Orthorexia Nervosa: The eating disorder that’s taking over
Orthorexia Nervosa. Eating healthy has become the main subject today in social media. There has been a craze over who is the fittest and who eats healthiest. While eating healthy is highly important to health and lifestyle, when staying away from unhealthy foods leads to shying away from eating out with friends, and struggling to find something on the menu that doesn’t make you cringe are good signs that you might be one of the many people with an eating disorder called orthorexia nervosa.
You might not have heard of this disorder, and it may not even seem like a classic eating disorder, but you might recognize some of the symptoms of orthorexia nervosa. Maybe a friend is obsessed with what they eat, wanting everything to be organic, low calorie, and what most people consider to be “healthy”. Do you think you might have orthorexia nervosa?
What is Orthorexia Nervosa?
Orthorexia nervosa was introduced in 1997 by doctor Steve Bratman when he suggested that dietary restrictions intended to promote health may lead to unhealthy consequences. These unhealthy consequences were social isolation, anxiety, reduced interest in other daily activities, worse cases severe malnutrition or even death. The term Orthorexia nervosa comes from the Greek ορθο meaning right or correct and όρεξις meaning appetite. The term nervosa indicates an unhealthy psychological state.
Orthorexia nervosa is not included in the DSM-5, however, authors Steve Bratman and Thom Dunn from the University of Northern Colorado proposed the following criteria:
Criterion A. Obsessive focus on “healthy” eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue, but this is conceptualized as an aspect of ideal health rather than as the primary goal. As evidenced by the following:
- Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health. (Footnotes to this criteria add: Dietary practices may include the use of concentrated “food supplements.” Exercise performance and/or fit body image may be regarded as an aspect or indicator of health.)
- Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame.
- Dietary restrictions escalate over time, and may come to include the elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy food.
Criterion B. The compulsive behavior and mental preoccupation become clinically impairing by any of the following:
- Malnutrition, severe weight loss or other medical complications from restricted diet
- Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet
- Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined “healthy” eating behavior.
In 1997 the test, called OTRO-15 was designed by Doctor Bratman and has been recently been validated as a tool to detect orthorexia nervosa. You yourself might not align with any of the characteristics, but you might know someone who does.
Dr. Bratman’s Test for Orthorexia Nervosa Detection:
- Do you spend more than 3 hours a day thinking about your diet?
- Do you plan your meals days in advance?
- Do you think that the nutritional value of food is more important than the pleasure that you get from eating?
- Have you seen your quality of life decrease as your diet improved?
- Have you become more strict with yourself over this time?
- Has your self-esteem improved while eating healthy?
- Have you given up food that you liked for “healthy” foods?
- Is it difficult to practice your diet when you go out to eat, causing a distance between you and your family and friends?
- Do you feel guilty when you don’t follow your diet?
- Do you feel happy and at peace when everything is under control and you eat healthily?
If you answered “yes” 4 or 5 of these questions, you need to take a step back from your healthy eating and try to control what may become a food addiction. If you answered “yes” to the majority or all of these questions, you have an obsession with healthy food.
Orthorexia Nervosa Symptoms
It starts with an innocent attempt to eat better and take care of yourself, choosing foods that make you feel good. You start to cut out hydrated fats, sugar, processed foods, animal protein, and grains, and you end up with a diet of organic fruits and vegetables and only eating “clean” foods.
While eating disorders like bulimia and anorexia nervosa aim to drop weight, orthorexia nervosa is characterized by the desire to eat “proper” food that the body needs.
People with orthorexia nervosa don’t limit how much they eat, which is generally a characteristic of other eating disorders, but it does reduce the “allowed” food groups, depending on the quality of the food, which could be a potential health risk.
We know that eating well and keeping track of what you eat is a good thing, but the problem is when you start obsessing over what you eat. Without realizing, you start planning your life around food, and it starts to affect other aspects of your life. Orthorexia nervosa causes you to lose sight of your original goal, which is to eat well and take care of yourself and leads you to create strict eating guidelines that might not be attainable.
It’s important to understand that the problem isn’t being conscious of what you eat, but, like with any addiction, it’s when this decision to eat well is practiced in excess. The danger isn’t in the food, but rather in how to approach it.
Orthorexia Nervosa Treatment
Since orthorexia nervosa is still not part of the DSM, a structured treatment is not available. However, orthorexia nervosa is multi-faceted, therefore many areas of treatment are involved., First the person involved must admit there is a problem and be able to identify what caused it. Then the therapist needs to start working with them on flexibility and less rigid eating as well as working through underlying emotional issues.
