My guest this week is Dr. Katherine Dahlsgaard, a clinical psychologist and specialist in treating kids and teens. We focused in this episode on extremely picky eating in kids, also known as avoidant/restrictive food intake disorder (ARFID). This was a fascinating topic for me and one I wasn’t that familiar with. But Katherine is extremely knowledgeable and does a great job describing the principles of treating ARFID, so I know you’ll find a lot of interest here.

Topics we discussed included:

• How Katherine came to specialize in treating picky eating
• Having parents present in treatment sessions
• “Door knobbing” in therapy
• The dilemma of continuing to work with a therapist who doesn’t specialize in our condition
• How avoidance reinforces anxiety and drives anxiety disorders
• Why exposure therapy works
• Admiration for the parents of the kids Katherine works with
• Katherine’s mentorship by Dr. Aaron T. Beck
• The legacy of psychology and psychiatry in blaming parents (especially mothers) for their kids’ struggles
• Avoidant/Restrictive Food Intake Disorder (ARFID)
• How extremely picky eating is different from anxiety disorders
• The role of disgust in maintaining food avoidance
• How ARFID is diagnosed, and how it differs from anorexia and bulimia
• The rigidify of orthorexia (“right eating”)
• The three types of ARFID
• When ARFID tends to emerge
• The frequent disgust in reaction to food that are part solid and part liquid
• Telling the difference between typical restrictive eating and ARFID, and a related article by Dr. Nancy Zucker
• Rigidity and extreme distress as characteristic of ARFID
• Why ARFID is not parents’ fault
• Risk factors for ARFID and nature/nurture: genetics + behavioral reinforcement/maintenance + culture
• The trap of bad food hygiene
• Katherine’s recommendation to read French Kids Eat Everything (affiliate link)
• The best treatment approach for extremely picking eating
• The problem with half completing an exposure exercise
• Using screen time as a reward in ARFID treatment

Here’s the link to the 2019 pilot study that Katherine mentioned.

Katherine K. Dahlsgaard, PhD, is board certified in cognitive and behavioral psychology and a licensed clinical psychologist. She is currently in private practice, treating children, adolescents, and adults through various applications of cognitive behavioral therapy.

Katherine was previously the Founder and Clinical Director of the Anxiety Behaviors Clinic, the Picky Eaters Clinic, and the Food Allergy Bravery Clinic at Children’s Hospital of Philadelphia.

She focuses her efforts on the promotion of evidence-based psychotherapy through her clinical practice, speaking and writing, and consultation and training. She also serves as a media expert, educator, writer, lecturer, and keynote speaker.

She regularly writes columns for The Philadelphia Inquirer on topics related to mental health, and serves on their Health Advisory Panel.

Katherine received her PhD from the University of Pennsylvania, where she was a National Science Foundation Fellowship awardee, and completed her postdoctoral training at the NYU Child Study Center.

Find Katherine online at her website and on Instagram, Facebook, and Twitter.