For most of us, when we go out to a restaurant, it's usually no problem to find at least a few options on the menu that suit our taste, and we'll likely even have trouble choosing between several favorite dishes.
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Now imagine that you go to a restaurant and when the menu arrives, you simply have nothing to order. You can't bring yourself to try foods you're unfamiliar with, and you don't even really want to; you're even afraid to.
For people like Eitan Hollander, 25, from Petah Tikva, this is their daily reality. Hollander suffers from a condition called Arfid (Avoidant Restrictive Food Intake Disorder), which prevents him from eating almost everything. "I'm scared to try new things, afraid I'll vomit, and I'm stuck with foods I ate in my childhood," he says.
Excited or curious about a new dish? Hollander is simply afraid to try it. "I look at food as a sort of threat, in some sense. I need to be in a very adventurous and daring mood to try something new," he explains.
This condition makes it very difficult for him to cope with anything related to nutrition, starting at home where he can't eat what the rest of the family eats. And it’s much worse in social situations.
"Beyond the fear of food, there's also a significant fear of embarrassment, for the reason that 'Eitan hardly eats anything.' If everyone goes to a restaurant once, you're suddenly in a dilemma: Do you go with your friends? Eat beforehand? You're at a loss. When colleagues order food in the office or among friends, I'm always the problematic one that people have to consider, so I bring food from home."
'I tried to eat it and ended up vomiting'
On the list of foods that Hollander won't put on his plate, there are some that might surprise you. "People look at me strangely and ask, 'You don't eat sushi, pasta, pizza, burgers?' and raise their eyebrows. And I answer them—nothing! I've heard phrases like 'I'll fix you,' 'I'll teach you to taste new things' multiple times. Let it go. Maybe I need to deal with it, but if you order sushi and force me to eat it, that's not going to solve the problem."
Even at shawarma places, he gets odd looks from the vendor when he asks for schnitzel or chicken in pita without any extras. "I'm always baffled by it," he says, and continues, "Eventually, I find the self-confidence to say 'Yes, this is my dish and this is what I'll eat,' and it takes time to develop that." One place where Hollander particularly struggled was in Officers Training School (Bahad 1). "I subsisted off waffles," he testifies.
It's hard to know for sure what causes Hollander to be so afraid of food, but a trauma from the age of eight might at least partially explain it. "I had a caregiver I would go to eat with after school, and she would have me try new things. One day she brought me a dish with beets and peas, and I really didn't want to eat it. I tried to taste it, it didn't go well, and she kept pushing me to eat the dish. I tried to eat it and ended up vomiting. Then she sat me back down at the table and forced me to finish the plate." Since then, he says, he stopped trying new foods.
Is it easy for you to talk about this?
"I'm usually a very open person and can talk about any subject from the moment you meet me, but it's hard for me to talk about this and call it an eating disorder; it feels strange to say that about myself. I have no problem laughing at myself—so my friends and I often joke about it, but sometimes there are hurtful comments. You have to explain that you're like the kids who only eat schnitzel and pasta, but that doesn't define me as childish or unadventurous. It's purely an eating disorder, and it's part of my story—don't judge me for it."
Hollander just wants to take the burden off himself, to stop constantly thinking about what he will eat, and so he has built himself a fixed menu that he eats every day. "I eat the same thing every day," he explains and details.
"In the morning, an omelette with cucumber, bell pepper, and pita; for lunch, chicken and pasta with cucumber—I call it a 'cucumber salad,' even though it's just cucumber and seasoning. In the evening, cornflakes with milk or schnitzel. Occasionally, some Bissli in between. This alleviates my fear of eating something new or tasting new things. Many people ask me, 'Isn't it boring to eat the same thing every day?' And no, because for me, food is more like fuel. I'd rather not take risks, and for me, that's fine."
Do you even enjoy food?
"Not really, maybe a little from my mom's cooking—like chicken for Shabbat—but people enjoy food much more than I do. For them, food can be about traveling abroad, people recommend restaurants and local cuisine, and I'm just not interested or excited about that. It actually scares me.”
Don't you feel like you're missing out?
"I understand the sense of missing out on an experience, but I don't feel it. Sometimes I even think there's an advantage to it. For instance, if I want to create a fitness menu, it's very easy for me to eat chicken and carbs every day, whereas some people struggle with that. I have no problem eating the same thing every day and I don't feel the need for variety. I don't understand people who need to think about what they want to eat all the time; that's just not on my mind. So there are supposedly some positive aspects that I try to take away from it.”
