Orthorexia Nervosa

What is it?

Orthorexia or orthorexia nervosa (ON) is the name given to a condition which involves a compulsive preoccupation or obsession with dietary purity. There may be preoccupation with the composition and origin of food. Priority may be given to biologically pure foods, which may contribute to significant diet limitations.

Background

  • First identified by Dr. Steven Bratman, in 1997
  • Currently, orthorexia is not a formal or recognised diagnosis
  • Few studies have been conducted internationally to determine prevalence of the issue.
  • Research instruments used to assess orthorexia have not been thoroughly validated or examined.

In 2016, Dr. Bratman wrote “While the literature is limited in this area, there are convincing case studies and broad anecdotal evidence to conclude that sufficient evidence exists to pursue whether ON is a distinct condition.”

It is clear that some individuals identify with orthorexia. However, further research is required to ground the issue scientifically, and to ensure that best practice is followed to facilitate the identification of possible instances of orthorexia and to inform potential treatments.

What happens?

Attention to a “pure” diet becomes problematic when it is an obsession that has a significant negative impact on a person’s life. Whereas anorexia nervosa and bulimia nervosa are marked by a chronic concern for the quantity of food being consumed, orthorexia is characterised by an over-concern with the quality of the food consumed.

Thinking about food and about how it is prepared becomes a means of coping with the stresses of life and avoiding the experience of negative emotions.

Priority may be given to biologically pure foods, which may contribute to significant diet limitations.

For the person with orthorexia, wavering from their “perfect” diet can lead to periods of even stricter rules around food and eating or to periods of fasting. Going against the “rules” may contribute to feelings of guilt, anxiety and shame, and lead to more stringent diet behaviours. The rules may become more complex and detailed over time. Efforts spent trying to satisfy the rules may increase and a person may avoid social situations where they are unable to follow their food related rules.

Orthorexia type behaviours may lead to a loss of moderation and balance, that is, obsession towards food and withdrawal from life.

Causes may be hidden and masked by the desire for total control over health and life, and the belief that one’s own perspectives on eating are the “best”. An individual may be consumed by the planning, purchase and preparation of food that they consider healthy.

Though often preliminary, past studies have identified to some possible traits of those who may develop orthorexia. These include:

  • Individuals affected by obsessive compulsive symptoms and some athletes.
  • Those who engage in specialised diets, a strict eating schedule, increased exercise frequency and who never drink alcohol

Treatment

Research on treatment is notably limited. One study suggested that an individual needs to learn that health is not solely based on the quality of food and that it is possible to eat without it becoming an obsession. Other suggested treatments include a multidisciplinary approach and promoting nutrition education. Cognitive behavioural therapy, combined with medication, may be effective in some cases.

Psychological therapy can help a person to gain an understanding of the thoughts, beliefs and value that underlie the emotions that are driving their obsession with the “right” diet and help them to restore balance to their relationship with food and to their lives in general.

References:

Babicz-Zielińska, E. (2006) Role of psychological factors in food choice – a review. Polish Journal of Food and Nutrition Sciences, 15/56(4), 379-384.

Bartrina, J.A. (2007) Ortorexia o la obsesión por la dieta saludable. Archivos Latinoamericanos de Nutrición, 57(4), 313-315.

Bratman, S. (1997) The health food eating disorder: http://www.orthorexia.com/original-orthorexia-essay

Bratman, S. & Knight, D. (2000) Health food junkies: overcoming the obsession with healthful eating. New York: Broadway Books.

Brytek-Matera, A. (2012) Orthorexia nervosa – An eating disorder, obsessive-compulsive disorder or disturbed eating habit? Archives of Psychiatry and Psychotherapy, 14(1), 55-60.

Donini, L.M. et al. (2004) Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eating and Weight Disorders, 9(2), 151-7.

Dunn, T.M. & Bratman, S. (2016) On orthorexia nervosa: A review of the literature and proposed
diagnostic criteria. Eating Behaviours, 21, 11-17.

Fidan, T., Ertekin, V., Işikay, S. & Kirpinar, I. (2010). Prevalence of orthorexia among medical students in Erzurum, Turkey. Comprehensive Psychiatry, 51(1), 49-54.

Janas-Kozik, M. et al. (2014) EPA-0578 – Is orthorexia nervosa an eating disorder an obsessive-compulsive disorder. European Psychiatry, 29, Supplement 1, 1 http://www.sciencedirect.com/science/article/pii/S0924933814779672

Koven, N.S. & Senbonmatsu, R. (2013) A neuropsychological evaluation of orthorexia nervosa. Open Journal of Psychiatry, 3, 214-222.

Mathieu, J. (2005) What is orthorexia? Journal of the American Dietetic Association, 105(10), 1510-1512.

Moroze, R.M. et al. (2015) Microthinking About Micronutrients: A case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria.  Psychosomatics, 56(4):397-403.

Neyman Morris, M., Clark, C. and Silliman, K. (2014) Prevalence of orthorexia nervosa among students at a rural university. Journal of the Federation of American Societies for Experimental Biology, 28(1), Supplement 1021.10.

Pember, S. (2014) Prevalence and correlates of sub-threshold disordered eating behavior in the Healthy Living Blog community. Soc Psychiatry Psychiatr Epidemiol. 2014; 49(8): 1335–1346

Segura-García, C. et al. (2012) Orthorexia nervosa: A frequent eating disordered behavior in athletes. Eating and Weight Disorders, 17(4), e226-33

Varga, M. et al. (2013) Evidence and gaps in the literature on orthorexia nervosa. Eating and Weight Disorders, 18( 2), 103-111.

Varga, M. et al. (2014) When eating healthy is not healthy: Orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry, 14:59