By Karin Kratina, PhD, RD, LD/N
Orthorexia nervosa is not currently recognized as a clinical diagnosis in the DSM-5, but many people struggle with symptoms associated with this term.
According to the National Eating Disorder Association, NEDA, 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 starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.” An iron-clad will is needed to maintain this rigid eating style. Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise). Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake.
Eventually food choices become so restrictive, in both variety and calories, that health suffers – an ironic twist for a person so completely dedicated to healthy eating. Eventually, the obsession with healthy eating can crowd out other activities and interests, impair relationships, and become physically dangerous.
Orthorexia is a term coined by Steven Bratman, MD in 1996. He began to use it with his patients who were overly health-obsessed. It was not meant as a diagnosis; instead, Dr. Bratman used the term to help his patients entertain the possibility that this “healthy” eating may not be as beneficial as they presumed. Over time, however, he came to understand that the term identifies a genuine eating problem. It is not an officially recognized disorder in the DSM-5, but is similar to other eating disorders – those with anorexia nervosa or bulimia nervosa obsess about calories and weight while orthorexics obsess about healthy eating (not about being “thin” and losing weight).
Orthorexia appears to be motivated by health, but there are underlying motivations, which can include safety from poor health, compulsion for complete control, escape from fears, wanting to be thin, improving self-esteem, searching for spirituality through food, and using food to create an identity.
Consider the following questions when determining if you or a loved one has Orthorexia.. The more questions you respond “yes” to, the more likely you are dealing with orthorexia.
• o you wish that occasionally you could just eat and not worry about food quality?
• o you ever wish you could spend less time on food and more time living and loving?
• oes 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?
• re you constantly looking for ways foods are unhealthy for you?
• o love, joy, play and creativity take a back seat to following the perfect diet?
• o you feel guilt or self-loathing when you stray from your diet?
• o you feel in control when you stick to the “correct” diet?
• ave you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?
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 in life 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. Instead of eating naturally they are destined to keep “falling off the wagon,” resulting in a feeling of failure familiar to followers of any diet.
Following a healthy diet does not mean you are orthorexic, and there is nothing wrong with eating healthfully. Unless, however, 1) it is taking up an inordinate amount of time and attention in your life; 2) deviating from that diet is met with guilt and self-loathing; and/or 3) it is used to avoid life issues and leaves you separate and alone.
While orthorexia is not a condition your doctor will diagnose, recovery can require professional help. A practitioner skilled at treating eating disorders is the best choice.