Would you like to try new things? To try and resolve it?
"I haven't tried to address it. I'm a bit scared to, actually. I'd like to try and overcome it because it feels like it really limits me in many ways, like a thorn in my side that's annoying and I want to remove. So I'd like to resolve it, but that's very theoretical; I'm afraid to engage with it. Also, constantly berating myself and saying, 'Why do you have this eating disorder? Why are you flawed like this?'—that's not healthy, and I wouldn't enjoy living my life that way. On the other hand, I also understand that ultimately, it is an eating disorder, and I'd like to overcome it."
Recently Hollander has been more open to new foods and has returned to eating French fries after four years. "Slowly but surely, I'm making some progress. It depends on my mood," he shares, adding that he recently tried lettuce for the first time while traveling in Mexico, but most of the time he still mainly subsisted off waffles there.
What else do you think people should know about ARFID?
"People from the outside who haven't experienced this should understand that in the end, it's an eating disorder just like any other. Would you go up to someone with bulimia and tell them not to vomit? Or to someone with anorexia and say, 'Just eat'? It's the same when you approach someone you know doesn't like trying new things—don't just tell them to 'just try it.' We need a bit more empathy and listening on this topic."
ARFID: Also Impacts Social Functioning
Prof. Yael Latzer, the founder of the Center for Eating Disorders at Rambam Hospital, who has managed it for 25 years and also researches and treats eating disorders at the Faculty of Social Welfare and Health Sciences at the University of Haifa, explains that ARFID is an eating disorder in every sense. It was officially recognized as such a decade ago in the American Diagnostic and Statistical Manual of Mental Disorders (DSM).
Prof. Yael LatzerPhoto: RambamThe DSM defines psychiatric disorders and establishes criteria that allow all researchers and clinicians to speak the same language. Prof. Silvana Fennig, director of the psychiatric department at the Schneider Children's Medical Center, adds, "ARFID is defined as an eating disorder when it impacts the normal functioning and development of that individual. This is often related to the development of children—vitamin intake, consumption of various nutrients, and impact on growth. However, it's not limited to childhood and can continue to develop into adulthood."
How common is it?
Prof. Fennig: "We focus more on children, where it is more common. It often fades away as they grow, but some people live with it their entire lives."
Prof. Latzer: "This disorder is primarily found in young people and affects about 5% of the total child population. Twenty percent of them are boys, the majority are girls, and the duration of the illness is usually long. If not treated at a young age, it can persist for many years. Even if it doesn't harm their health, they still suffer from it. It accounts for 8%-14% of all those seeking treatment for eating disorders, which is a very high number. Since it was included in the DSM, there have been more referrals because there's now recognition.”
When is it a real eating disorder and not just picky eating?
Prof. Latzer: "Not every slightly different approach to food is an eating disorder. You can avoid eating familiar items based on texture, shape, color, disgust or trauma. Between the ages of two and six, most children are picky eaters, which is normal. There's no need to consult a dietitian; just increasingly expose the children to new foods. It’s also important to distinguish this from neophobia—a natural suspicion of new things—especially common in children between one and a half to three years old, where the kids are afraid to try unfamiliar foods.”
Prof. Silvana FennigPhoto: Schneider Medical CenterProf. Fennig: "The disorder is not related to body image, unlike classic eating disorders such as anorexia and bulimia. It's related to sensitivities to textures and foods. The person becomes very selective about what they can eat, and this can affect functioning and development. Generally, we're relieved when our child eats because we know that food is the key to healthy development. It is defined as ARFID when it adversely affects health and impacts growth or social interactions."
What does someone experiencing ARFID go through?
Prof. Latzer: "They experience depression, but primarily very high levels of anxiety. That's why the treatment method for ARFID is gradual exposure to new foods along with a lot of practice in distraction techniques to cope with the high anxiety levels. The exposure engages all the senses even before they eat, in order to reduce anxiety levels. It's much like exposure therapy for other phobias and anxieties, such as fear of heights, claustrophobia and more."
Prof. Fennig: "Even adults can develop anemia if they're not consuming essential nutrients. For example, if there's not enough calcium, it can lead to complications. In such cases, a dietitian ensures that, despite the difficulties, they are getting all the essential nutrients or at least the supplements, in order to prevent complications."