January
2008
Orthorexia Nervosa and Dietary Obsession
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What’s For Dinner?
For an increasing number of well-intentioned, health conscious individuals, some researchers say, the pursuit of healthful eating is taking an ominous turn toward clinical obsession, an as-yet unofficial eating disorder condition labeled Orthorexia nervosa. I thought it was time to explore the subject and ask you to weigh in with your thoughts.
Dr. Stephen Bratman, a holistic physician and practitioner of dietary medicine, initially proposed the condition in 1997, and simultaneously coined the Orthorexia label, from the Greek words “orthos” for correct and “orexis” for appetite.
Unlike those with anorexia or bulimia, orthorexics obsess over the quality, not quantity of their food intake. The condition develops with a continuing and increasingly more rigid pursuit of dietary purity. Some begin with food restriction based on genuine medical recommendations (e.g. allergies). Others begin with common health and ethical priorities, such as organic food, vegetarian or vegan diet, and/or raw or macrobiotic preparation. (Orthorexia is not applied to dietary restriction for religious purposes or to short term dietary focus for long term changes, whether they be for medical treatment or personal choice.)
For most of us, “sensible vice” (and not-so-sensible vice) indulgence might result in a pang of conscience. For those with orthorexia, however, a “slip” induces genuine psychological distress and, according to Bratman, a series of penitent measures, including days of fasting for a “transgression” as small as a chocolate chip.
Though orthorexics may start out with “normal” dietary goals, they gradually escalate their pursuit and narrow the criteria for “acceptable” food so severely that their social, mental, and (finally) physical health suffer. Although orthorexics enjoy proselytizing about their dietary views, it is common for sufferers to increasingly isolate themselves because of their fear and disgust of impure foods they will encounter. As their obsession grows, orthorexics spend more time planning their dietary regime and less time enjoying the things and people they used to spend time with. Their radical restriction can eventually cause various forms of malnutrition. In extreme cases, orthorexia, Dr. Bratman reports, results in anorexia and even death.
Bratman created a questionnaire based on the criteria he’d established for the disorder. (The test is intended as one tool to help assess risk for the condition, but it does not, by itself, determine diagnosis.)
The Bratman Test for Orthorexia
- Do you spend more than 3 hours a day thinking about your diet?
- Do you plan your meals several days ahead?
- Is the nutritional value of your meal more important than the pleasure of eating it?
- Has the quality of your life decreased as the quality of your diet has increased?
- Have you become stricter with yourself lately?
- Does your self-esteem get a boost from eating healthily?
- Have you given up foods you used to enjoy in order to eat the ‘right’ foods
- Does your diet make it difficult for you to eat out, distancing you from family and friends?
- Do you feel guilty when you stray from your diet?
- Do you feel at peace with yourself and in total control when you eat healthily?
“Yes” to 4 or 5 of the above questions means it is time to relax more about food.
“Yes” to all of them means a full-blown obsession with eating healthy food.
Researchers continue to study the condition and debate about the necessity of a formal diagnosis. Though psychologists and physicians agree that sufferers’ obsession is, ultimately, connected to personal mental health, some researchers are also pointing to the power of recent cultural changes surrounding food in the
Researchers stress that the line between health consciousness and targeted obsession differs from one individual to the next. They encourage people to make diet related choices that are in keeping with both recommended health guidelines and personal enjoyment of life and social relationships.
So, now we turn it over to you:
When do earnestness, discipline and conscience (normally our best attributes), lead us down a slippery slope? Though you may not see your own experience in this picture, what does this research say to you about the culture of food and diet in our society? Lastly, what do you think of Dr. Bratman’s test for orthorexia? Shoot me a comment.
malias Flickr Photo (CC)
Further Reading:
If You’re Gonna Cheat, Do It Right
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Technorati Tags: orthorexia nervosa, anorexia, bulimia, eating disorder, obsession, discipline, health condition
Orthorexia sounds like a very undesirable mental health issue. To be so consumed with every little detail about what we put into our bodies to distraction, is indeed a terrible every day hindrance.
If you ask me, some of the questions are silly. Perhaps the need more refinement For instance:
- Does your self-esteem get a boost from eating healthily?
Yes, I feel better about myself and my body when I’m eating healthy foods, rather then junk food. So what?
