Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder are recognized by psychologists and psychiatrists around the world and can result in severe co-morbidities and even death if left untreated. With the continued social stigma attached to eating disorders and in general, mental health disorders; often times it can be challenging to discern the truth from fiction. New innovations in treatment are continuously being published however the mainstream media often does not shed light on these important findings. Below are three published articles that had eating disorders professionals talking this week.
What Are Some Orthorexia Therapies for Eating Disorder?
If you are surfing Internet headlines for the symptoms of Orthorexia, the newest eating disorder diagnosis, it might sound confusing. But understanding therapists at a holistic family-based treatment center know it’s a real and valid threat to a healthy lifestyle.
We are overwhelmed with advice about healthy eating, clean foods, and cleansing diets almost daily. Some people take this information to heart and begin a special diet meant to improve overall health or add or remove certain foods from their diets to improve a health condition. While it’s true that there are many foods that are considered particularly healthy or therapeutic for certain conditions, it is important to pay attention to when healthy eating is taken too far. In fact, there is a name for healthy eating that becomes an obsession: orthorexia nervosa.
The term orthorexia was named by Dr. Stephen Bratman to describe his own personal experiences with food (Kratina, n.d.). The term literally means “fixation on righteous eating” and is characterized by rigid attachment to food quality and purity. People who struggle with orthorexia become fixated on maintaining very strict diets. For example, a person who takes up a raw or vegan diet may become addicted to maintaining strict eating habits- which can ultimately, and ironically, result in health consequences.
It is important to understand that orthorexia is not considered an eating disorder in the Diagnostic and Statistical Manual, Fifth Edition (DSM-V). While individuals struggling with anorexia or bulimia have a focus on weight loss and calories, those with orthorexia become obsessed with healthy eating. And it is when healthy eating becomes an all-consuming activity that an individual is considered to be orthorexic.
Orthorexia is supremely isolating. Important social interactions occur around meals, and individuals who are focused on extremely rigid food habits often may withdraw and prefer to eat alone because of the anxiety they feel around foods that may not fit into their diet.
Orthorexia is a disordered eating pattern that can have serious health consequences. Recovery includes therapy and consultation with a registered dietitian to assess current eating habits and address the individual’s inaccurate beliefs about healthy eating (Marcason, 2013).
Kratina, K.(n.d.). Orthorexia nervosa. National Eating Disorders Association. Retrieved from www.nationaleatingdisorders.org.
Marcason, W. (2013). Orthorexia: An obsession with eating “pure.” Retrieved from www.eatright.org.
Orthorexia may not get as much recognition as the better-known eating disorders such as anorexia or bulimia, however the disordered eating behavior of orthorexia deserves a closer look.
Just as excessive dieting can be the simple start of anorexia, trying to limit oneself to “good” or “pure” foods may lead to orthorexia. According to Kratina, “Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.” Orthorexia may start out as an innocent attempt to eat more healthfully, but people who have orthorexia become fixated on food quality and purity.”
Those suffering from orthorexia may have difficulty eating food that they have not personally prepared as they may question the quality of the food. This can make socializing around meals difficult for someone with orthorexia. According to Marcason (2013), “Someone suffering from orthorexia likely doesn’t enjoy food in the same way that someone with a healthy relationship to food does. Rather, orthorexics feel virtuous when they eat the foods they consider to be good or safe, while deviating from their self-imposed extreme diet restrictions causes anxiety and self loathing.”
Like eating disorders, there are medical complications associated with orthorexia. Because many people with orthorexia will eliminate or greatly reduce certain food groups that are vital to a balanced diet, these people may not be getting adequate nutrition.
Another concern with this condition is that many individuals with orthorexia will have a great knowledge of food and nutrition but may not have factually correct knowledge of food and nutrition. Individuals should seek help from medical and nutritional specialists in order to receive the most accurate information and to better understand balanced nutrition (Marcason, 2013).
