Orthorexia

Disordered eating can take many forms, whether it’s classified in the DSM as an actual eating disorder or not (could be considered ED-NOS, but that doesn’t make it any less valid or harmful).

In 1997, Steven Bratman coined the term orthorexia nervosa, which means “correct appetite/diet.” He has said it is "a disease disguised as a virtue.”

Some people have doubted this disorder, but I consider it very real.

It’s compared to anorexia nervosa, “without appetite,” but while the two disorders can result with similar consequences and both have obsessive compulsive components to them, the mentality behind them is quite different, although there are also overlapping issues as well.

Whereas anorexia is, on the surface, about weight and being thin, orthorexia is an extreme fixation on what a person considers to be healthy eating. Righteous eating. While this might not sound like a problem, anything that is extreme can be and usually is unhealthy, especially in  this case where the effects often cause eliminating food groups, causing malnutrition, emaciation, and sometimes death.

What foods an orthorexic deems unhealthy and feels the need to eliminate vary from person to person, but some examples include foods containing fats, preservatives, or additives, or things like meat. Really, anything. Sometimes s/he feels the need to only eat organic or raw foods or foods that have been prepared a certain way. Anything to feel pure.

One thing I read said, “[e]ventually food choices become so restrictive, with both variety and calories, that health suffers – an ironic twist for aperson so completely dedicated to healthy eating.”

From what I have read and understand, orthorexia can stem from a recent illness (e.g., I read a case that started with an asthma diagnosis) or an innocent desire to lose weight or lead a healthier lifestyle. I think, however, that it can also be sparked by a warped recovery from anorexia or bulimia, where one is no longer focused on weight, although losing might be an outcome and the person might be happy about that, and might be okay with eating enough calories and not be trying to lse, but focuses solely on subjectively healthy foods as another way to control eating, have that be a main focus and distraction, and use it as a way to feel superior, again, thru food. The same amount of time spent thinking about food and all the issues surrounding it are completely comparable. Maybe that wouldn’t be a true version of orthorexia, but in my mind, pretty close and something worth looking at. And, it should be noted, that some suggest that orthorexia could lead to anorexia. I could see this happening with the restrictive subtype but the binge/purge subtype as well. Orthorexics often do self-punish if they eat badly, and when people “mess up” and eat something unhealthy, it could easily spiral; further,binging could happen as a result of malnutrition. As well, a lot of the proposed personality traits seen in anorexia and orthorexia are the same.

There are questionnaires similar to “typical” eating disorder questionnaires that help determine whether a person suffers from this form of disordered eating, including two that Bratman uses: “Do you care more about the virtue of what you eat than the pleasure you receive from eating it” and “Does your diet socially isolate you?” Other questions seem even more like questionnaires used as a self-test for anorexia:

• ·         Are you spending more than three hours a day thinking about healthy food?
• ·         Are you planning tomorrow's menu today?
• ·         Is the virtue you feel about what you eat more important than the pleasure you receive from eating it?
• ·         Has the quality of your life decreased as the quality of your diet increased?
• ·         Have you become stricter with yourself?
• ·         Does your self-esteem get a boost from eating healthy? Do you look down on others who don't eat this way?
• ·         Do you skip foods you once enjoyed in order to eat the "right" foods?
• ·         Does your diet make it difficult for you to eat anywhere but at home, distancing you from friends and family?
• ·         Do you feel guilt or self-loathing when you stray from your diet?
• ·         When you eat the way you're supposed to, do you feel in total control?

Treatment can be difficult. Part of it involves trying to get the person to eat more spontaneously or intuitively, but that is not easy, especially when beliefs become ingrained in a person’s head and/or s/he doesn’t feel like help is necessary because s/he doesn’t seeing the  eating/behaviors as bad and thinks eating “normally” would be bad.

randi morse, randi.morse@gmail.com, newton, ma