Orthorexia: Can Eating Healthy Kill You?
A Case of the Development of Orthorexia: Laura
A woman named Laura is preparing to get married and decides to try to lose weight for the wedding, a relatively common occurrence. Having been a dancer she was surrounded by others who suffered from eating disorders and while she hadn’t, she did restrict her diet during those years to 400-500 calories a day. When she quit the ballet and no longer had to look at herself in the mirror all the time she began to eat junk food. In addition to gaining weight, this caused problems at home as her mother is a health food advocate and stocks the house only with what she considered “healthy foods”. When Laura tells her mother about her desire to lose weight her mother is ecstatic and offers to help. Her mom is quite thin herself, due to the limitations she places on what she eats and she begins making suggestions to her daughter about what to cut out of her diet.
First, she encourages Laura to become a vegetarian then a vegan. Laura begins to have cravings but as the pounds start dropping off she ignores these desires. As the wedding gets closer Laura begins to direct her own eating, becoming more obsessed with healthy foods until even her mother is concerned. She researches every food she eats for nutritional value before she’ll consume it. Finding negative press on almost every food group, she stops eating anything with gluten, then all the possible substitutes including flour made from spelt, rice, bean, sorghum and potato as well as any type of starch. When her mother points out Laura doesn’t have a gluten allergy and asks about the other types of flour and starch she refuses to eat, her daughter becomes hysterical claiming they are all toxic and will kill you if you eat even a little regularly.
Next Laura begins to eat only raw foods refusing anything that is processed. By then she’s dropped 50 pounds and while happy with the decrease she still isn’t satisfied, though her primary focus is on the health value of what she eats and drinks not her weight. She begins to obsess, spending much of her day worrying about having possibly eaten something she wasn’t aware was unhealthy, planning her meals, though by then there are few foods she considers healthy and will eat. She drops another 10 pounds and her mother became frightened, approaching her again about her eating habits.
Laura then begins refusing to go out with friends or make plans to eat out even with her fiancé to avoid being faced with eating somewhere she can’t know everything about what goes into her mouth. She has already decided there is no way to avoid poisons if she can’s completely control what she eats. Eventually, after almost dying from lack of sufficient nutrients and what the doctor refers to as “starvation” resulting in multiple organ failure, Laura is hospitalized and placed in a program which specializes in eating disorders, despite continuing to refute this diagnosis. She insists the doctor is wrong about what had caused her “illness”, since she always eats in a healthy manner – the complete opposite of what defines a eating disorder.
What is Orthorexia Nervosa?
While it’s not unusual for people to change their eating habits to improve their health, get over an illness or lose weight, usually once they are used to these new habits they stop focusing on them and the habits become a normal part of their life. However, some remain obsessed with everything they eat, continuously worrying about how healthy the ingredients are. When it reaches a stage that the obsessing becomes detrimental to their health they may have developed an eating related syndrome or disorder which has been termed Orthorexia Nervosa. Orthorexia Nervosa is translated to mean “fixation on righteous eating,” and those suffering from the problem become increasingly fixated on the purity of what they eat and drink.
According to Dr. Steven Bratman, an expert on the disorder who first coined the term Orthorexia, the condition is due to the obsessive thoughts related to the perceived spiritual nature of eating foods only considered wholesome and without contaminants or pollutants (Bratman, 2016). The obsessive thoughts change over time, as the person defines what they consider to be wholesome more strictly which causes them to rule out more foods. When someone with Orthorexia “falls off the wagon,” which may be as minor as eating a single raisin due the preservatives within it, they feel they must take on penitent acts which, similar to anorexics, involve stricter dieting. However, whereas those with anorexia are concerned with weight, calories, fat and all types of food, in orthorexics stricter dieting involves restrictions as to the types or categories of foods allowed.
A Young Woman With Orthorexia Shares Her Experiences
How important is it to you to eat healthy foods?
Causes of Orthorexia
Little research has been conducted to date on Orthorexia so underlying causes of the disorder are currently unknown. While the course of the disorder and the ability to distinguish it from other eating disorders have been published in case studies, determining whether there are genetic, biological, neurological or psychosocial causes or predispositions of the disorder. This can make treatment difficult.
It has been determined that other illnesses could lead to the development of Orthorexia. In particular, food allergies and related conditions which lead to an unhealthy fear of certain foods has been identified in a small sub-population of those believed to have Orthorexia. This has been attributed to the course of nutritional therapy which generally involves elimination diets for food allergies.
Patients with suspected food allergies are taken off a number of foods to see if they are contributing to the allergy symptoms. Those foods that are not found to be related to symptoms are later reintroduced but when allergy symptoms are severe, sometimes individuals fear the foods that had been removed from their diet. Even though the provider tells them to begin eating certain foods again, the fear of redeveloping the allergy symptoms causes some people to continue to avoid those foods.
While this sequence has been found in a small but significant number of those thought to suffer from Orthorexia it does not explain why only 10 percent to 15 percent of those with food allergies develop such fears. Also not explained are what factors differentiate those who develop Orthorexia from the majority who do not. Like other eating disorders, Orthorexia is believed to be a complex disorder caused by both physiological and non-physiological factors and it will take a body of research to better delineate what the specific causes are.
