Food OCD: Why am I afraid of certain foods?

It’s not difficult to understand that while everyone needs to eat to survive, each individual’s relationship with food is quite different. We all have different preferences for particular ingredients we enjoy, how meals are prepared, the environments we eat in, and even who’s doing the cooking. 

Since we interact with food multiple times a day, there are ample opportunities for fears about food to grab hold. How this happens varies from person to person. Maybe you’re scared of processed foods because of an underlying fear that eating any amount of “junk” will lead to illness or cancer; meanwhile, your sister refuses to eat carb-heavy meals because she doesn’t want to gain weight. Someone might have a fear of eating out at restaurants because they don’t trust that safety regulations are being followed—and their worst nightmare is contamination—while others are afraid that the ingredients just aren’t up to their standards. 

Having certain eating habits and food “likes and dislikes” can be completely normal. But if you find yourself constantly distressed at meal time, or even have disturbing intrusive thoughts about food, you may be dealing with a legitimate mental health issue.

Can fear of food be an actual phobia?

When getting to the root of a fear of food, it’s important to consider what’s actually making you anxious. Sometimes it can be as simple as feeling distress when in the presence of specific foods. This would be considered cibophobia, the persistent and irrational fear of food.

Cibophobia can latch onto a wide range of foods, or be limited to certain ingredients or beverages. For example, someone may only be afraid of perishable foods, like meat and dairy products. Whatever someone’s individual trigger foods, cibophobia causes people to go out of their way to avoid them. When that’s not possible, coming into contact (not even necessarily eating them—but just seeing them) may lead to a slew of symptoms. These include:

• Gastrointestinal issues 
• Panic attacks
• Chest pain and/or heart palpitations
• Shortness of breath
• Sweating, shaking, and/or chills
• Feeling like they’re dying, about to faint, or in some form of danger
• Having an urge to escape their environment

It’s important to note that sometimes an irrational fear of food isn’t about the item itself, but about potential “consequences” of eating certain foods. Tracie Zinman-Ibrahim, LMFT, CST, and Chief Compliance Officer at NOCD, sees a lot of food-related fears with emetophobia, a.k.a the intense fear of vomiting. She’s heard from a therapy member who only ate smooth foods, so that if she happened to throw up, the experience wouldn’t be as “disgusting” to her. “This particular member I worked with was only having smoothies,” Ibrahim says. “Her smoothies could only have certain ingredients that didn’t feel ‘bumpy’ going down her throat. “She wouldn’t do berries because they have seeds and she didn’t want to vomit seeds.”

Cibophobia and emetophobia both fall under the umbrella of specific phobias, which are anxiety disorders that revolve around distinct objects, places, situations, or activities. 

The DSM-5 requires the following criteria to make a diagnosis for any specific phobia:

• Your fear is excessive or out of proportion to the actual “threat”
• Your fear leads to intense distress, anxiety, or panic 
• Your fear (or avoidance of the thing you fear) significantly interferes with your life 
• You’ve had the fear for at least six months
• Your fear is not a result of another mental disorder 

Are food-related phobias different from eating disorders like ARFID?

While cibophobia may sound like an eating disorder, it’s not classified as one. For one thing, cibophobia has nothing to do with a person’s body image, like in anorexia; it occurs when a person has a fear of the actual food itself.

That said, it’s possible to have both an eating disorder and cibophobia at the same time.

For example, you may be familiar with a newer form of an eating disorder known as avoidant restrictive food intake disorder (ARFID), a severe form of food restriction. If your fear of food leads you to remove a large variety of foods from your diet, you could be dealing with both cibophobia and ARFID.

It’s important to emphasize that unlike with eating disorders like anorexia or bulimia nervosa, a concern with body shape or size isn’t at the core of an ARFID diagnosis. Rather, people with ARFID have food aversions and fear certain consequences of eating such as choking, which causes them to severely limit their diet. 

People with ARFID will only eat a short list of foods that they deem “safe.” Often, this has to do with sensory issues, like the way it feels to chew or swallow certain foods. The eating disorder might cause ritualistic meal-time habits, like eating items on one’s plate in a specific order. It’s not uncommon for those with ARFID to lose interest in eating altogether because of the amount of anxiety introducing new foods causes.

