In the modern age of blogging, Instagramming and Facebooking about our clean & healthy meals, orthorexia nervosa becomes increasingly common and can be a dangerous health condition. It’s a an easy switch from trying to eat healthy to developing an obsession with eating right.
What is orthorexia?
Orthorexia, short for orthorexia nervosa, is a medical condition in which one systematically avoids specific foods that they believe to be harmful or insufficiently clean, healthy or wholesome. The term was introduced in 1997 by physician Steven Bratman to describe those people who have developed a fixation with healthy or righteous eating (Chaki et al., 2013). The word orthorexia comes from the Greek words ‘orthos’ which stands for right and correct and ‘orexis’, which means appetite. Orthorexia is not currently recognized as a psychological eating disorder (see; www.nationaleatingdisorders.org/orthorexia-nervosa) but it may be considered as a personality or behavioral disorder that results in obsessive phobic personality traits. Orthorexia nervosa is expressed in a qualitative way (quality of the food consumed) instead of a quantitative way as seen in anorexia nervosa and bulimia nervosa.
There hasn’t been done a lot of research on orthorexia and therefore, little is known about whether it should actually be a disorder. (see; www.theguardian.com/lifeandstyle/2015/sep/26/orthorexia-eating-disorder-clean-eating-dsm-miracle-foods. Scientists don’t agree on the diagnostic criteria. Many researchers claim that orthorexia nervosa is not a unique condition, but a variant of existing eating or anxiety disorders. Without a proper diagnostic code, it’s hard to say how many people are actually sufferring from orthorexia nervosis. In a study done in 2004, researchers found a prevalance rate of 6.9% amongst the citizens of Rome (Italy) (Chaki et al, 2013). The rates for this emerging condition seem to be growing in the last years.
How to recognize orthorexia?
An orthorexic person becomes extremely selective about food choice in the context of its purity, origin, presence of artificial ingredients or additives, preservatives and such. Over time, someone suffering from orthorexia develops his own highly specific food rules and restricts himself to a self-imposed dietary regimen. The way of food preparation and tools that are used are often also part of the obsessive ritual. In recent media, also excessive exercising seems to play a central role in orthorexia nervosa (Håman et al., 2015).
Common behaviors to be aware of include the following:
- Elimination of entire food groups in attempt for a ‘clean’ or ‘perfect’ diet
- Severe anxiety regarding how food is prepared
- Avoidance of social events involving food for fear of being unable to comply with diet
- Thinking critically of others who do not follow strict diets
- Spending extreme amounts of time and money in meal planning and food choices
- Feelings of guilt or shame when unable to adhere to diet standards
- Feeling fulfilled or virtuous from eating ‘healthy’ while losing interest in other activities once enjoyed (see; www.eatingdisorderhope.com/information/orthorexia-excessive-exercise/understand-orthorexia).
Health consequences of orthorexia
As orthorexia develops, the diet gets more restricted. Nutritional deficits, extreme weight loss and other medical complications that mimic the effects of bulimia nervosa and anorexia nervosa. Often, loss of social relationships is the consequence of the obsessive behavior as people who develop orthorexia may have little time left for anything other than thinking about and planning food intake. They may also lose the ability to eat intuitively, to know when they’re hungry, how much they need and when they’re full (www.nationaleatingdisorders.org/orthorexia-nervosa). Also, worsening emotional symptoms can indicate that the condition may be progressing into a serious eating disorder. Feelings of guilt and fear when deviating from strict diet guidelines, distancing from friends or family who don’t share similar views about food and worsening depression, mood swings or anxiety are common (www.timberlineknolls.com/eating-disorder/orthorexia/signs-effects/).
What are the causes of orthorexia?
The causes of orthorexia are mainly psychological, but also genetics and environmental factors play a role. Factors that play a role in the development of orthorexia:
- Genetic predisposition
- Traumatic experiences
- Perfmance anxiety, perfectionism
- Fear to lose control
- Unrealistic self-image
Are you afraid that you might be orthorexic or may be developing the disorder? Do the following self test (the Bratman Test).
Answer the following questions with yes or no:
- Do you spend more than 3 hours a day thinking about your diet?
- Do you plan your meals several days ahead?
- Is the nutritional value of your meal more important than the pleasure of eating it?
- Has the quality of your life decreased as the quality of your diet has increased?
- Have you become stricter with yourself lately?
- Does your self-esteem get a boost from eating healthily?
- Have you given up foods you used to enjoy in order to eat the ‘right’ foods
- Does your diet make it difficult for you to eat out, distancing you from family and friends?
- o you feel guilty when you stray from your diet?
- Do you feel at peace with yourself and in total control when you eat healthily?
Yes to 4 or 5 of the above questions means it is time to relax more about food.
Yes to all of them means you have an obsession with eating healthy food (www.dailymail.co.uk/health/article-3238456/Are-orthorexic-test-obsession-healthy-eating-making-ill.html#ixzz41UQDByQn).
- Bishwajit Chaki, Sangita Pal, Amit Bandyopadhyay, ‘Exploring scientific legitimacy of orthorexia nervosa:a newly emerging eating disorder’, Journal of Sport and Exercise, 8, nr. 4, 2013 (www.jhse.ua.es/jhse/article/view/426).
- Dunn, T.M & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors, 21, 11 -17.
- Linn Håman, Natalie Barker-Ruchti, Göran Patriksson, Eva-Carin Lindgren, ‘Orthorexia nervosa: An integrative literature review of a lifestyle syndrome’, International Journal of Qualitative Studies on Health and Well-being, 2015, 10 (www.ncbi.nlm.nih.gov/pmc/articles/PMC4539385/)