- Have you given up foods you used to enjoy in order to eat the ‘right’ foods
Yes… Sadly I gave up cake and cookies I used to enjoy every day as a kid (I have my occasional vice, mind you). Is giving up junk food a clinical disease now?
- Does your diet make it difficult for you to eat out, distancing you from family and friends?
Doesn’t everyone who tries to eat healthy in America feel even a little bit of difficulty when your family goes to the local Italian restaurant or your friends go to Bert’s Burger Shack and Pub.
Taking care of our bodies in a society where excess and neglect does indeed take some sacrifice. Though I don’t think I fit the bill for this disorder, I’m sure some of my peers think I’m a bit whacko for my healthy lifestyle. This poses the question: Am I crazy because I’m not like (most) everyone else?
Good point Moe. Though, I certainly know a few people who might be Orthorexia nervosics.
When I was a kid, my best friend’s mom was a health food pedant. Of course, he rebelled and became a junk food junkie because of it.
I’m not sure a health food obsession needs to be classified as an official disorder. It’s just a clear example of the problems with taking things to an extreme. The same goes for over-exercising (roiding), hardcore fundamental religious fanatacism, and guys who bass fish way too much.
I was wondering about the same things as Moe. I very much enjoy baguette bread with Nutella, or chocolate cake and coffee-flavoured ice-cream, but ‘giving up’ on that was kind of a prerequisite to put my health and weight back on the right track. And like everyone who has to face weight problems (if I ‘eat like everyone else around me’, a.k.a junk food and/or in too high quantities, I just put on weight, period), I unfortunately have to exert constant vigilance, plan my meals, etc. (Planning days in advance is another matter: I do it, but because I need to know what to write down on my shopping list, else I just end up buying too much or getting tempted by crap.
Also, my diet indeed makes it difficult at times to eat out with friends/family, when the only alternatives I’m given are “shall we go to McDonald’s or do you prefer Burger King?”. So I too had to answer yes to several of these questions.
On the other hand, my healthy choices are also foods that I enjoy. The other way would just be running for Martyrdom of Year 2008. I guess *this* might have a place in the list?
Great points Moe and I totally agree with you statements on the questions.
Reminds me of the “tests” to see if you have a drinking problem. I drink only a few times a year most years, but on two occasions had 4 or 5 beers when I did. Acccording to the tests I’m a binge alcoholic because I consume more than 3 drinks in one night.
I think anyone who reads this site on a regular basis and follows at least some of the guidelines, challenges, opinions, and directives given in most of the posts would have to score at least a YES on 4 to 5 of these questions. I have noticed since I have read this blog on a daily basis that my thoughts have been much more focused on the negatives of what I should not eat at a restaurant,at a dinner party, and fix for myself. I have been made aware of all sorts of dietary pitfalls, pratfalls and taboos as well as many things I should or could be doing to make my body more healthy and ageless. I guess we should just embrace one balance but then I already thought I had that until this article.
This is deeply interesting to me as when I was diagnosed with an eating disorder, I “officially” got ED-NOS (not otherwise specified) but my counselor told me I was a textbook “Orthorexic.” I think the difference between me (then) and what you all are saying (”I eat healthy so do I fit the questionarre”) is that, given an “unhealthy” food I would choose to starve rather than eat it. (I mean literally starve - not just skip a meal) And I was so rigorous in my specification as to what “healthy” meant that it basically limited me to eating only what I myself bought and prepared in an environment that I completely controlled. I refused to eat so much as a single taste at friends’ homes. I was so rigid that I lost an extreme amount of weight, lost my period and compromised my health. Never was my goal to be “skinny” like, say, a traditional Anorexic but only to be “healthy” However, the net result was the same. And traditional outpatient eating disorder therapy helped me overcome it. New Year’s eve I actually ate an entire meal that I didn’t cook (in front of people!) - that’s something I would never have done a year ago.
I am glad that (so far) none of you can really relate to Dr. Bradford’s description. It means you haven’t taken your healthiness to an extreme. But I do, firmly, believe that Orthorexia is a valid disorder and ought to be made official in the DSM. It’s a fine line but, like anything, it’s all about the extremes.
