This year my 20-year-old son is skipping Thanksgiving.
I texted him to ask how he would explain ARFID to a friend who didn’t understand eating disorders. “It’s like a fight or flight response with food,” he texted back. “People with ARFID have a small number of ‘safe foods’ they can eat without any psychologically adverse effects, something they default to on a daily basis. There’s vomiting only with certain foods.”
Avoidant and Restrictive Food Intake Disorder (ARFID), a new diagnosis, not widely understood, is a type of sensory processing disorder, affecting 3% of the population. It often co-occurs with anxiety, attention deficit and hyperactivity issues, and neurodivergence.
When he was little, his mother and I thought our son was just a “picky eater.” At family meals he preferred to hold forth in conversation, his charming self, forgetting to touch his food. When one of us nudged him to try the broccoli, the power struggles started, often leading to tears and temper tantrums.
As he grew up, his food preferences narrowed. The number of safe foods ― white bread, cheddar cheese, green apples, noodles, bagels ― had to be specific brands from particular stores, one of ARFID’s signature characteristics. Worried, we pestered, even criticized, as if it were a question of personal will.
He was at risk for nutritional deficits and anemia, had blood work at all pediatrician visits, and was often prescribed vitamins and supplements which made him gag. It all felt like a punishment.
When we first started seeing nutritionists, they recommended different ways of sneaking nutritious stuff into the few foods he liked ― the chocolate zucchini birthday cake will never be forgiven ― which always failed.
Until you have ARFID, or have a child who has ARFID, you do not realize the extent to which human relationships are organized around eating together. Holidays like Thanksgiving are the worst.
When well-intentioned people notice my son eating his safe foods ― it happens every Thanksgiving ― they default to the ways they respond to toddlers who are picky eaters: cajoling, encouraging, talking up new foods (sometimes more direct, critical ways of responding).
During food-focused holidays, people like my son face a barrage of uncomfortable corrections when they just want to be left alone with what is essentially an invisible disability. He can either smile and tolerate the interrogations, educate the person ― which is fraught because it is sad to have ARFID ― or escape the situation. Any conversation about food is associated with shame and being reminded that there’s something “wrong” with you.
In earlier food-focused holidays, my son would join us, reluctantly, after we insisted, and either tolerated the alarmed attentions of others or escaped and didn’t come back.
A specialized nutritionist told us he had ARFID. Proteins in his taste buds didn’t communicate with his brain in the same way that ours did. As a teenager, he worked for several years on “exposures.”
“Because taste buds change every 30 days or so, ‘exposures’ get your body accustomed to a food in hopes that it will become safe,” he texted me. The logic is that continued exposures to new foods eventually changes the communication between taste buds and the brain. It is a frustratingly slow process.
Each month he chose one “food challenge.” He took one to two bites a day and kept a log of his reactions. One summer month he chose strawberries. While he took a bite and grimaced, I had several. (OK, I ate the rest of the pint, delighted with the juicy sweetness.) In his log, my son wrote words like “bitter” and “nasty.” Strawberries never became a safe food.
The sad reality hit me: Food gave him no happiness.
As a psychotherapist, I frequently find myself playing this cognitive game: What if the “disorder” demanding “cure” ― shame-infused words that become part of the problem ― is just an exception to the usual ways of social being, putting the “sufferer” in the position of having to adapt, adjust, minimize, rationalize, or deny legitimate feelings of inconvenience, when the real problem is that the world is organized around other people’s way of doing things? What if the problem is other people with their insistence on social conformity?
When he told us he was sitting out this holiday, my son mentioned the persistent grievance about Thanksgiving: It celebrates what is essentially the genocide of native populations. To enjoy it, you have to unsee, or at least reckon with, a tortured history, a reality ignored in the warm colors and ambient light of the Norman Rockwell painting. The insistence on one narrative, one imposed meaning, sidesteps other realities. As we talk about Thanksgiving with friends with marginalized and targeted identities, we realize that my son won’t be the only one doing something else.
Still I was disappointed that he wouldn’t join us, secretly wishing he would change his mind.
Last spring, when his older brother finished college, our family made a trip to Berlin for his graduation. Historically, travel abroad has been terrible because of the lack of familiar foods. This time, armed with self-awareness, we packed a suitcase full of safe foods: macaroni and cheese, peanut butter and jelly, his favorite crackers. But we still wanted to have a special dinner out.
My younger son, who hates restaurants but loves his brother, begrudgingly conceded. He dreads the attention of the wait person when he only orders one bland dish. Inevitably, they ask questions like, “Are you sure?” or they talk up other items, or other members of the dinner party launch into correcting mode.
In our hotel before the dinner, we checked the online menu to confirm there was a safe food. When we entered the bustling restaurant, the yellow glow on the tables, happy diners chattering, beautifully plated dishes being brought to tables, my son looked pained. The waiter mentioned there was a fixed prix “Family Feast.” A chef’s selection of dishes would be brought to our table. No one had to order an individual meal. We were thrilled. My son wouldn’t be asked any questions.
“And there will be french fries?” I asked the waiter. “We all want to try them.”
“There are always french fries,” he said.
My son’s expression relaxed. He even ordered a fancy cocktail ― bourbon, sherry, cranberry syrup and lemon ― and he liked it! It was a rare moment when we had a family dinner at a restaurant. It was the best dinner we ever had, and he didn’t feel like there was something wrong with him.
Early in my journey as a dad I might have said that I loved my three children unconditionally, but that’s a lie. Discovering them as complex individuals with their own ways of navigating a difficult, unfair, sometimes cruel world, has revealed that there are conditions: my own needs, attachments, and fantasies about who they might be, which are sometimes unclear, unconscious, but potent.
Continually shedding expectations, I move closer and closer to a purer form of caring ― that ideal of unconditional love. That self-discovery is the real pleasure of parenting.
This Thanksgiving some of us will have dinner with our neighbors. We are in charge of pies ― chocolate pecan, traditional pecan, and pumpkin ― and my partner will bring a new gnocchi and Brussel sprouts dish for my daughter’s girlfriend, who is vegan. My son will stay home where he wants to be, away from the attention of others (and the bad memories that brings up), play video games and watch movies, and talk to his grandmother who is in a different time zone.
We will miss him, of course, but I trust he will be OK.
Later we plan to come home for dessert with him. Through some holiday magic I don’t pretend to understand, but for which I am grateful, pumpkin pie is a safe food.