Orthorexia: The Other Eating Disorder
Maybe you gave up sugar. Then you stopped eating anything that contained ingredients you couldn't pronounce. Now you never eat anything that comes in a package, and you don't think you can attend a friend's upcoming birthday dinner because you won't be able to eat any of the food being served.
If this sounds familiar, you may be dealing with orthorexia.
What Is Orthoexia?
Orthorexia nervosa (ON) is a form of disordered eating that shares some characteristics with other eating disorders, like anorexia and bulimia. There is an obsessive-compulsive component to ON, but unlike anorexia or bulimia, which is characterized a preoccupation with weight, body image, and the amount of food eaten, people with ON are fixated on the quality, purity, and safety of food.
Of course, we all want to eat high quality, healthy, and safe food. What distinguishes someone with ON is the obsessiveness and the degree to which this eating behavior affects other aspects of life. While someone with ON may appear to simply prioritize her health, ON is actually about using food to control weight, to improve self-esteem, as a form of spiritualism, or even to shape an identity for oneself.
Someone with ON feels guilty or bad if they stray from their self-imposed diet. Orthorexics may seem to know a lot about food and nutrition, but they don’t necessarily have accurate information. There is often no real basis for their fear that certain types of food are harmful to their health.
"Like any eating disorder, orthorexia is really a disorder of the thinking process," says New York City and Long Island, NY-based Sondra Kronberg, MS, RD, CEDRD, spokesperson for the National Eating Disorders Association and Executive Director of the Eating Disorder Treatment Collaborative/F.E.E.D. Who is at risk for the condition? "Someone with a rigid, compulsive or controlling type of personality, what you might call a perfectionist, is more likely to develop an eating disorder."
Symptoms of Orthorexia
Simply adopting an alternative style of eating, such as a vegetarian, vegan, or gluten-free diet, is not a form of ON, unless perhaps if it is accompanied by extreme dietary behavior.
People with ON plan their lives around food, and may
try to control what others cook and serve.
judge the way others eat.
feel superior to others because of their own eating habits.
find themselves socially isolated as a result of their obsession.
In addition to potential psychiatric and social issues, a severely restrictive diet can be very unhealthy because it excludes too many foods that contain essential nutrients. This extreme form of "healthy" eating can actually result in malnutrition and medical problems.
Colorado physician Steven Bratman, MD, first coined the phrase "orthorexia nervosa" in a 1996 article he wrote for a yoga magazine. He used the term to describe some of his patients, who seemed to be fixated on health and healthy eating.
It was an informal concept drawn from his observations, as well as his own personal experience decades earlier. Although the term stuck, and has been used in the international medical and research, formal criteria for diagnosing the condition were lacking. But international interest in ON grew, and in a 2016 issue of the journal Eating Behaviors, Bratman proposed specific diagnostic criteria. They are summarized as follows:
Obsessive thinking about diet, accompanied by compulsive and restrictive eating habits.
Feelings of shame, anxiety, unhappiness, and impurity if dietary rules are broken.
More and more dietary restrictions imposed over time, to the point where complete food groups are eliminated and self-purifying or detoxifying treatments such as “cleanses” and partial fasts are involved.
In addition, these eating behaviors result in at least one of the following:
Malnutrition, severe weight loss, or other medical complication.
Social, academic, or work-related problems.
Excessive dependence on self-defined "healthy" eating behavior to maintain a positive body image, identify and sense of satisfaction and self-worth.
ON can also accompany or follow a diagnosed eating disorder, such as anorexia. An increasing number of people combine a conscious focus on eating healthy food with a desire to lose weight, in the belief that losing weight optimizes good health, Bratman points out. In this way they may develop anorexia and ON simultaneously. Some people recovering from anorexia may “graduate” to ON he adds. In that case, they are just exchanging one eating disorder for another.
In her practice, Kronberg is seeing more cases of orthorexia in younger clients, whose culture, she says, is supporting the disorder because the media message today is all about "eating clean."
"Years ago, someone with anorexia would be eating low-calorie foods like diet Jello in an attempt to lose weight or stay thin," she points out. "Now I see people with anorexia avoiding that and instead, focus on pure, low-calorie whole foods like organic vegetables with no additives."
The first step to healing orthorexia is understanding there’s a problem. It can be difficult to recognize the difference between eating nutritious foods and obsessive behavior, especially in a world that values thinness and healthy eating. Treatment may involve psychological work to understand the root of the problem as well as practical steps toward resolving malnutrition and learning to eat in a more psychologically healthy fashion. This doesn’t mean learning to eat a "bad" diet, Bratman adds; rather, it entails healing the disordered relationship with eating that has overtaken the initial desire for a healthy diet.
"Dietitians and therapists with experience in eating behavior can help identify and treat someone with ON." Bratman says. "Consultation with an eating disorder specialist who has an awareness of this condition can be extremely helpful, even life-saving."
If you or a loved one need help dealing with orthorexia or another eating disorder, the National Eating Disorder Association's website provides information on where to find help and support. Visit nationaleatingdisorders.org/find-help-support.