Orthorexia Nervosa
Orthorexia Nervosa is characterized by an intense preoccupation with healthy eating, where individuals become fixated on consuming what they perceive as "pure" foods while avoiding those they deem unhealthy, such as processed or high-fat items. This obsession can lead to severe nutritional deficiencies and unhealthy weight loss, as those affected may restrict their diets to a limited range of foods. Though the term was coined by Steven Bratman in 1997, orthorexia is not officially recognized as a clinical disorder like anorexia nervosa, and it differs in that the primary goal is not weight loss but rather the pursuit of optimal health. Symptoms may include excessive time spent analyzing food sources, strict dietary planning, and feelings of guilt when deviating from their food rules.
Research indicates that there might be overlaps between orthorexia and other eating disorders, with a significant percentage of individuals developing clinical eating disorders after prolonged fixation on healthy eating. Diagnosis typically involves a specialized questionnaire, ORTO-15, and treatment options remain varied but often include therapy and nutritional counseling aimed at promoting a balanced approach to eating. Understanding and addressing orthorexia is crucial, as it can have serious health implications if left unrecognized or untreated.
On this Page
Subject Terms
Orthorexia Nervosa
Orthorexia nervosa refers to an obsession focused on the optimal healthfulness of an individual’s diet. As more information about nutritional research is released to the public it generally results in a healthier population. However, some individuals take this information as absolute fact, without understanding that research is a work in progress. They develop an obsession with applying the knowledge at a level that most in the population do not. This obsession is most commonly focused on types of foods purported to be best for perfect health. In the current obesity epidemic, paying close attention to one’s diet is important for maintaining good health and reducing the risk of developing chronic diseases, such as heart disease and cancer. On the other hand, orthorexia nervosa can lead to unhealthy weight loss, nutritional deficiencies, and can be a gateway for developing anorexia or bulimia.
Background
The term orthorexia nervosa was coined by Steven Bratman in 1997. The term means "correct diet," and is not considered to be a disorder like anorexia nervosa. It does not appear as an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. The condition is characterized by a fixation on eating healthy foods. Ursula Philpot, chair of the British Dietetic Association, stated that individuals who have this condition are only concerned about the quality of food they consume, and only eat what they perceive to be "pure" food. When these individuals experience intense feelings of hunger and cravings, they punish themselves for being weak. The deprivation can be so severe that it results in death.
Physicians and eating disorder specialists often fail to distinguish between orthorexia nervosa and anorexia nervosa. It is important to understand the difference; anorexia nervosa is an eating disorder that results from the fear of being overweight, whereas in orthorexia nervosa, the goal is to achieve perfect health, not necessarily to lose weight. Still, both disorders can lead to malnutrition and health problems.
Even though increased attention is being given to better understanding the risk factors, behavior, and outcomes of therapy (if needed), there remains much to be learned. A 2017 review of the literature on orthorexia found fewer than 100 peer-reviewed studies. Few studies have addressed the overlap of orthorexia, or other obsessive-compulsive disorders, with another type of eating disorder, including bulimia and anorexia. It appears that the longer a person is preoccupied with healthy eating, the higher the likelihood that he or she will develop a clinical eating disorder (up to 53 percent three years after diagnosis). Orthorexia can also present in the patient with an eating disorder during their recovery period.
Overview
Orthorexia nervosa is an eating disorder where the affected individual is preoccupied with eating healthy foods, and avoids those high in fat, preservatives, animal products, or pesticides. Many of these individuals become malnourished as a result of avoiding sources of necessary nutrition in favor of a small number of "safe" foods. In order to obtain optimal nourishment, it is necessary to eat a variety of foods.
One example of dietary restriction is the raw food diet. Individuals who follow this and similarly restrictive diets (i.e., veganism or fruitarianism) have an elevated risk of becoming emaciated, and can develop nutritional deficiencies if they do not sufficiently vary their diet and ensure adequate intake of vitamins, minerals, proteins, fiber, and other nutritional requirements found in food.
Orthorexia disorders are similar to and potentially overlap other psychiatric disorders such as obsessive-compulsive disorders, somatic symptom disorder, hyperchondria, and psychotic spectrum disorders. One interesting overlap between orthorexia and other eating disorders is the displeasure with eating and the trading of control over one’s life for control over diet.