There is hope for those with orthorexia. There are trained specialists available to work with those suffering from this condition. Specialized treatment offers clients a better understanding of this condition and ways to help the individual adopt healthier outlook and relationship with food.
Kratina, K. Orthorexia Nervosa. Retrieved from: http://www.nationaleatingdisorders.org/orthorexia-nervosa
Marcason, W. (April 2013). Orthorexia: An Obsession with Eating “Pure”. Retrieved from: http://www.eatright.org/Public/content.aspx?id=6442471029
Many have heard of the terms ‘Anorexia’ and ‘Bulimia,’ but few have heard of an emerging concept known as ‘Orthorexia Nervosa’. The term, which is not listed as a mental health diagnosis in the DSM-V, was coined by Dr. Steven Bratman n 1997 and further explored in his book with David Knight, Orthorexia Nervosa: Heath Food Junkies: Overcoming the Obsession with Healthful Eating (American Psychiatric Association, 2013; Bratman, 2000). Orthorexia describes someone who is overly focused on “righteous” eating. Most often this refers to someone who is focused on healthy eating and to the types of foods they put in their bodies. Often they will follow common health fads such as macrobiotics, the paleo diet, etc. They may also cut out entire food groups such as starches or certain food dyes and additives in the quest to eat righteously. Reasons for cutting out these food groups or additives may be given as allergies or intolerances. As Dr. Bratman describes in his book, people may be so overly focused on eating the ‘right’ foods that they suffer health problems or become underweight due to excessive restriction, (Bratman, 2000).
However, the mentality of someone with orthorexia is much different than someone with anorexia or bulimia. The focus is not on becoming thin, but on being pure. Their focus on food is not the amount, but the purity (Krumer, 2008). What is similar is that both are willing to go hungry to attain their goal.
It is unknown how many people suffer from Orthorexia because only a handful of studies have examined it and there is no agreed upon definition of it. Bratman named the disorder from “ortho” meaning correct or true, melding it together with anorexia nervosa as the disorder involves restriction (Bratman, 2000). Some authors have proposed that orthorexic tendencies are actually precursors of more serious eating disorders (Krumer, 2008).
The term orthorexia has been expanded to include those who restrict food to the extreme for religious purposes such as fasting. Martin Luther, the protestant reformer was known to fast until he fainted, and other Christian mystics and ascetics were praised for their extreme fasting practices. This is not to say that the practice of fasting in any religion constitutes an eating disorder, however, fasting taken to a dangerous level in the pursuit of extreme holiness has been classified by some as a form of orthorexia (Apsell and Larson, 2000).
How does one distinguish healthy or pure eating from Orthorexia? Bratman does give some guidelines. First, the amount of time spent thinking about food is excessive. Bratman defines this as three or more hours per day thinking about healthy food. He also labels planning what one will eat in the future as a red flag. Second, he focuses on one’s relationship with food. For instance, does the person care more about the virtue of the food versus enjoying the food, or finding no joy in previously enjoyed food because it has been categorized as unhealthy? In addition, if one takes pride in what they eat in a way which causes them to believe they are superior to other “unhealthy” or “impure” eaters or if a person feels extreme guilt for eating “unhealthy” or “impure” food, they might be orthorexic. Perhaps the rules for what one can and cannot eat are become stricter as time goes on and as a result of eating “healthier” the person’s quality of life has decreased, rather than increased. Lastly, Bratman states that if the diet isolates a person from others, this could be a symptom of orthorexic eating.
It is possible that one could answer yes to one of these questions and not be orthorexic. One symptom does not create a disorder. It is the accumulation of these symptoms that Bratman states is an issue. If someone believes that they have Orthorexia, they can do a few things. First, recognize the issue and objectively evaluate the justification of such a diet. Second, think about eating in a different way or about eating something “unhealthy.” If anxiety occurs, the behavior is most likely more than healthy eating. Third, if you believe you or someone you know is orthorexic, consult a mental health professional who can assist in differentiating what is health driven and what is obsession. Also see your physician to address any health issues sustained as a result of the restrictive diet.