Cibophobia

The exact underlying causes of cibophobia are poorly understood, but it is thought to be multifactorial, involving a combination of genetic, environmental, and social factors. There may be genetic factors that predispose the individual to develop mental health conditions (e.g., anxiety disorder), eating disorders, and specific phobias. For example, individuals with a known family history of a specific phobia have an increased risk of developing a phobia compared to individuals without a family history. 

Most individuals develop cibophobia following a traumatic experience related to food such as choking incidents, allergic reactions to food, or witnessing others experience these food-related incidents. Social and cultural factors may also play a role, as the media may label certain foods to be “clean” or “dirty,” which creates a stigma associated with specific foods. 

Signs and symptoms of cibophobia may vary between individuals, but the hallmark feature is an overwhelming fear of food that ultimately interferes with the individual’s daily life and social activities. Signs and symptoms may include those associated with panic, such as increased heart rate, diaphoresis, shortness of breath, nausea, vomiting, and heightened anxiety levels when thinking about all types of food and beverages, or when exposed to certain food items only. Individuals typically fear perishable foods (e.g., milk-containing products), undercooked foods (e.g., medium-rare steak), recently expired food or foods with upcoming expiration dates, and prepared food from restaurants. As a result, they will avoid food and situations where food may be present. 

Over time, this avoidance behavior can lead to the development of avoidant restrictive food intake disorder (ARFID). While cibophobia and ARFID both involve restrictions with food intake resulting in complications such as dehydration, malnutrition, and social isolation, ARFID is driven by a lack of interest in eating due to sensory issues of specific foods, rather than a fear of eating to avoid negative consequences as seen in cibophobia. 

Diagnosis of cibophobia begins with a thorough review of symptoms, medical history, and physical exam. The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) criteria for diagnosis of a specific phobia include the following:

Treatment of cibophobia consists of a combination of psychotherapy, pharmacotherapy, and supportive care measures to address disease-related complications. Psychotherapy options include cognitive behavioral therapy (CBT) and exposure therapy. CBT is a form of talk therapy designed to help individuals address and manage problematic patterns of thinking. CBT usually requires multiple sessions with a psychotherapist or psychiatrist, who helps the affected individual gain a deeper understanding of the underlying problem and recognize problematic thoughts and behaviors related to identified triggers. Exposure therapy is another form of talk therapy in which the individual is gradually exposed to the trigger. During exposure therapy, a therapist creates a safe environment and gradually exposes the individuals to feared objects and situations.