It is not clear what demographic group is more susceptible to developing the disorder. In one 2008 study in Germany, nutrition students were investigated for developing the disorder because of their in-depth knowledge of nutrition and how to achieve optimal health. It was found that nutritional students did not have higher orthorexic tendencies than non-nutrition students. In a similar study in Portugal, it was found that orthorexic tendencies measured by a diagnostic questionnaire decreased as a nutrition student progressed through their education. The orthorexia questionnaire measured eating behaviors and attitudes toward nutrition. The students did have higher scores in regard to having more restrictive eating behaviors than non-nutrition students, but this is to be expected. It did not indicate that these students had unhealthy attitudes towards eating.
Symptoms of orthorexia nervosa include obsessive concern about one’s diet, spending excessive amounts of time analyzing the source of a food for pesticides, worrying about whether milk contains growth hormones or antibiotics, overcooking food (thus losing nutrition), and avoiding packaged food. These individuals spend a lot of time planning menus, measuring portions, and obsessively counting calories. Orthorexic individuals develop nutritional deficiencies because they tend to omit entire food groups. Nutritional deficiencies can lead to medical complications such as anemia, osteopenia, and metabolic, hormonal, and blood deficiencies.
Diagnosis is performed using a fifteen-point questionnaire, called ORTO-15. This questionnaire assesses the beliefs of patients about their perception of eating healthy, food selection attitudes, food consumption habits, and the extent that food concerns affect daily life. Responses are scored using a four-point scale; a score below 40 is considered diagnostic of orthorexia whereas a score higher than 40 indicates a healthy view of eating. In addition, blood samples are drawn to assess for nutritional deficiencies.
Treatment for orthorexia nervosa has not been standardized. After a diagnosis has been made the patient is referred to psychotherapists and dietitians, as well as prescribed medication (often antidepressants) and behavioral therapy. Psychotherapists focus their therapy according to the patient’s needs. Among the varied approaches, patients undergo cognitive restructuring to reprogram their minds to avoid obsessive behavior and attitudes toward their diet. It appears that patients who undergo these therapies have a good outlook in changing their attitudes towards food, through correct education about nutrition, and can avoid developing nutritional deficiencies and more severe medical complications.
Bibliography
Brauser, Deborah. "Orthorexia Nervosa: When 'Healthy' Eating Turns Dangerous." Medscape, 31 May 2017, www.medscape.com/viewarticle/880916. Accessed 27 Feb. 2018.
Brytek-Matera, Anna. "Orthorexia Nervosa—An Eating Disorder, Obsessive-Compulsive Disorder or Disturbed Eating Habit?." Archives of Psychiatry & Psychotherapy 14.1 (2012): 55–60. Academic Search Complete. Web. 9 Jan. 2016.
Brytek-Matera, Anna, et al. "Predictors of Orthorexic Behaviours in Patients with Eating Disorders: A Preliminary Study." BMC Psychiatry 15.(2015): 1–8. Academic Search Complete. Web. 9 Jan. 2016.
Cinosi, E., et al. "Prevalence of Orthorexia Nervosa in a Population of Young Italian Adults." European Psychiatry 30 (2015): 1330. Academic Search Complete. Web. 9 Jan. 2016.
Costa, Christine B., et al. "Orthorexia Nervosa: A Review of the Literature." Issues in Mental Health Nursing, vol. 38, no. 12, 2017, pp. 980–88.
Koven, N. S., and A. W. Abry. "The clinical basis of orthorexia nervosa: emerging perspectives." Neuropsychiatric Disease Treatment, 11 (2015): 385–94.
Missbach, Benjamin, et al. "When Eating Right, Is Measured Wrong! A Validation and Critical Examination of the ORTO-15 Questionnaire in German." Plos ONE 10.8 (2015): 1–15. Academic Search Complete. Web. 9 Jan. 2016.
Nevin, Suzanne M., and Lenny R. Vartanian. "The Stigma of Clean Dieting and Orthorexia Nervosa." Journal of Eating Disorders, vol. 5, no. 37, 2017, doi.org/10.1186/s40337-017-0168-9. Accessed 27 Feb. 2018.
Reddy, Sumathi. "When Healthy Eating Calls for Treatment." Wall Street Journal - Eastern Edition 11 Nov. 2014: D1+. Academic Search Complete. Web. 9 Jan. 2016.
Saddichha, Sahoo, Girish N. Babu, and Prabha Chandra. "Orthorexia Nervosa Presenting as Prodrome of Schizophrenia." Schizophrenia Research 134.1 (2012): 110. Academic Search Complete. Web. 9 Jan. 2016.
Varga, Márta, et al. "When Eating Healthy Is Not Healthy: Orthorexia Nervosa and Its Measurement with the ORTO-15 in Hungary." BMC Psychiatry 14.1 (2014): 1–23. Academic Search Complete. Web. 9 Jan. 2016.