Orthorexia Nervosa, Manifestation and Management

Orthorexia Nervosa, Manifestation and Management

Orthorexia nervosa is a proposed eating disorder or mental disorder characterized by an extreme or excessive preoccupation with avoiding foods perceived to be unhealthy. The term orthorexia derives from the Greek ορθο- (ortho, “right” or “correct”), and όρεξις (orexis, “appetite”), literally meaning ‘correct appetite’, but in practice meaning ‘correct diet’. It was introduced in 1997 by Steven Bratman, M.D., to be used as a parallel with other eating disorders, such as anorexia nervosa. Orthorexia is not mentioned in the widely used DSM, but was coined by Bratman who claims that in rare cases, this focus may turn into a fixation so extreme that it can lead to severe malnutrition or even death. Even in less severe cases, the attempt to follow a diet that cannot provide adequate nourishment is said to lower self-esteem as the orthorexics blame themselves rather than their diets for their constant hunger and the resulting cravings for forbidden foods.

Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.”  Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity.  They become consumed with what and how much to eat, and how to deal with “slip-ups.”  An iron-clad will is needed to maintain this rigid eating style.  Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise).  Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake.

Eventually food choices become so restrictive, in both variety and calories, that health suffers – an ironic twist for a person so completely dedicated to healthy eating.  Eventually, the obsession with healthy eating can crowd out other activities and interests, impair relationships, and become physically dangerous.

In 2009, Ursula Philpot, chair of the British Dietetic Association and senior lecturer at Leeds Metropolitan University,[7] described people with orthorexia nervosa to The Guardian as being “solely concerned with the quality of the food they put in their bodies, refining and restricting their diets according to their personal understanding of which foods are truly ‘pure’.” This differs from other eating disorders, such as anorexia nervosa and bulimia nervosa, whereby people focus on the quantity of food eaten.

Steven Bratman coined the term “orthorexia nervosa” in 1997 from the Greek orthos, meaning “correct or right”, and orexis, meaning “appetite”.[8] Literally “correct appetite”, the word is modeled on anorexia, meaning “without appetite”, as used in definition of the condition anorexia nervosa. Bratman describes orthorexia as an unhealthy fixation with what the individual considers to be healthy eating. The subject may avoid certain unhealthy foods, such as those containing fat, preservatives, man-made food-additives, animal products, or other ingredients considered by the subject to be unhealthy. If the sufferer does not eat appropriately, malnutrition can ensue. Bratman claims orthorexia sufferers have specific preferences about the foods they are eating and avoiding. Products that are preserved with additives can be considered dangerous. Industrial products can be seen as artificial, whereas fruits and vegetables can be seen as healthy.[9] Bratman asserts that “emaciation is common among followers of certain health food diets, such as rawfoodism, and this can at times reach the extremes seen in anorexia nervosa.” In addition, he claims that “anorexic orthorexia” can be as dangerous as anorexia. However, he states, “the underlying motivation is quite different. While an anorexic wants to lose weight, an orthorexic does not desire to become thin[9] but wants to feel pure, healthy and natural. Eating disorder specialists may fail to understand this distinction, leading to a disconnect between orthorexic and physician.”

Orthorexia is a term coined by Steven Bratman, MD to describe his own experience with food and eating.  It is not an officially recognized disorder, but is similar to other eating disorders – those with anorexia nervosa or bulimia nervosa obsess about calories and weight while orthorexics obsess about healthy eating (not about being “thin” and losing weight).

Orthorexia appears to be motivated by health, but there are underlying motivations, which can include safety from poor health, compulsion for complete control, escape from fears, wanting to be thin, improving self-esteem, searching for spirituality through food, and using food to create an identity.

Orthorexia – an unhealthy fixation on eating only healthy or “pure” foods – was originally defined as a disordered eating behavior in the ’90s, but experts believe it has been gaining steam in recent years, fed by the profusion of foods marketed as healthy and organic, and by the media’s often conflicting dietary advice. Like anorexia nervosa, orthorexia is a disorder rooted in food restriction. Unlike anorexia, for othorexics, the quality instead of the quantity of food is severely restricted.

“Orthorexia starts out with a true intention of wanting to be healthier, but it’s taken to an extreme,” says Academy of Nutrition and Dietetics Spokesperson Marjorie Nolan, MS, RDN, CDN, ACSM-HFS, who specializes in working with eating disorder clients. “If someone is orthorexic, they typically avoid anything processed, like white flour or sugar. A food is virtually untouchable unless it’s certified organic or a whole food. Even something like whole-grain bread – which is a very healthy, high-fiber food – is off limits because it’s been processed in some way.”

Orthorexics typically don’t fear being fat in the way that an anorexic would, but the obsessive and progressive nature of the disorder is similar. Orthorexics may eliminate entire groups of food – such as dairy or grains – from their diets, later eliminating another group of food, and another, all in the quest for a “perfect” clean, healthy diet. In severe cases, orthorexia eventually leads to malnourishment when critical nutrients are eliminated from the diet.

