Orthorexia nervosa

Orthorexia nervosa (also known as orthorexia) is a term used by Steven Bratman to describe people who have developed a fixation with healthy or righteous eating^[1] and has been referred to as a mental disorder.^[2] It is not a medically recognized term.^[a] Bratman claims that in rare cases, this focus may turn into a fixation so extreme that it can lead to severe malnutrition or even death.^[3] Even in less severe cases, the attempt to follow a diet that cannot provide adequate nourishment is said to lower self-esteem as the orthorexics blame themselves rather than their diets for their constant hunger and the resulting cravings for forbidden foods. ^[4]

The term orthorexia derives from the Greek ορθο- (ortho, “right" or "correct”), and όρεξις (orexis, "appetite"), literally meaning a correct diet. It was introduced in 1997 by Colorado Doctor of Medicine Steven Bratman, to be used as a parallel with other eating disorders, such as anorexia nervosa.

History

Bratman coined the term in 1997 from the Greek orthos, "correct or right", and orexis for "appetite".^[5] Literally "correct appetite", the word is modeled on anorexia, "without appetite", as used in definition of the condition anorexia nervosa. Bratman describes orthorexia as an unhealthy fixation with what the individual considers to be healthy eating. The subject may avoid certain unhealthy foods, such as those containing fats, preservatives, man-made food-additives, animal products, or other ingredients considered by the subject to be unhealthy; if the sufferer does not eat appropriately, malnutrition can ensue. Bratman claims Orthorexic sufferers have specific preferences about the foods they are eating and avoiding. Products that are preserved with additives can be considered dangerous. Industrial products can be seen as artificial, whereas fruits and vegetables can be seen as healthy.^[6] Bratman asserts that "emaciation is common among followers of certain health food diets, such as rawfoodism, and this can at times reach the extremes seen in anorexia nervosa." In addition, he claims that "anorexic orthorexia" can be as dangerous as anorexia. However, he states, "the underlying motivation is quite different. While an anorexic wants to lose weight, an orthorexic does not desire to become thin^[6] but wants to feel pure, healthy and natural. Eating disorder specialists may fail to understand this distinction, leading to a disconnect between orthorexic and physician."^[3][7]

According to the Macmillan English Dictionary, the word is entering the English lexicon.^[8]

Diagnostic criteria

Although Orthorexia is not recognized as a mental disorder by the American Psychiatric Association, and it is not listed in the DSM-IV^[9] or planned to be included in the DSM-V to be published May 2013,^[10] it is still used as a diagnosis by some practitioners who have documented the damaging results of the condition as they have seen in their practices.^[11][12][13]

As of January 2007, only two peer-reviewed studies have been published on the alleged condition.^[14][15] In the studies, Donini et al. define orthorexia nervosa as a "maniacal obsession for healthy foods" and propose several diagnostic criteria.^[14] Sufferers of orthorexia often display symptoms consistent with obsessive-compulsive disorder and have an exaggerated concern with healthy eating patterns. Like anorexia, however, these obsessive compulsive symptoms may be an effect of starvation rather than a cause of the disorder.^[16] A diagnostic questionnaire has been developed for orthorexia sufferers, similar to questionnaires for other eating disorders.^[15] Bratman proposes an initial self-test composed of two direct questions: "Do you care more about the virtue of what you eat than the pleasure you receive from eating it?... Does your diet socially isolate you?"^[17] Other questions concerning those who may be suffering from orthorexia provided by Davis on the WebMD (2000) website are: Do they spend more than 3 hours a day thinking about healthy foods? When they eat the way they're supposed to, do they feel in total control? Are they planning tomorrow's menu today? Has the quality of their life decreased as the quality of their diet increased? Have they become stricter with themselves? Does their self-esteem get a boost from eating healthy? Do they look down on others who don't eat this way? Do they skip foods they once enjoyed in order to eat the "right" foods? Does their diet make it difficult for them to eat anywhere but at home, distancing them from family and friends? Do they feel guilt or self-loathing when they stray from their diet? If yes was answered to two or more questions, the person may have a mild case of orthorexia.^[11]

Symptoms and theory

Symptoms of orthorexia nervosa may include obsession with healthy eating, and emaciation among other things. Orthorexic subjects typically have specific feelings towards different types of food. The obsession for healthy foods could come from a number of sources such as family habits, society trends, economic problems, recent illness, or even just hearing something negative about a food type or group, which then leads them to ultimately eliminate the food or foods from their diet.^[18] According to the abstract of a 2004 study quoted on PubMed, a service of the National Institutes of Health, "The analysis of the physiological characteristics, the social-cultural and the psychological behaviour that characterises subjects suffering from ON shows a higher prevalence in men and in those with a lower level of education."^[14]