Unlike with a specific phobia, an AFRID diagnosis requires more distinct criteria related to physical health. One must have some sort of eating or feeding disturbance, which could be a lack of interest in eating or food. It could also mean avoiding food due to sensory qualities or out of concern for potential negative outcomes, like vomiting, choking, or diarrhea. These restrictions must not be due to food insecurity, religious, or cultural practices (like fasting), or another medical condition or treatment. And as mentioned earlier, body image issues, like a desire to lose weight, must also be ruled out as a root cause. Additionally, diagnosis requires at least one of the following symptoms:

• Notable weight loss, or growth difficulties in children
• Significant nutritional deficiency
• Dependence on tube-feeding or oral supplements for nutritional value
• Food aversion that interferes with the ability to perform tasks and interact with others

Is my fear of food related to OCD?

At first glance, it can seem that people with ARFID or a phobia related to food are actually obsessive about limiting their diet. So can food fears be related to obsessive-compulsive disorder (OCD)? Every case looks different, but for some people, the answer is yes. 

OCD is a chronic mental health condition defined by two symptoms: obsessions and compulsions. Obsessions are recurrent and unwanted thoughts, urges, feelings, sensations or images that cause distress. These obsessions lead to compulsions, or repetitive behaviors or mental acts done in an attempt to ease discomfort or neutralize distressing thoughts.

Food-related obsessions and compulsions can show up across many different OCD subtypes. Take, for instance, magical thinking OCD. Some people with this form of OCD have seemingly superstitious intrusive thoughts about food—for instance, they may eat a specific meal for breakfast every day because of an intrusive thought that tells them: “What if you don’t eat this food and something bad happens as a result?”

Ibrahim, who has OCD herself, has dealt with contamination-related fears surrounding food. “I used to not want to touch raw meat or poultry or fish because I just felt like I just couldn’t get it off my hands,” says Ibrahim. She constantly felt like the residue was stuck under her nails, which led to excessive hand-washing.

“I would let someone else do it or I would get surgical gloves,” Ibrahim says.

Of course, different OCD subtypes may lead to different food-related fears and obsessions. Here are some examples.

• Contamination OCD: “What if my bread is moldy and I get sick?”
• Just right OCD: “What if I don’t take the right amount of bites and something bad happens?”
• Scrupulosity OCD: “If I eat non-kosher foods, will I be punished?”
• Relationship OCD: “What if my partner and I don’t agree about what kinds of foods we should eat and that makes us break-up?”
• Responsibility OCD: “I need to prepare all of my family’s meals because otherwise, I’ll be responsible if they get food poisoning.”
• Somatic OCD: “What if I swallow my food incorrectly and I choke?”

As a result of their food-related intrusive thoughts, someone with OCD also performs compulsions. Here are some examples:

• Avoidance of certain foods
• Hoarding a surplus of food because of a fear of running out 
• Refusing to eat food prepared by others
• Eating food in a specific order to prevent something “bad” from happening
• Excessively sanitizing groceries and kitchen counters
• Only eating a specific amount of certain items (i.e. an even amount of cookies)
• Checking and re-checking calories or dietary restrictions on menus or food labels

How to overcome a fear of food

How you treat a fear of food depends on the underlying cause. For instance, if cibophobia is at play, cognitive behavior therapy (CBT) may be helpful. CBT is a type of therapy in which a licensed therapist helps their patient identify their thinking patterns, understand how thoughts influence actions, and move away from negative behaviors.

As for ARFID, it’s best handled by a healthcare team including a therapist and a dietitian. If ARFID has developed to the point where a person is severely malnourished, hospitalization to get them back to a healthy weight may be necessary. Once they’re physically stable, therapy can be introduced. “You can’t take part in therapy if your brain isn’t functioning because you’re malnourished,” says Ibrahim.

Similar to cibophobia, many mental health practitioners treat ARFID with CBT. But therapists may also incorporate some exposure and response prevention (ERP) therapy for ARFID patients. ERP is an evidence-based therapy that’s highly effective in treating OCD, and it’s different from general CBT. (It should also be noted that ERP can also be effective in treating specific phobias.)

ERP works by gradually exposing you to what triggers your specific fears, and then teaching you strategies to cope with any distress. For example, Ibrahim is working with a therapy member who has fears related to eating in public. One of her obsessions is that she may try to talk while chewing and start choking. Ibrahim has designed specific exercises to practice facing this fear head on. “We did an exposure where we ate peanut butter crackers with no beverages while also talking,” Ibahim says.

As you practice the exposure exercises with your ERP therapist, you’ll find that the discomfort caused by food-related fears gets easier to manage—and, almost always, that your worst-case scenarios don’t come true. In time, the rules and rituals you have developed around food start to lose their power over you.

Bottom line

If you’re participating in behaviors that cause you to severely restrict your diet, it’s important to check in with a healthcare provider. Whatever the root cause of your fears, there are specially trained professionals out there who are ready to help you make mealtime—and life—more enjoyable and less stressful.