Treatment of Orthorexia
Those suffering from Orthorexia may be helped through several potential treatment options. It is important to remember that the underlying causes for each individual may be different and that the event or mindset which lead them to develop the disorder must be addressed. This means fully exploring the onset of the disorder and determining what the initiating factors were so as to prevent relapse once treatment gains have been made. Meal support at the beginning of treatment can help with anxiety around meal times and provide reinforcement for healthy food choices. Nutritional counseling can be useful throughout treatment, initially to provide information about the reality of what is healthy and nutritious and later on to provide support for continuing to meet nutritional goals or to alter the nutritional plan as appropriate.
Some of the other treatment options for the disorder include psychotherapy aimed at addressing disordered thinking about health, food and self-esteem as well as to help the person process psychosocial difficulties and stressors in their life. Cognitive behavioral therapy focusing on restructuring thought processes to affect eating behavior along with practical behavioral strategies. These strategies may include activities such as creating a meal chart to construct healthy yet appropriate meals with a menu to choose different desirable foods from, eating at home with a parent where the meal is planned together, or eating out with a friend while making healthy yet appropriate food choices.
While some medications for anxiety and depression and disordered thinking have been shown to have positive effects for orthorexia they are usually rejected as a treatment due to the individual’s avoidance of chemicals and what they believe to be unnatural and thus toxic, ingredients. It is possible to use medication at later stages of therapy once some of the individual’s ways of thinking about what is healthy, what constitutes a contaminant and what constitutes a toxic ingredient have been addressed.
It is clear that more knowledge about effective treatment options for Orthorexia is needed. Before this can be accomplished, however, research must be conducted to better determine the causes, features, symptoms, associated disorders and how the condition can vary from one person to another. Only then can effective treatment options and components best suited to address this complex and multifaceted disorder be established (Brytek-Matera, 2012).
Treatment for Orthorexia - Expert Panel
The Controversy Over the Existence of Orthorexia
Despite the seriousness of the behavior and outcomes seen in individuals who have been classified as having this syndrome, including dangerously low weight, organ failure and death, many fail to consider Orthorexia a disorder. Instead they may simply call it a “health phenomena.” While other experts consider it a genuine concern, they fail to view it as clinically useful in terms of a diagnoses, and Douglas Bunnell, president of the National Eating Disorders Association stated that while for lay people the term may be important for descriptive purposes and understanding, it is largely irrelevant for treatment implications. This is largely due to the fact he believes it to differ from anorexia on only a few fine points (Chaffee, & Kahm 2015).
Others point out that while the disorder does focus on food and the rigid rules created to define what is consumed, with the anorexic patient the focus is on calories and how likely it is the food will add weight while for the orthorexia the focus is exclusively on how healthy they believe the food to be. This suggests that the disorder is, in fact, a distinct disorder which deserves its own diagnostic title and inclusion in the DSM and other diagnostic classification systems. These advocates warn that until the condition is treated like the serious problem that it is with its own series of causes, symptoms, thought patterns and established treatment options, those with the disorder will be unable to find a cure that will allow them to return to previous levels of functioning and to regain the quality of life to which they aspire (Koven & Abry, 2015).
Summary and Concluding Remarks
The term “Orthorexia Nervosa” was first used by Dr. Steven Bratman, M.D. to describe individuals suffering from an obsession to eating only healthy foods, which becomes stricter over time until what the individual defines as “healthy” is so limited that their health is or is likely to become compromised. Despite the controversy over whether this cluster of symptoms is really a subcategory of Anorexia it differs significantly enough from this disorders that it appears to warrant its own diagnosis which would lead to valuable research and hopefully, implications for treatment to address it’s unique symptoms.
Bratman, S. A. (2016, February). Orthorexia Comes of Age: Past, Present and Future of the Most Controversial Eating Disorder. In iaedp Symposium 2016. iaedp.
Brytek-Matera, A. (2012). Orthorexia nervosa–an eating disorder, obsessive-compulsive disorder or disturbed eating habit. Archives of Psychiatry and psychotherapy, 1(14), 55-60.
Chaffee, C. H., & Kahm, A. (2015). Measuring Health From The Inside: Nutrition, Metabolism & Body Composition. FriesenPress.
Elliott, G. (2014). Orthorexia. When healthy eating becomes an obsession. GRIN Verlag.
Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease & Treatment, 11.
Moroze, R. M., Dunn, T. M., Holland, J. C., Yager, J., & Weintraub, P. (2015). Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics, 56(4), 397-403.
The Bratman Orthorexia Self-Test*
If you are a healthy-diet enthusiast, and you answer yes to any of the following questions, you may be developing orthorexia nervosa. [and should consult your physician or a trained specialist in eating disorders for further evaluation]:
(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.
*[From Steven Bratman] There are a number of orthorexia self-tests on the Internet, including several that are purportedly designed by me. However, this is the only self-test that I actually authorize and approve. I freely make it available to anyone who wishes to use it.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
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© 2016 Natalie Frank