Orthorexia revisited

Dear Readers,

My freelance writing has taken me lately into research on orthorexia, a topic that Marcia addressed a little while back in one of her posts. Described as a “fixation on righteous eating,” orthorexia is a condition where obsession with eating healthily becomes so extreme that it leaves no room for other interests or activities and can imperil the sufferer’s health.

Sounds familiar, right? Marcia described it as a modern-day variant on anorexia. Another researcher I spoke to sees orthorexia as an amalgam of an eating disorder and its frequent partner condition, obsessive-compulsive disorder (OCD). The term "orthorexia" is not in the Bible of mental illnesses, the DSM (Diagnostic and Statistical Manual of Mental Disorders), so is not recognized by the psychiatric community as an eating disorder or any other type of mental illness. So we are relying on the definition of the man who first coined the term back in 1997,  Steven Bratman, M.D.,  who described what he saw: people not motivated by a desire to lose weight, but by the desire to become as healthy and "pure" as possible.

But once you starting talking to eating disorders professionals who have seen these so-called "orthorexics" first hand, it appears that as Marcia surmised, things aren't so clear cut. Marcia told me, "We're seeing a lof of kids falling into this type of dangerous eating  and parents are missing it because it looks like their child is interested in becoming more healthy. Almost always these kids are vegetarian. There are a number of studies about the higher risk of eating disorders among vegetarians, and declaring one is vegetarian often precedes the diagnosis of an eating disorder."

Often, Marcia sees patients like these striving to elevate their vegetarianism into veganism, an even higher level of self-denial.

So can someone who fits the orthorexic profile so clearly also want to lose weight, counter to Dr. Bratman’s definition of the condition?

“I have not seen a young teenager where there isn’t an eating disorder lurking in all this,” declares Marcia. Among adults, she adds, it can be harder to tease out the eating-disordered component in the orthorexia because the “healthy behaviors” are so ingrained in the person’s life that it has become the norm for them.

Marcia often hears the refrain “I didn’t mean to lose all this weight!” from her patients. When she hears this, she always asks herself, “Is the healthy eating/vegetarianism/veganism/raw foodism/ a cover for an eating disorder?" She explains, "It’s hard to find a woman who doesn’t feel reinforced by the culture because she is thin.”  I suspect the same goes for many men who suddenly find they are thinner as a result of a new and obsessive interest in “healthy eating.”

Let us know your thoughts on this topic!

Take care,

Nancy

Comments

[Rachel]

Interesting article, I think orthorexia is definitely one of the most interesting "eating disorders" to study! There's an article about it on my company's website: http://www.casapalmera.com/articles/orthorexia-nervosa/.

I think that maybe orthorexia starts out as a form of dieting for many people and then turns into a type of eating disorder, although I think OCD does have a big role in many cases. This topic is even more interesting since everyone seems to be so focused on organic, healthy eating.

[Nancy]

Dear Rachel,

Thank you for your comment. I was interested to see that your center, Casa Palmera, addresses this issue on its website without getting into the overlap with anorexia that can happen.

I agree that it is an especially pressing issue now, when there is an extreme interest in healthy eating. As the mother of a 12-year-old boy, I see kids his age (often kids with no weight issues) conscious of not eating too much sugar, denying themselves desserts, worried about excess fat and calories. I would be interested to see what eating disorders professionals out there think of this behavior. Is it a good thing that kids are so aware, or do you worry that this hyperawareness about nutritious eating could backfire and lead to eating problems?

Also, I would like to point out that Dr. Steven Bratman has corrected my earlier post (I have since corrected it as well), noting that he coined the term "orthorexia nervosa" in 1997, not 1977. My apologies, Dr. Bratman.

Take care,
Nancy