US Pharm. 2017;42(12):9.

There are several eating disorders categorized as mental-health problems. A recent example is an obsessive behavior with healthy eating called orthorexia nervosa. Orthorexia generally begins as an attempt to eat more healthfully. Since it is not easy to maintain this rigid eating style, people punish themselves if temptation wins, usually through stricter eating, fasts, and exercise.1 Eventually, orthorexics become so restrictive and picky in their food choices, both in kind and calories, that their health suffers. The obsession with healthy eating can overshadow other activities and interests, impair relationships, and become physically dangerous.1

Orthorexia was first mentioned by Steven Bratman, MD, in 1996. He was suffering from this condition and began to share it with his patients who were overly health-obsessed. He used this term to help them understand the possibility that their “healthy” eating might not be as beneficial as they presumed. Over time, however, he realized that the term orthorexia identifies a serious eating problem.

Orthorexia is not yet an officially recognized disorder in the Diagnostic and Statistical Manual of Mental Disorders-5th Edition, but it is similar to other eating disorders. Patients with anorexia nervosa or bulimia nervosa obsess about calories and weight, while orthorexics obsess about healthy eating beyond simply being in good shape or losing weight.1,2 An orthorexic person may avoid numerous foods, including those made with artificial colors, flavors or preservatives, pesticides or genetically modified organisms, fat, sugar, salt, and animal or dairy products. In this article, we look into causes of orthorexia and strategies employed to achieve recovery from this disorder.

Causes

Orthorexic symptoms are serious, chronic, and go beyond a lifestyle choice. Often, they co-occur with psychiatric and addictive disorders. In fact, orthorexia is a medical disease that can result in irreversible health complications.2

The disorder appears to be motivated by health concerns, but there are underlying causes, which can include seeking safety from poor health; having a compulsion for complete control; escaping from fears; improving self-esteem; searching for spirituality through food; and using food to create an identity.2

Obsession with weight is one of the primary signs of anorexia, bulimia, and other eating disorders, but is not a symptom of orthorexia. Instead, the object of the orthorexic’s obsession is with the health implications of their dietary choices. While a person with anorexia restricts food intake in order to lose weight, a person with orthorexia wants to feel pure, healthy, and natural. The focus is on quality of foods consumed rather than quantity.3,4 (See Sidebar 1 for an orthorexia questionnaire.)



Healthy or Unhealthy Diet?

The diet of orthorexics can actually be unhealthy, with nutritional deficits specific to the diet they have imposed upon themselves. These nutritional issues may not always be apparent; social problems are more obvious. Orthorexics may be socially isolated, often because they plan their life around food. They may have little room for anything other than thinking about and planning food intake. Orthorexics lose the ability to eat intuitively—to know when they are hungry, how much they need, and when they are full.1,5

Dr. Bratman, who finally recovered from orthorexia, states, “I pursued wellness through healthy eating for years, but gradually I began to realize that something was going wrong. 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 and it was terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life’s meaning had been transferred in a way that it was impossible to stop or prevent thinking about food, and I could not reclaim it.”6

Following a healthy diet does not mean one is orthorexic. There is nothing wrong with eating healthfully, unless it takes up an inordinate amount of time and attention; deviating from the diet is met with guilt and intense dislike; and it is used to avoid life issues and leaves one feeling separate and alone.

Recovery and Treatment

Healthy eating and thinness may be valued in one’s social circle, so it may be easy to be unaware of how problematic this behavior can become. Even more difficult is that the person eating healthfully can hide behind the thought that he or she is simply eating well and that others are not. Complicating treatment is the fact that motives behind orthorexia are multifaceted. The orthorexic must first admit there is a problem, then identify what caused the obsession. She or he must also become more flexible and less dogmatic about eating. Working through underlying emotional issues will make the transition to normal eating easier.1,7 Although orthorexia is not a condition clinicians will formally diagnose, recovery can require professional help. A healthcare practitioner skilled at treating eating disorders is the best choice.

Recovered orthorexics will still eat healthfully, but there will be a different understanding of what healthy eating is. They will realize that food will not make them a better person, and that basing their self-esteem on the quality of their diet is irrational. Their identity will shift from “the person who eats health food” to a broader definition of who they are—a person who loves, who works, who has fun, etc. They will find that while food is important, it is one small aspect of their life.1,7

There are currently no specific treatments for orthorexia. Many clinical eating disorder experts treat orthorexia as a variation of anorexia and/or obsessive-compulsive disorder. Thus, treatment usually involves psychotherapy to increase the variety of foods eaten and expose the patient to anxiety-provoking or feared foods, as well as weight restoration, if needed.7

REFERENCES

1. Websites: www.nationaleatingdisorders.org, www.orthorexia.com.
2. Koven NS, Senbonmatsu RA. Neuropsychological evaluation of orthorexia nervosa. Open Journal of Psychiatry. 2013;3:214-222.
3. Brytek-Matera A. Orthorexia nervosa—an eating disorder, obsessive-compulsive disorder or disturbed eating habit. Archives of Psychiatry and psychotherapy. 2012;1(14):55-60.
4. Brytek-Matera A, Donini LM, Krupa M, et al. Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. Journal of eating disorders. 2015;3(1):1.
5. Koven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease & Treatment. 2015;11.
6. Chaki B, Pal S, Bandyopadhyay A. Exploring scientific legitimacy of orthorexia nervosa: a newly emerging eating disorder. Journal of Human Sport and Exercise. 2013;8(4):1045-1053.
7.Rangel C, Dukeshire S, MacDonald L. Diet and anxiety. An exploration into the Orthorexic Society. Appetite. 2012;58:124-132.

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