Lifelong solid food refusal in an 8-year-old girl with a choking phobia: a case report

Background This case report describes the presentation and clinical care of an 8-year-old girl treated in an eating disorder partial hospitalization program (PHP) for Avoidant/Restrictive Food Intake Disorder (ARFID), fear of aversive consequences subtype, who had never transitioned from liquids and purees to solid food. Case presentation The patient’s choking fears manifested as complete avoidance of solid foods, maladaptive mealtime behaviors, marked food selectivity, and significant emotional, cognitive, and interoceptive distress. This report describes the successful use of multimodal therapy, including Family-Based Treatment (FBT) and Cognitive Behavioral Therapy for ARFID (CBT-AR), adapted for a higher level of care and delivered using an inhibitory learning-informed exposure framework, in combination with psychopharmacologic treatment. Conclusions This case highlights the applicability of the inhibitory learning approach to exposure therapy within CBT-AR for pediatric choking phobia and underscores the value of PHP-level of care for younger children with severe ARFID. It also suggests that targeting anxiety, appetite, and cognitive rigidity with psychopharmacological treatments may increase food approach and interest in patients with specific food- and eating-related phobias. Finally, the report illustrates the successful treatment of an atypically severe, longstanding illness and offers clinical guidance for similar cases.