Eating disorders come in many different guises. And by reading this article, you’ll almost certainly be familiar with anorexia and binge eating disorder. But both of these represent completely opposite sides of the spectrum. You may be surprised to learn there exists a quasi-satellite condition that in some ways work in tandem with anorexia, and in others is its own separate condition – although it has yet to be officially recognised by the DSM-5.
What is Orthorexia Nervosa?
At its base level, Orthorexia is defined as the need to constantly eat healthily. It’s a compulsion centred around eating as cleanly as possible and was first introduced as a term by a physician named Steve Bratman in 1996. And while it’s been argued that Orthorexia is a distinctly separate ‘disordered pattern of eating’ from anorexia, there are more similarities’ that bridge the two than there are unique symptoms. Although Orthorexia has been labelled as an issue relating solely to healthy eating and anorexia one of maintaining one’s body image, new research has found that the underlying motivation of ‘clean eating’ is also a covert means of maintaining body image.
The resulting profile of someone who may be considered orthorexic is one who will adhere to a strict and/or restrictive diet. This means that diets such as vegetarianism, veganism, raw foods and fruitarianism are often very attractive. The ideology of these ‘lifestyle diets’ is centred on the restriction of certain food groups, such as animal protein/fats, refined oils, processed foods and grains to greater or lesser degrees. It creates the perfect storm that leads to obsessive-compulsive tendencies, which in turn can result in malnutrition. But to be clear, no diet and none of those mentioned above are necessarily bad if they provide you with adequate nutrition.
Orthorexia could be considered a progressive mental condition in that there is no absolute clear and defined trigger at which you feel its onset. It’s unlike anxiety or depression where you can point to a specific date, which serves a the tipping point. Orthorexia often starts innocently enough, with the intention of just being ‘healthier.’ This then leads to the exploration of new ways of eating. And as mentioned above, plant-based diets often appear to offer the best chance of improved health.
And so, vegetarianism might be explored initially, which then for many people, leads to veganism and the exclusion of all animal products. An unexpected by-product of this venture in new ways of eating is often weight loss. This then creates something of an aha moment, or a pandora’s box situation for some who’ve been prone to yo-yo dieting in the past – or who already had some sense of a disorder eating pattern. The ethos of a morality-based and more conscious healthy way of eating becomes the perfect cover and motivation to exclude certain foods.
Over time, a snowball effect occurs, whereby foods are excluded from the diet, but they’re not replaced with adequate alternatives to replace the nutrition that’s been lost. The individual who’s orthorexic is always in a mode of cutting out, reducing the number of calories per bite – eating bulk quantities with little to no nutritional value. But it’s a slow process and one that can take many years to fully take hold. So much so, that the evolving nature of eating often appears like a journey of education and self-care.
Some of the most common signs and symptoms include:
- Strict Eating Plans/Diets: This involves a compulsion to adhere to a strict eating style. So, what was once a choice, now becomes a necessity. This is often the case with morality-based styles of eating, such as vegetarianism and veganism.
- Eating Only ‘Optimal’ Foods: Here, people will find themselves on a seemingly never-ending quest to eliminate all junk and sub-par food from their plate. This may extend to only eating organic and a heavy reliance on certain superfoods.
- Shame and Guilt: The longer an identity is built around an ideological way of eating, the more it will hurt mentally and emotionally if that path is deviated from even slightly. So consequently, the more the diet will be adhered to.
- Dysfunctional Social Life: It can reach a point where a person’s eating style is so restrictive, they become so dogmatic about their way being the only way. This, in turn, can limit their social circle and their capacity to engage in anything other than pursuing their idea of the perfect diet.
Although there still remains no official criteria for diagnosis, in a 2016 paper by Steve Bratman, he proposed that the following diagnostic criteria be taken into account:
All of the following should be present:
- Compulsive behaviours towards eating and a preoccupation with diets that promote optimal health.
- When the rules of the diet are ‘broke,’ it causes a heightened/exaggerated fear of disease, injury, and negative mental effects, including shame and guilt.
- Over time, dietary restrictions may lead to the complete elimination of food groups, such as all overt fats and adopting cleansing/fasting approach of constantly ridding the body of toxins.
Any of the following could be present:
- Malnutrition may be a factor as well as severe weight loss or other negative medical consequences due to dietary restrictions.
- There may be a sense of intrapersonal stress at play in social relations, as well as a decline in the functioning of academic or social functioning due to one’s beliefs and behaviours around food.
- Self-worth identity and self-image become so closely intertwined with diet that without it in place, all of these things start to break down.
Although there is no specific protocol for treating Orthorexia, it’s been reported by clinicians that treatments which challenge dietary theory have been successful in helping people find greater balance in their eating habits. As Orthorexia is a behaviour disorder, cognitive behavioural therapy and dialectal behavioural therapy have both been proven to be effective solutions.