is severe adult picky eating an "eating disorder," and "should" it matter?

It's time to throw out the kale that has been sitting on my counter in a cup of water this week (after wilting in the fridge.) It has been judging me. It scolded me from the shelf at the market. "I am a super food! You should be eating more of me!" I popped it in my cart and brought it home to live out it's fate.*As I worked this week with an adult on her concerns around her picky eating, she told me how she "should" be eating fish and that was one of her treatment goals. So my client has to deal with her own voice (I guess we all have it to some degree) along with the chorus of voices her whole life that have shamed and guilted her about her eating; who told her she "should" eat this, or that, or she was doing it wrong while not only not supporting,  but actively undermining her learning around food.The idea of the adult picky eater as one suffering from an eating disorder has been hot in the news. Do the eating patterns of selective adults cause major problems in their lives? Yes. But is it the same biological process that we see in the thirteen-year-old who begins her first diet only a few weeks later to be in the full-throes of anorexia nervosa? Does it need to be?The selective adults I have heard from have shared a feeding history that is complex, difficult and fraught with anxiety. Yes, there is likely something about many of these folks that made them more of a challenge with feeding.  In the article, Ellyn Satter says  "Everyone has got something and everyone has to learn to cope. And children need to learn to deal with their predilections."  (Feeding often plays a large role in selective eating and even children with concerns like reflux or sensory issues can mature well with eating and are not doomed to  an "eating disorder." The 'nurture' part of this equation must be considered, and as a culture, as physicians and health care providers we do a terrible job overall supporting parents with feeding challenges. Back to adults...)The stories I hear from adult selective eaters describe screaming at meals over who is eating what,  escaping meals altogether and eating out for years to avoid being home,  not being supported or exposed to a variety of foods, kids vomiting at the table and being forced to eat the vomit, or parents fighting openly, punishing, shaming, rewarding... (This is not a scientific review, and I'm sure there are adult selective eaters who have a different story.)Am I qualified to proclaim this is or isn't an "eating disorder?" Probably not.Am I happy if it helps people access treatment? Yes.Would I like to see parents of children with feeding challenges get amazing support so they can optimize feeding no matter what the concern is? Yes.Am I concerned that the treatment many will access won't help and will bring on further shame? (Like the parents who call me because their child "failed" the feeding clinic?) Yes.Does the label of an eating disorder help or harm healing? Does it stigmatize and make the situation into a more powerful external process? I don't know.Is there a higher prevalence of coexisting conditions like anxiety or OCD that needs to be addressed? I don't know, but this needs to be explored.And then the therapist in the article says, "We don't yet know how much they can be pushed ..."     Which gets me back to "should."Here is the crux of the problem, if adults are being "pushed," whether by a professional or a feeding group or themselves to smell, touch, eat a food- if they have to "force" themselves to eat something they will likely fail. For many, their past history with feeding, the trauma, the "you are not OK, you cannot be trusted" with this all comes back and there they are at the table with stress levels off the charts. Food= fight or flight.  My friend said it well,  familiar foods "mean safety."Long-term sustainable change does not come from a place of shame, guilt or "shoulds," it comes about when the changes are themselves rewarding. When the change makes you feel better from the inside out.  Will forcing herself to eat fish make my client feel better? No. Will learning to come to the table and feel calm there, and recognizing that she did the best she could, and learning to feel good, first about the food she IS eating, make her feel better? Yes. Will that open the door for more change? We hope so. Will it be a slow process? Yes, and that's OK.How to begin? First, I encouraged my clients to banish should from the vocabulary around food. I encouraged them to give themselves permission to eat what tastes good as we work on healing the relationship with eating, as we work around decreasing the anxiety that is at the table after years of stress around food. But, I had to chuckle this week as I shared my own should food wilting on my counter.Should is a taste-killer. Should is the worst word there is if you are trying to heal your eating or help your child learn to eat. Should makes us think something will taste bad. It makes us want to rebel and push back. Someone pushing you doesn't make you feel safe.  Forcing yourself to eat something because you should is not going to heal you. (I am referring here to selective eating, not eating disorders with malnutrition and restriction.) It is not going to make you like new foods. (Is it?)We eat foods first because they taste good. If we can tap into that pleasure around food, approach the relationship with food from a point of kindness, curiosity, patience, work to rid that relationship of anxiety and conflict, perhaps there will be a space for tasting foods and discovering some that actually taste OK, and even taste pretty good.And maybe you'll find out that you don't like crunchy textures, or fish, or stews with mixed textures. Maybe you'll find out that you perhaps are more cautious, or a "super-taster" or find your mouth feels different with starchy foods. But, until you make peace with the table and what you are eating now, there isn't really any room for discovery.A reader writes in response to a comment about adult picky eating. She has done some considerable work around this issue. Note that while she makes vegetables and is regular about providing opportunities, she still gives herself permission not to eat vegetables, and is finding out that sometimes she even "craves" them...I too (and my husband) are learning how to eat vegetables now, and we're considerably older than you.  Progress comes in fits and starts.  I make myself prepare veggies every day, but that doesn't mean I have to eat them.  I usually do, because once I've gone to the effort... but sometimes the effort is minimal, like with a basic green salad.  I also stay in my comfort zone with veggies and only once a week or sometimes once every two weeks try something new.  And every so often, I'll have a craving for a vegetable, which is still a foreign experience for me.  I've been at this for a little over a year.  I've been very focused on being patient with myself and so far as I am able, treat my veggie hating brain like a child separate from myself.I would LOVE to hear your thoughts on this. I really struggled with this post. I still haven't wrapped my brain around all of this in terms of the eating disorder diagnosis. Are you someone that has learned to like foods by forcing yourself? Did it not work? Share whatever comes up, again I want to learn from you!*I acknowledge the privilege I have that I can do this, and contemplate throwing food away and know this will be hard for some to get over.p.s. I also know I will get recipes now from readers who love kale, who prepare it and enjoy it regularly. The only way I have found that I enjoy it is in a rich and hearty veggie soup, but that's not what I feel like cooking. I also once almost sliced my finger off with my new Santoku knife while I chopped a bunch of kale :)