive eating. Factors that can contribute to this kind of food anxiety include:
Overwhelming nutritional information or food choicesUnrealistic expectations and perfectionismCultural, community, and peer pressure about appearance Negative self-talk about eating or appearanceEarly experiences or trauma
Types of Food Anxiety
The two major types of food anxiety are anxiety-based feeding disorders and eating disorders.
Anxiety-Based Feeding Disorders
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), food anxiety is not a specified feeding and eating disorder.
Anxiety-based feeding disorders occur when someone fears what could happen to them if they eat certain foods or try new foods. The fear is not related to body image or a drive to be thin. Instead, a person might be scared of the texture of a food or worry about choking or having an allergic reaction if they eat a particular food.
Anxiety-based feeding disorders are not the same as picky eating. Picky eaters are particular about what foods they will eat, but they are usually able to stay nourished and maintain the expected weight and growth for their age.
A person with food anxiety’s refusal to eat can become so extreme that they get malnourished and require medical treatment. Anxiety around eating also has a major effect on a person’s mental health and daily life.
Avoidant-Restrictive Food Intake Disorder
Avoidant-restrictive food intake disorder (ARFID) is an eating disorder characterized by very selective eating. In some people with ARFID, limited food intake is due to fears around food and eating. Others are simply not interested in food or don’t have much desire to eat.
ARFID is a common diagnosis in people with autism, ADHD, or OCD, as well as in people who have other sensory differences. Kids who struggle with trying new things in general may also develop ARFID.
People with ARFID often have a specific list of foods that they are comfortable eating and may have a hard time getting adequate nutrition from these limited diets. It can also be challenging for people with ARFID to maintain a weight that supports their health.
It’s important to note that, unlike other eating disorders, people with ARFID do not limit what they eat because they are afraid of gaining weight.
Although people with ARFID may be underweight, they are not purposefully restricting food or avoiding certain types of food because they are afraid of gaining weight. It can be quite the opposite: People with ARFID are often distressed by being underweight.
Some people even struggle with misdiagnosis because loved ones and even their healthcare providers have accused them of having an eating disorder like anorexia or bulimia.
Eating Disorders
Food anxiety can also be related to a fear of gaining weight, body image distortion, or trying to be healthier. These worries can lead to over-restrictive eating and specific eating disorders, like anorexia nervosa, bulimia nervosa, or orthorexia.
People with specific eating disorders may become fearful of the health consequences of eating certain foods or eating too much.
For example, a person who is worried about gaining weight may try to avoid fat, carbohydrates, and sugar. A person who wants to only eat “clean” foods may avoid any processed foods and only eat foods that are “natural.”
Diagnosing Food Anxiety
If a person has been eating less or only eating certain foods, a provider can use the following tools and strategies to figure out how to best help them:
Reviewing growth and development chartsAdministering questionnaires Suggesting evaluation by a therapist Referring to a dietitian for consultation
Depending on how much weight a person has lost and how malnourished they are, providers may do some tests to assess their health:
Lab work (blood tests)
Urinalysis (urine test)
Imaging tests (X-rays, CT, MRI, bone density)
Electrocardiogram (ECG or EKG), which checks the heart
Treatment for Food Anxiety
The treatment for food anxiety depends on a person’s mental and physical health, as well as other factors like their age. Some people may need a combination of therapy and medication to help them cope with food anxiety.
Medical Care
People with food anxiety who are underweight may need medical treatment to address their physical health before they can address their mental health. If a person is severely malnourished, intravenous (IV) infusions or feeding tubes might be needed to help them recover.
Once a person is medically stable, they will need to build a treatment plan and support network so they can start to work through their food anxiety.
Nutritional Counseling
A dietitian or nutritionist who can provide nutritional counseling is an essential part of the support team for a person with food anxiety. These professionals can provide education about nutrients, foods, and portions based on a person’s size, age, and circumstances.
Therapy
The following types of therapy can be helpful for food anxiety:
Psychotherapy (talk therapy): Talking to a therapist or counselor who uses specific techniques like cognitive-behavioral therapy (CBT) can be helpful for someone with food anxiety.
Family-Based Treatment (FBT): Therapy sessions that include a person’s family can help a person with food anxiety get the support they need and help their loved ones understand disordered eating.
Support groups: Some people with food anxiety benefit from doing group therapy because it gives them a chance to be around people who are going through similar challenges.
Medication
Medications that treat anxiety and depression can also be helpful for people with food anxiety and eating disorders. A specific antidepressant called Remeron (mirtazapine) is sometimes suggested because it has increased appetite as a side effect, and it’s common for people taking the drug for depression to gain weight.
There is some evidence that Remeron may have effects on metabolism, but it’s not clear whether these changes always directly lead to weight gain.
While Remeron is an antidepressant first, it can be prescribed “off-label” to help stimulate appetite in people who need to gain weight. Since people with food anxiety can also have depression or another mental health condition like OCD, a provider may recommend they try Remeron instead of a more commonly prescribed antidepressant because the weight- and appetite-related side effects could be helpful.
