Orthorexia Nervosa

Orthorexia Nervosa is not currently recognised by the Diagnostic and Statistical Manual (DSM) for Mental Disorders as an Eating Disorder, however as research is evolving and more and more people are presenting with this specific set of symptoms, it is becoming a accepted as a serious illness. It is characterized by;

  • An unhealthy fixation on righteous eating. This includes ‘clean eating’ and ‘raw diets’.
  • A ‘health obsession’, in which a person may be excessively worried about being healthy and ‘pure’.
  • Exclusion of several food groups including sugar, carbs, gluten, fats, salt, dairy, processed foods and foods exposed to pesticides.
  • In some cases, an addiction to exercise is also reported. A person feels the strong compulsion to exercise regardless of how exhausted they feel, and may exercise upwards of 2 hours a day. The severity of the exercise addiction is observed when a person becomes unable to exercise and experiences feelings of guilt and high levels of anxiety.

Orthorexia in many respects is similar to Anorexia Nervosa, with the key distinguishing  feature of Anorexia being an obsession with low body weight, while Orthorexia is an obsession with ‘pureness’. While reading through the characteristics of Orthorexia you may find yourself identifying with or recognizing traits in others. That is because in a culture obsessed with ‘being the best version of yourself’ and countless health and diet trends, we are exposed to these messages every day. The difference between making healthy changes to your diet and Orthorexia, is the level in which your diet and diet rules cause distress.

Using two real world examples you can see this difference clearly.

  1. Joseph has recently read an article on the internet titled ‘The food you choose to eat could be killing you’. Joseph immediately messages his friends to share his new found knowledge and announces that he will be making changes to his diet. Over the next few weeks, Joseph cuts out meat products, dairy products, carbohydrates, sugars, processed foods and gluten. He limits himself to only eating raw foods as he believes it is what his body needs. In order to maintain his diet, he has stopped going out with friends and has dropped out of University to spend up to 4 hours every day reading about new ways to make his body cleaner and preparing meals. Joseph continues this for 6 months and over this time has lost a considerable amount of weight, has become moody and irritable and is frequently becoming unwell. When his friends ask him about his wellbeing he becomes defensive and states “I am the healthiest and purest I have ever been. You’re just envious of my life”. Joseph’s doctor tells him he is suffering from malnutrition and strongly suggests he starts eating a more wholesome diet. Joseph gets angry and refuses to see his doctor anymore.
  2. Katie and her friends are in a shopping centre when they are approached by sales representatives from her local gym. They tell Katie that the milkshake she is drinking is unhealthy and she should swap it out for a raw food smoothie instead. They then offer her a free pass to the gym and walk away. Katie goes home and starts to think about all the ‘unhealthy foods’ she is consuming. She decides to use the free pass to the gym and with that stops eating take away and starts a diet designed for ‘healthy living’. Two weeks in Katie starts experiencing headaches and cravings for a chocolate milkshake. While out with her friends, she wants to get a milkshake but feels guilty for ‘cheating’ on her diet. Her friends tell her that balance is healthy and that her headaches are probably caused by the changes in her diet. Katie decides to get the milkshake and cut back on the diet to reduce the severity of her headaches.

As you can probably tell, Joseph is showing signs of Orthorexia. Despite the damage his new diet is doing to his body, he refuses to make changes as he does not want to sacrifice his ‘pureness’. Katie on the other hand is able to recognise that her diet changes are causing painful physical consequences and allows more flexibility within her diet. Joseph remains rigid and adopts a ‘black and white’ thinking pattern that determines foods to be ‘good’ or ‘bad’.

Orthorexia has been compared to Obsessive Compulsive Disorder (OCD), due to the presence of obsessions (‘I must eat clean foods so I don’t die’) and compulsions (eating only raw, clean foods to avoid the fear of death or impurity). In the same way, Anorexia has been compared to OCD, however as Orthorexia and Anorexia are both disordered relationships with food and the body, they should remain classified within Feeding and Eating Disorders.

What does Orthorexia Nervosa look like?

The Bratman Orthorexia Self-Test
(Steven Bratman, MD, MPH, http://www.orthorexia.com, 2017)

If you are a healthy-diet enthusiast, and you answer yes to any of the following questions, you may be developing orthorexia nervosa:

(1) I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.

(2) When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.

(3) My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.

(4) Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply.)

(5) Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.

(6) Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.