Biology of orthorexia nervosa

There has been no investigation into whether there may be a biological cause specific to orthorexia nervosa. However, Donini et al. link orthorexia to a food-centered manifestation of obsessive compulsive disorder, which has a lot to do with control.^[6]

See also

• Comfort food
• Emotional eating
• Diet
• Coping (psychology)
• Food guide pyramid
• Chemophobia

Notes

• ^{^} Medical manuals that do not recognise orthorexia nervosa include; ICD-10,^[19] DSM-IV,^[20] and DSM-5.^[21]

References

1. ^ Bratman, Steven (4 June 2009). "What is Orthorexia?". http://www.orthorexia.com/. Retrieved 16 October 2010. 
2. ^ Hill, Amelia (16 August 2009). "Healthy food obsession sparks rise in new eating disorder". The Guardian. http://www.guardian.co.uk/society/2009/aug/16/orthorexia-mental-health-eating-disorder. Retrieved 16 October 2010. 
3. ^ ^{a b} Bratman, Steven (October 1997). "Obsession with dietary perfection can sometimes do more harm than good, says one who has been there". Yoga Journal. http://www.beyondveg.com/bratman-s/hfj/hf-junkie-1a.shtml. Retrieved 16 October 2010. 
4. ^ Billings, Tom (1999). "Raw Vegan Calorie Paradox—Potential Solutions/Reality Checks". http://www.beyondveg.com/billings-t/cal-par/calorie-paradox1d.shtml. Retrieved 19 October 2010. 
5. ^ S. Bratman, D. Knight: Health food junkies. Broadway Books, New York, 2000.
6. ^ ^{a b c} Getz, L. (June 2009). "Orthorexia: When eating healthy becomes an unhealthy obsession". Today's Dietitian. http://www.todaysdietitian.com/newarchives/060109p40.shtml. Retrieved 2009-10-13. 
7. ^ Palo Alto Medical Foundation Summary of Eating Disorders
8. ^ Macmillan English Dictionary entry for Orthorexia Nervosa
9. ^ Orthorexia nervosa
10. ^ Rochman, B. (2010). Orthorexia: Can Healthy Eating Be a Disorder?. TIME.com, Feb 12. Retrieved 2010-02-12.
11. ^ ^{a b} Web MD report: Orthorexia: Good Diets Gone Bad
12. ^ Orthorexia: Too Healthy? Specialists have coined a new term-orthorexia-to describe an obsessive concern with healthy eating that often leads to social isolation, Psychology Today, Sept/Oct 2004.
13. ^ Observer Guardian Newspaper, Sept 9, 2001, column reporting on Orthorexia
14. ^ ^{a b c} Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2004). "Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon". Eat Weight Disord 9 (2): 151–157. PMID 15330084. 
15. ^ ^{a b} Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2005). "Orthorexia nervosa: validation of a diagnosis questionnaire". Eat Weight Disord 10 (2): e28–32. PMID 16682853. 
16. ^ Carlson, N: Physiology of Behavior, 10th ed., page 435. Person Education Inc., 2010
17. ^ McCandless, David (29 March 2005). "'I am an orthorexic'". BBC News. http://news.bbc.co.uk/1/hi/magazine/4389849.stm. 
18. ^ Getz, L. (June 2009). "Orthorexia: When eating healthy becomes an unhealthy obsession". Today's Dietitian. http://www.todaysdietitian.com/newarchives/060109p40.shtml. Retrieved 2009-10-13. 
19. ^ "ICD10 Codes". Psychiatr Online. http://priory.com/psych/ICD.htm. Retrieved 16 October 2010. 
20. ^ "APA Diagnostic Classification". BehaveNet. http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm. Retrieved 16 October 2010. 
21. ^ "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence". American Psychiatric Association. http://www.dsm5.org/ProposedRevisions/Pages/InfancyChildhoodAdolescence.aspx. Retrieved 16 October 2010. 

• "Orthorexia: Too Much Of A Healthy Thing?". Huffington Post. 8/26/11. http://www.huffingtonpost.com/2011/08/26/orthorexia-nervosa_n_937268.html.