Other medications can also stimulate appetite. For example, olanzapine is an atypical antipsychotic that can help with anxiety but often has weight gain as a side effect. Like Remeron, this side effect might be useful for someone who is underweight due to food anxiety.
Antihistamines can also help people with food anxiety feel hungrier. The boost in appetite can encourage healthy weight gain. Sometimes, antihistamines can also have a sedating effect, which may help people feel more calm about eating.
Self-Help
Once a person is nutritionally stable and has a support network set up, self-help techniques can help them cope with food anxiety.
Here are a few examples of self-help for food anxiety you can try:
Positive journaling: Use journaling to recognize negative self-talk and harmful thinking patterns. Try to redirect yourself and learn to see your progress, even if it is small. Focus your journal entries on your positive achievements, like listing any new foods you tried and enjoyed and appreciating how your well-nourished body takes care of you.
Understand triggers: Learn about your triggers and try to avoid them. For example, you may want to limit your time on social media if you find it makes you worry about your body. If you’ll be in a situation that may make you feel overwhelmed (like a party where there will be a lot of food), make a plan so you’ll have support and coping skills to help you navigate your feelings.
Reduce stress: Managing stress will help lower your anxiety levels. Simple habits like taking a relaxing bath, taking up a new hobby, or spending time in nature can all help you manage your stress.
Coping With Food Anxiety
Having food anxiety is challenging, but it is something that you can learn to manage. If you love someone who has food anxiety, there are also some specific things you can do to support them and take care of yourself.
Here are some tips for coping if you have food anxiety:
Reach out for help. Know that you’re not alone. Turn to your loved ones or a healthcare provider that you trust. Ask them for guidance and support as you work on addressing your food anxiety. You may also find that joining an in-person or online support group helps you feel less alone.Learn about anxiety. When we don’t understand something, it can be more intimidating to deal with—even frightening. Try to learn about how anxiety works in your brain and body and the role that food plays in these responses.Use mindfulness. Anxiety is often made worse by imagining “what if.” Trying to be more present in the moment can help you stay calm in potentially triggering situations. Daily practices like yoga and meditation can also be very relaxing and restorative. Start small. Focus on making one food-related goal at a time. You’ll gain more confidence each time you meet a goal, which will make it easier to take on a bigger goal. Don’t try to change everything all at once, and try not to get discouraged if your progress feels slow at times.Make nutrition a priority. You need to consistently eat enough nutritious food to support your physical and mental health. Don’t try to take on the task alone. Reach out to a registered dietitian (ideally one who is familiar with eating disorders) to work on establishing a diet that will keep you healthy.
Here are some ways you can support someone who has food anxiety:
Encourage them to get help. Make sure your loved one knows that you’ll help them get the support they need. If you’re worried, try to be open and honest with them without casting blame.Offer to help, but don’t judge. Instead of commenting on what your loved one is eating or how much they’re eating, ask them what you can do to support them in the moment. It might be something as simple as sitting with them through a meal or chatting with them about their goals.Try to see things from their perspective. Keep in mind that your loved one isn’t just refusing food because they don’t want to eat it—and in fact, they may wish more than anything that they could. People with food anxiety aren’t being “difficult” about a snack or a meal. The emotions they’re feeling about food are intense, and they may feel like they can’t control the strong reactions they have to food.Focus on the positive. Your loved one will have some days that are harder than others. On the tough days, be a listening ear and a supportive shoulder to lean on. Try to resist the urge to offer advice unless you’re asked for it. When you do offer feedback, try to emphasize the successes you’re loved one has had—especially if they seem stuck in a loop trying to figure out what went wrong.
If you’re caring for a child with food anxiety, here are a few things to keep in mind while you’re helping them navigate their fears around eating:
Expose your child to new foods with reasonable goals, such as once a week.Offer your child new foods, but do not force them to try them.Let your child explore food through touch, smell, or taste.Rotate your child’s plate to include their favorite foods and something new.
When to See a Healthcare Provider
Food anxiety has very negative effects on your physical and mental health. It’s very important that you reach out for support so that you can get help and avoid serious health consequences.
You should talk to a healthcare provider if:
You have thoughts of food so intense that they affect your relationships, daily functioning, and well-being.You eat fewer calories than your body needs to stay nourished.You have lost too much weight.You throw up, use laxatives, or do enemas to avoid gaining weight.You feel overwhelmed by anxiety, depression, or other emotions.
If you or someone you know is struggling with eating disorders or body image issues, you can reach out to the National Alliance for Eating Disorders Helpline at 1-866-662-1235. The helpline is open Monday to Friday, 9 a.m. to 7 p.m. EST and offers emotional support, education, and assistance finding eating disorder treatment and care.
Summary
Food anxiety can have serious physical and mental health consequences. Sometimes, the anxiety is related to concerns about body weight or image, but not always. A person may worry about choking on or having an allergic reaction to what they’re eating. Others have an aversion to the texture of a specific food.
No matter what triggers it, food anxiety can lead people to restrict what they eat so much that they become malnourished. A support team comprised of mental health providers and nutrition experts can help people learn how to manage their symptoms and nourish their bodies.