While orthorexia nervosa is not a condition your doctor will normally diagnose, recovery can require professional help. We recommend you seek a professional or practitioner skilled at treating eating disorders.
Orthorexia Nervosa and Celebrity Diets
You’ve probably heard of celebrity diets, seen healthy eating pictures on Instagram, and seen amazing transformations after eating healthy. You might even feel like you want to copy these trends and diets because you’ve seen them work so well on other normal people like you! I’ll give you a few examples (I’m not sure if they’re really true, but if the shoe fits…).
They say that Madonna chews her food 50 times before swallowing and that Jean Paul Gaultier drinks 68 glasses of orange juice a day. Julia Roberts is rumored to be addicted to soy milk. Angelina Jolie, among many others, is said to eat cloves of garlic to stave off various diseases. Kim Kardashian was able to lose, like, 70 lbs in a few months with a protein-based diet. Gwyneth Paltrow published a book called “It’s All Good”, in which she talks about Hollywood’s obsession with “healthy” food. In her book, Paltrow suggests cutting out dairy, sugar, eggs, certain fish, potatoes, corn, soy, tomatoes, eggplant, and all types of processed foods, meat, and a long list of other “no-no’s“. No one should attempt to try this diet on their own, as it could seriously affect your health. Our brain needs nutrients to function properly, and eating disorders affect the brain.
The problem with this social phenomenon is that these celebrities don’t actually have an obsession with food, and yet it’s an ideal that they push on to their readers and society. More than one of these practices, without the supervision of a specialist, could cause major health issues.
Try it for yourself. Type in #cleaneating on Instagram and you’ll see a plethora of social media stars with their perfectly made meals, telling you how “carb free is the way to go!”. You’ll wake up one day without realizing it and open your Instagram while sipping your organic wheat-grass smoothie.
Dr. Bratman who recovered himself from Orthorexia nervosa stated:
“I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong. The poetry of my life was disappearing. My ability to carry on normal conversations was hindered by intrusive thoughts of food. The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach. I was lonely and obsessed…I found it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life’s meaning had been transferred inexorably to food, and I could not reclaim it.”
To make sure this doesn’t happen to you, take a minute to think about it. Eat well, take care of yourself, and give yourself a little treat every once in a while. Take a look at the tips below to see how to resist the urge to follow the crowd.
Following a healthy diet does not mean you are orthorexic, however, keep in mind that if it is taking up an inordinate amount of time and attention in your life; deviating from that diet is met with guilt and self-loathing; and/or it is used to avoid life issues and leaves you separate and alone, it might be time to visit your primary physician.
In the following video, you can hear first-hand from someone who suffered orthorexia nervosa and how nutritionists value this eating disorder.
Orthorexia Nervosa: Tips on Healthy Eating Without Obsessing
- Don’t take health advice at face value without doing your own research: Before starting the diet your favorite celebrity is doing, talk to a specialist.
- Find joy in eating, not food: Eating is beneficial to our bodies, and not only on a physiological level but on a psychological level as well. When we eat, we release dopamine, which is also known as the happiness hormone. If you feel guilty when you eat because your food isn’t 100% organic, you end up blocking the production of serotonin.
- Find beauty systems outside of the celebrity world: This is good for both you and your children. The most important thing you can do for yourself and loved ones learn to tolerate, love yourself and work on your self-esteem. After that, you have to learn how to do your own research and judge for yourself if you really think that what you’re reading is true. Compare and contrast articles and specialists, and always be wary of “magic diet pills”.
- No reading labels: There are no “good” and “bad” foods. Repeat this mantra until it’s stuck in your head. It’s all about moderation. Don’t obsess over calories, and enjoy the simple act of eating! You’ll see the benefits over the long term.
- Don’t lose sight of your relationships: People who suffer from orthorexia nervosa reach a state of social isolation because of their fear of eating out in restaurants or at friend’s houses. It might seem like a leap, but it’s just a small road from reading labels in the store to turning down dinner invites. Orthorexia nervosa is a 21st-century eating disorder.
- A glass of wine, a beer, some fries, or a little hamburger everyone in a while never hurt anyone!: Don’t let anyone tell you otherwise. If you get back looks when snacking on your go-to sin, remind yourself that it’s ok! You have to be mentally flexible and tell yourself “today I’m having that chocolate, and I won’t feel bad about it.” It’s important for you- but for someone with orthorexia nervosa, it’s impossible. Your brain needs different nutrients to function properly- don’t starve it!
- Do a social media detox: Clean up your social networks. Unfollow, delete, and block the accounts that make you feel like you shouldn’t be eating something. Try this trick: if you go to the profile and see a picture with some lettuce and 4 nuts that are more filling to see than to eat, run away.
Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.