Diagnostic criteria

  • Although orthorexia is not recognized as a mental disorder by the American Psychiatric Association, and it is not listed in the DSM-5, it is still used as a diagnosis by some practitioners who have documented the damaging results of the condition as they have seen in their practices.
  • As of January 2007, only two peer-reviewed studies have been published on the alleged condition. In the studies, Donini et al. define orthorexia nervosa as a “maniacal obsession for healthy foods” and propose several diagnostic criteria. Sufferers of orthorexia often display symptoms consistent with obsessive-compulsive disorder and have an exaggerated concern with healthy eating patterns. Like anorexia, however, these obsessive compulsive symptoms may be an effect of starvation rather than a cause of the disorder. A diagnostic questionnaire has been developed for orthorexia sufferers, similar to questionnaires for other eating disorders. Bratman proposes an initial self-test composed of two direct questions: “Do you care more about the virtue of what you eat than the pleasure you receive from eating it?… Does your diet socially isolate you?” Other questions concerning those who may be suffering from orthorexia provided by Davis on the WebMD (2000) website are: Do they spend more than 3 hours a day thinking about healthy foods? When they eat the way they’re supposed to, do they feel in total control? Are they planning tomorrow’s menu today? Has the quality of their life decreased as the quality of their diet increased? Have they become stricter with themselves? Does their self-esteem get a boost from eating healthy? Do they look down on others who don’t eat this way? Do they skip foods they once enjoyed in order to eat the “right” foods? Does their diet make it difficult for them to eat anywhere but at home, distancing them from family and friends? Do they feel guilt or self-loathing when they stray from their diet? If yes was answered to two or more questions, the person may have a mild case of orthorexia.

Symptoms

  • Orthorexia nervosa is characterized by an obsession with avoiding foods perceived to be unhealthy. It is important to differentiate between healthy individuals who choose specific diets for any number of reasons, and those who exhibit obsessive compulsive behavior that leads to an unhealthy condition or lifestyle. What tips the balance from being committed to healthy eating and having orthorexia is the extreme limitation and obsession in food selection. Orthorexics find themselves being unable to take part in everyday activities. They isolate themselves and often become intolerant of other people’s views about food and health. This obsession for healthy foods could come from a number of sources such as family habits, societal trends, economic problems, recent illness, or even just hearing something negative about a food type or group, which then leads them to ultimately eliminate the food or foods from their diet.ON seems to be more common in men than in women and in those with a lower level of education The concept of orthorexia as a mental illness has attracted significant media attention.
  • There has been no investigation into whether there may be a biological cause specific to orthorexia nervosa. However, Donini et al. link orthorexia to a food-centered manifestation of obsessive compulsive disorder, which has a lot to do with control. A 2013 study of college students found that orthorexia severity was negatively associated with self-reported executive functioning. This means that the better the student did with cognitively complex tasks, including planning and decision-making, the less likely the student was to have orthorexia.

Management

  • Society pushes healthy eating and thinness, so it is easy for many to not realize how problematic this behavior can become.  Even more difficult is that the person doing the healthy eating can hide behind the thought that they are simply eating well (and that others are not).  Further complicating treatment is the fact that motivation behind orthorexia is multi-faceted.  First, the orthorexic must admit there is a problem, then identify what caused the obsession.  She or he  must also become more flexible and less dogmatic about eating.   Working through underlying emotional issues will make the transition to normal eating easier.
  • While orthorexia is not a condition your doctor will diagnose, recovery can require professional help.  A practitioner skilled at treating eating disorders is the best choice.  This handout can be used to help the professional understand orthorexia.

 

References

  • Bratman, Steven (4 June 2009). “What is Orthorexia?”. Retrieved 16 October 2010.
  • Rochman, Bonnie (12 February 2010). “Orthorexia: Can Healthy Eating Be a Disorder?”. Time. Retrieved 4 January 2012.
    http://udini.proquest.com/view/in-sickness-and-in-health-pqid:2428837551/ In Sickness and In Health: Orthorexia Nervosa, the Study of Obsessive Healthy Eating
  • Bratman, Steven (October 1997). “Obsession with dietary perfection can sometimes do more harm than good, says one who has been there”. Yoga Journal. Retrieved 16 October 2010.Billings, Tom (1999). “Raw Vegan Calorie Paradox—Potential Solutions/Reality Checks”. Retrieved 19 October 2010.
  • Getz, L. (June 2009). “Orthorexia: When eating healthy becomes an unhealthy obsession”. Today’s Dietitian. Retrieved 2009-10-13.
    Palo Alto Medical Foundation Summary of Eating Disorders
  • Macmillan English Dictionary entry for Orthorexia Nervosa
  • Rochman, B. (2010). Orthorexia: Can Healthy Eating Be a Disorder?. TIME.com, Feb 12. Retrieved 2010-02-12.
  • Web MD report: Orthorexia: Good Diets Gone Bad
  • Orthorexia: Too Healthy? Specialists have coined a new term-orthorexia-to describe an obsessive concern with healthy eating that often leads to social isolation, Psychology Today, Sept/Oct 2004.
  • Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2004). “Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon”. Eat Weight Disord 9 (2): 151–157. PMID 15330084.
  • Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2005). “Orthorexia nervosa: validation of a diagnosis questionnaire”. Eat Weight Disord 10 (2): e28–32.
  • Carlson, N: Physiology of Behavior, 10th ed., page 435. Person Education Inc., 2010

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