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Fear Food Hierarchy

A fear or challenge food hierarchy is something you can work on with your eating disorder treatment team to continue making progress towards specific foods or food events that feel challenging for you. For example, someone might have eating a slice of birthday cake on their hierarchy and/or going out to eat at a restaurant for someone’s birthday, so incorporating both foods and food experiences that feel meaningful to you.

The primary goal of a fear food hierarchy is gradual exposure therapy. Just like someone with a fear of heights might start by looking at pictures of tall buildings before eventually standing on a balcony, individuals with eating disorders work through their challenge foods in a step-by-step manner. The hierarchy helps break down overwhelming challenges into manageable steps, allowing individuals to confront their fears in a controlled and supportive environment. So how does it work in practice? Let’s see…

  1. Identifying Fear Foods: The first step is identifying the specific foods/food groups or food experiences that trigger anxiety or fear. This is done through open communication between the client and their treatment team.

  2. Ranking the Hierarchy: Once fear foods are identified, they are ranked from least to most anxiety-provoking, usually on a scale of 0-100%.

  3. Setting Goals: Goals are set based on the hierarchy. The initial goal might be to incorporate a small portion of the least anxiety-provoking item into a meal or snack. It can be helpful to pair something more anxiety-provoking with something you feel comfortable with. So let’s say yogurt is on someone’s hierarchy but fruit feels safe - having a bowl of fruit with a dollop of yogurt on it for an initial exposure may be the first goal.

  4. Gradual Exposure: Over time, clients work their way up the hierarchy, gradually increasing exposure to more challenging exposures as they build the ability to challenge cognitive distortions related to these experiences and build their toolbox to include coping strategies and distraction techniques, to name a few.

  5. Monitoring Progress: Progress is monitored regularly with your treatment team, and adjustments are made to the hierarchy as needed. Successes are celebrated, and setbacks are used as learning opportunities! Over time it can also be helpful to reassess where certain things are landing on the hierarchy, and this can serve as a tangible check in for someone’s progress if something is able to move down from a higher to lower percentage!


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