This is a great post by nutrition student Elisabeth Daniels! She is currently working on her master’s in nutrition with the hope of becoming a registered dietitian. Her interests include eating, especially locally grown, whole foods, writing, hiking, perusing the local farmer’s market, and baking. For many people, the New Year heralds a new opportunity for health, happiness, and prosperity. In fact, USA.gov lists weight loss, improved fitness, healthy eating, and stress reduction among the top ten New Year’s resolutions. But what happens when these good intentions toward healthy living turn into obsessive behaviors? When healthy eating turns into obsessive eating, a condition known as orthorexia may manifest.
What is Orthorexia?
Orthorexia is defined as a fixation on “right” or “proper” eating. Dr. Steven Bratman created the term in 1997 to describe his personal experiences with rigid eating behaviors. The Diagnostic and Statistical Manual of Mental Disorders (DSM V) does not yet recognize orthorexia as a condition, so it would currently be considered an Eating Disorder Not Otherwise Specified (EDNOS).
Dr. Bratman characterized this EDNOS by obsessive thoughts and behaviors associated with perceived health. This can refer to rigidly adhering to calorie restrictions, avoiding fats, avoiding animal products, or eating only “organic” foods.
Orthorexia vs. Healthy Eating Behaviors
Does this mean preferring locally grown organic food is indicative of disordered eating? Not necessarily. I spoke with Dr. Veronica Sullivan, a psychologist at California State University, Northridge who specializes in eating disorders to understand the difference between orthorexia and healthy eating. Dr. Sullivan states that the distinction between healthy eating and orthorexia is “obsessiveness and rigid thinking.”
“Feelings of self-worth will get wrapped up in their eating so that if they’re following their ‘plan’ they may have high self-worth, and maybe even self-righteousness over others, but if they slip up and ‘fail’ on their diet plan they are likely to be extremely self-critical and may even punish themselves with excessive exercise, an even more restricted diet, etc. The line between anything going from a hobby or interest into more obsessive territory also has to do with its interference in one’s daily life. For example, someone with orthorexia might start to spend more and more time on food preparation to the point they are isolating themselves, withdrawing from friends and family, spending more than they can afford on things like supplements or juicing, turning down any social opportunity that involves food, etc. These would be some of the signs that it has crossed the line from healthy eating to disordered eating.”
Anxiety & Control
Few studies have been conducted on the prevalence of orthorexia. However those that exist have discovered commonalities with other disorders like obsessive-compulsive disorder (OCD), anorexia nervosa, and bulimia nervosa. Similarities between OCD and orthorexia include obsessive behaviors and interference with daily routines and social interactions. Similar behaviors in people with anorexia nervosa and bulimia nervosa include preoccupation with food, food restriction, and perfectionistic tendencies. Unlike these other disorders, orthorexics are more likely to flaunt their behaviors rather than hide them and are more likely to believe they are bettering their health. Dr. Sullivan recalls some example of orthorexic behavior in her patients.
“I have worked with several clients with eating disorders who started out as orthorexic. Pretty much every eating disorder starts with a diet. One client started using Weight Watchers to lose weight but it turned into an unhealthy obsession, where she would challenge herself to eat fewer and fewer points and would only allow herself to eat a very restrictive range of foods. While she was eating fairly healthfully, and even getting close to enough calories, the fact that she was so obsessive about it and had so many food rules for herself was problematic. She felt that food was ruling her world and she no longer had a healthy relationship with food or her body. Another client began by changing her diet to a low fat, raw, vegan and spent all of her waking hours finding and preparing foods that met these criteria. While it did lead to weight loss, her hair was falling out and she was extremely fatigued. Yet, she continued this lifestyle despite these things because she had read a number of books touting this as the healthiest diet. She came to me when she realized how much it was impacting her academically. She actually had to work closely with a nutritionist as she had been doing this restrictive diet for so long that as she introduced other foods into her diet, it would lead to a lot of GI problems as her body wasn’t used to processing cooked, non-vegan foods.”
Am I Orthorexic?
Overall, the underlying problems involved with these disorders are anxiety and need for control. If this sounds like familiar, you may want to reconsider your motivation behind healthy living.
Ask yourself: are you trying to be healthy out of self-love, out of fear of illness, or need for control? This important distinction is helpful in determining whether you are orthorexic or at risk for developing an eating disorder.
Another question to ask is whether or not you have “fear foods.” Fear foods are food items that cause immense fear and panic in a person even though they present no immediate threat. These may include chocolate, ice cream, or even foods with unknown ingredients (foods you did not prepare).
The National Eating Disorder Association provides the following questions to determine orthorexic status:
- Do you wish that occasionally you could just eat and not worry about food quality?
- Do you ever wish you could spend less time on food and more time living and loving?
- Does it seem beyond your ability to eat a meal prepared with love by someone else – one single meal – and not try to control what is served?
- Are you constantly looking for ways foods are unhealthy for you?
- Do love, joy, play and creativity take a back seat to following the perfect diet?
- Do you feel guilt or self-loathing when you stray from your diet?
- Do you feel in control when you stick to the “correct” diet?
- Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?
If you are concerned that you or a loved one is at risk for orthorexia, it’s important to consult with a health care professional that understands disordered eating behaviors and nutritional therapy and also with whom you feel comfortable. Often there are underlying causes to these behaviors that prevent us from achieving health and wellness.