What Is Food Anxiety?

Those with food anxiety worry about the consequences of food or types of food on their bodies, leading to food avoidance. Their concerns may involve excess calories, being judged, or gaining weight. Some people with food anxiety may be afraid of the texture, allergic reactions, or choking. When this worry affects day-to-day life or interferes with quality of life, it can be limiting or dangerous.

Characteristics, Traits, and Symptoms

Food anxiety is induced or triggered by food and can interfere with a person’s health, daily activities, and quality of life.

When the cause of food anxiety stems from a fear of how food will affect the body, in the absence of body image disturbance or fear of weight gain, characteristics may include:

• Dramatic restriction of food or types of food
• Only eating certain textures
• Lack of appetite or interest in food
• Fear of choking or an allergic reaction
• Picky eating that gets worse over time

However, when body image distortion or fear of weight gain causes food anxiety, signs may include:

• Becoming overwhelmed with food choices
• Overly restricting food because the person is not sure what to eat
• Obsession with weight or body image

Regardless of the root cause, those with food anxiety become tense when thinking about or deciding what to eat. This creates a physiological reaction called the “fight or flight” reaction. It causes symptoms such as:

• A rapid heartbeat
• Stomach-churning or butterflies in the stomach
• Shakiness or clamminess (looking pale, hot, or sweaty)
• Rapid breathing

If food anxiety leads to not eating or eating very little, symptoms may include:

• Difficulty concentrating
• Dizziness or fainting
• Irritability or grumpiness

Depending on the severity of the decreased food intake, time frame, and level of malnourishment, the following symptoms may occur:

• Significant weight loss
• Failure to meet expected growth in children
• Symptoms of malnutrition

Regardless of the source of food anxiety, it can affect a person’s quality of life. For example, some people with food anxiety may avoid social events. They fear that the food choices will be overwhelming and anxiety-provoking, so they decide not to go. If a child is afraid to eat new foods, the family may never go out to eat or have dinner at a friend’s house. 

Diagnosis or Identifying

When a person has symptoms of decreased food intake, the healthcare team will want to identify the underlying cause. 

The healthcare provider may utilize tools such as:

• Growth and development charts
• Questionnaires 
• Evaluation with a counselor or therapist  
• A consultation with a dietitian

Depending on the severity of weight loss or malnutrition, the healthcare team may perform the following tests: 

• Lab work (blood tests)
• Urinalysis (urine test)
• Imaging tests (X-rays, CT, MRI, bone density) 
• Electrocardiogram (ECG or EKG), which checks the heart

Causes

Anxiety-based feeding disorders, caused by a phobia about what food will do to the body, are most often seen in children. It occurs at a higher rate for children with sensory disorders such as those on the autism spectrum. 

When food anxiety is related to body image distortion or fear of weight gain, it can lead to over-restrictive eating due to underlying factors such as:

• Overwhelming amount of nutritional information or food choices
• Unrealistic expectations and perfectionism
• Cultural, community, and peer pressure about appearance 
• Negative self-talk about eating or appearance
• Early experiences or trauma

Types

The two major types of food anxiety are anxiety-based feeding disorder and eating disorders.

Anxiety-Based Feeding Disorders

Although food anxiety is not a specified feeding and eating disorder in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), it can cause significant distress and functional difficulties. Anxiety-based feeding disorders occur when someone fears what may happen to them if they eat certain foods or new foods. This is not the result of body image or a drive to be thin. They may be scared of the texture, choking, or having an allergic reaction. 

Anxiety-based feeding disorders differ from picky eating because their refusal to eat is so severe that it causes malnutrition that requires medical intervention. Picky eaters are generally able to maintain appropriate nutrition, weight, and height for their age.

Eating Disorders

Food anxiety can stem from a fear of gaining weight, body image distortion, or an attempt to be more healthy (such as starting a diet). These worries may result in over-restrictive eating or a variety of eating disorders. In this case, food choices and decisions can become overwhelming and cause anxiety.

Treatment 

If you have a child who is experiencing an anxiety-based eating disorder, it is recommended that you:

• Expose them to new foods with reasonable goals, such as once a week
• Do not force new foods; simply offer
• Let them explore food through touch, smell, or taste
• Rotate their plate (include their favorite foods and something new)
  

Self-Help

Self-help is a great starting point, however, those who are severely underweight should seek professional medical treatment quickly. Self-help ideas for food anxiety include:

• Positive journaling: Recognize negative self-talk and harmful thinking patterns. Try to re-direct yourself to train yourself to recognize progress, even if it is small. Focus your journal entries on positive aspects such as which foods you enjoyed, what nutrients you received, and how your body has taken care of you today. 
• Limit triggers: Recognize and limit triggers such as magazines or social media. 
• Self-care: Take a relaxing bath, start a new hobby, or spend time in nature.
  

Nutritional Counseling

A dietitian or nutritionist can provide nutritional counseling. They provide education about nutrients and proper amounts of food based on an individual’s size, age, and circumstances. 

Therapy

• Psychotherapy (talk therapy): Including cognitive-behavioral therapy (CBT).
• Family-Based Treatment (FBT): Therapy sessions that include the family in helping with disordered eating.
• Support groups: Therapy that occurs in groups. This is helpful because patients can listen and share with those in similar situations.
  

Medical Care

Any underlying health concerns may need to be treated by medication or medical treatments. Intravenous (IV or in the vein) infusions or feeding tubes may be required when severe malnutrition is present.

Coping

Having food anxiety may feel overpowering and consuming, but it does not have to be permanent. Seeking treatment is the first step in living a longer, high-quality, healthy life.

When making lifestyle changes, remember it’s OK to start small. Try picking one simple healthy choice, and once you’ve mastered that habit, add in another change and continue this pattern.

When to See a Doctor

A person should talk to a doctor about food anxiety if they or a loved one:

• Have thoughts of food so intense that they affect relationships, daily functioning, or well-being
• Eat fewer calories than is healthy
• Lose an unhealthy amount of weight 
• Throw up, use laxatives, or administer enemas to avoid gaining weight
• Feel overwhelmed by anxiety, depression, or other negative emotions
• Is refusing food despite your at-home efforts