Orthorexia Nervosa

Health Food Junkies

Orthorexia [awr-thuh-rek-see-uhnervosa [nur-voh-suh] is a proposed eating disorder characterized by an excessive preoccupation with avoiding foods perceived to be unhealthy. The term ‘orthorexia’ derives from the Greek ‘ortho’ (‘right’ or ‘correct’), and ‘orexis’ (‘appetite’), literally meaning ‘correct appetite.’ It was introduced in 1997 by primary care physician Steven Bratman, who claims that in extreme cases, 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.

In 2009, Ursula Philpot, chair of the British Dietetic Association and senior lecturer at Leeds Metropolitan University, 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.

An obsession for healthy foods can 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 an orthorexic to ultimately eliminate the food or foods from their diet. The subject may avoid fat, preservatives, man-made food-additives, animal products, or other ingredients considered suspicious. Bratman claims orthorexia sufferers have specific preferences about the foods they are eating and avoiding. Products that are preserved with additives are often feared. Industrial products can be seen as artificial, whereas fruits and vegetables can be seen as healthy.

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 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.’

Although orthorexia is not currently recognized as a mental disorder by the American Psychiatric Association, and it is not listed in the DSM-5, the term is gaining currency in the field. As of January 2007, 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 include: 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? Has the quality of their life decreased as the quality of their diet increased? Do they look down on others who don’t eat this way?’ If yes was answered to two or more questions, the person may have a mild case of orthorexia.

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 is related to 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. The condition seems to be more common in men than in women and in those with a lower level of education.


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