Don’t forget that in psychology, something is really only considered a disorder if it’s screwing up your life in some way. Being inconvenienced and finding it challenging to eat healthfully in modern society is a bit different than entirely withdrawing socially for fear of encountering “bad” food, or imposing penance on yourself like a medieval monk for the slightest food transgression.
Mentally healthy people know that having a plate of potato skins on a rare night out at the bar is not an occasion for purging and fasting, though it’s no cause for self-congratulation either.
Questionnaires like this are used as one step of evaluating a patient that has come to a psychologist because they have a problem and their life is not working in some way. Identifying the specific nature and roots of the problem is step two. Evaluating the patient individually is also part of it.
It’s kind of like BMI- it makes a decent tool for evaluating broad population trends when you can’t do detailed testing for bodyfat percentage or waist circumference, but a completely lousy one to base an individual evaluation on alone.
So the big question is, how many people have this? Because it does sound like a real disorder, but it also sounds like a disorder that could be misdiagnosed ad-nauseum if it gains any popularity. I feel I’m right in claiming a gross number of children are diagnosed with ADHD who are simply active children. The same could easily happen to people who are simply “very health concious.” In other words, you refuse to eat non organic veggies at your friend’s and consequently your friends hold an intervention to make you deal with your Orthorexia.
Anyone trying to improve their health can answer yes to most of those questions. The questions aren’t “extreme” enough to really get a good idea of what’s going on with the person.
Its hard to say if this is a real disorder, its a good avenue for a self-fulling prophecy. It sounds like another thing to be worried about. Its like “I am a health food nut! i must be abnormal! gahh i am orothrexic!”. and you know so what if you are, the real question is, are you hurting yourself. So what if your pre-occupied with health food. i though i must be disordered, but i need to look at my life, i am in culinary school, of course i am supposed to think about food! and heck we all need to eat, its not exactly like alcoholics because one can abstain from drinking, but we will always need to eat. with anorexia and bulemia, your really risking your life, but if you just focus a lot about eating healthy, i dont see how that is too much cause for concern. I just also must question what are the “treatment” options. for most eating disorders they suggest anti-depressants and inpatient treatment, but would that work for so-called “orthrexics”?
I knew someone like this, for whom eating healthy wasn’t just important, but a debilitating obsession. People stopped wanting to associate with this person because she couldn’t just settle down and enjoy life–or let other people enjoy theirs–without counting every scrap of carbohydrates, fat, protein. I think it progressed to some kind of athletic anorexia, though, because in the end she was only counting calories and exercising obsessively, and her hair was falling out.
[...] our usually positive programming to, well, complain for a minute. This article on “Orthorexia nervosa,” what some researchers are calling a new eating disorder, frustrates [...]
A few thoughts from me - a licensed clinical psychologist:
1) Tests need to be normed and empirically validated before being useful. Until validation occurs, they are just a collection of questions that you might otherwise see while reading “Cosmo” in the grocery line (not that I do that :).
2) I would be surprised if this “condition” makes it into the DSM anytime soon. There is usually a long list of new “disorders” to be considered for the newest DSM edition and most of them do not make the cut - thank goodness.
3) I really do not care about labels anyway. If a behavior pattern or thought pattern is sigficantly impairing life’s activities then it is worthy of being addressed IMHO.
4) I am sure that Pfizer or Eli Lilly will find a way to treat to Orthorexia.
This is a VERY interesting article and while I agree that the “tests” are rather vague, I think it’s something to be aware of. As I was reading the article, I was astounded at how closely this matched the escalation of my strict eating habits over the past year. Recently, I have realized how much it has effected my daily life and social interactions and it’s not something I want to continue. Charlotte’s comments are spot on- these are the exact struggles I go through everyday in trying to plan out my meals, especially when I’m off my routine. The first step is recognizing the issue and I think increased awareness will help people realize that they are damaging not only their physical but mental health.
There are some misconceptions about what specific behaviors are characteristic of someone having an eating disorder. I want to suggest an anonymous tool from the Center for Eating Disorders for any readers who may have questions about eating disorders. http://www.eatingdisorder.org/about_eating_disorders/resources/quiz.php. As the most common eating disorders are Anorexia Nervosa and Bulimia, this is a good place to get more information on other eating disorders and the right treatment for them.
[...] Orthorexia Nervosa and Dietary Obsession - Jan. 1 [...]
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