Orthorexia Nervosa

J. Violet Jayamani

Lecturer, Sri Ramakrishna College of Nursing, Coimbatore, Tamilnadu

INTRODUCTION:

Almost one in four people are classed as clinically obese, so it’s no wonder nutritionists are constantly telling us to eat more fruit and vegetables and less fat. But what happens when a desire to eat well goes too far? Eating disorder charities are reporting an increase in the number of people suffering from a potentially serious condition, which is an obsession with healthy eating called “Orthorexia Nervosa”.

Until a few years ago, there were so few sufferers that doctors usually included them under the label of “EDNOS”-Eating Disorders Not Otherwise Recognized. Now Orthorexia Nervosa take up such significant proportion that experts say they should be treated separately. The people who suffer with such disorder are called orthorexic. While anorexics limit the quantity of food they eat, orthorexics fixate on the type and quality of it. They often display symptoms consistent with obsessive-compulsive disorder and have an exaggerated concern with healthy eating patterns.

Definition:

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 so extreme, that it can lead to severe malnutrition or even death. Hence it has been referred to as a mental disorder. The term orthorexia derives from the Greek ορθο- (ortho, “right" or "correct”), and όρεξις (orexis, "appetite"), literally meaning a correct diet.

Although Orthorexia is not medically recognized as a mental disorder by the American Psychiatric Association, and is not listed in the DSM-IV or planned to be included in the DSM-V to be published in May 2013, 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. As of January 2007, only two peer-reviewed studies have been published on the alleged condition.

Incidence:

The National Centre for Eating Disorders (NCFED) receives more than 6000 calls and e-mails a year from people who suffer from eating disorders, many with orthorexia. It affects both men and women. One in 10 women and around one in 20 men has orthorexia. It is rising among young people because it is this age group that wish to be “impressionable”. Although it can start in adolescents the sufferers tend to be aged over 30, middle class and well educated.

Causes:

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, desire to improve self-esteem, searching for spirituality through food, and using food to create an identity. There are weight loss plans disguised as healthy eating plans that make people feel that eating the right type of food will prevent them from the risk of diseases.

The obsession for healthy foods could come from a number of sources too, 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 orthorexics to ultimately eliminate the food or foods from their diet.

How to identify orthorexics?

Every day is a day to eat right, be ‘good,’ rise above others in dietary prowess, and self-punish if temptation wins. Self-esteem becomes wrapped up in the purity of their diet and they often feel superior to others, especially in regards to food intake. Orthorexics 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.

Orthorexics don’t necessarily set out to lose weight but wants to feel pure, healthy and natural. Their obsession will often see them cutting out fat, salt, sugar, gluten, wheat, yeast, corn, and dairy foods, leading them to drop pounds. Many people won’t realize that they have the condition, telling themselves they are just being healthy. And orthorexics are not only careful about what they eat, but they over-exercise too. When they slip from their “perfect” diet they feel bad about themselves and may resort to extreme acts of further self-discipline including even stricter regimens and fasting.

People suffering from this obsession may display the following signs.

· Spending more than three hours a day thinking about healthy food

· Planning tomorrow's menu today

· Feeling virtuous about what they eat, but not enjoying it much

· Continually limiting the number of foods they eat

· Experiencing a reduced quality of life or social isolation (because their diet makes it difficult for them to eat anywhere but at home)

· Feeling critical of others who do not eat as well they do

· Skipping foods they once enjoyed in order to eat the " right" foods

· Feeling guilt or self-loathing when they stray from their diet

· Feeling in "total" control when they eat the correct diet

· Assessing the nutritional value of foods before eating

· Feeling distanced in relationships

· Strictly controlling self

· Often spending hours in the gym

· Reading up on the latest food research and

· Scouring health food shops to find foods that’ll allow themselves to eat.

· Mealtimes becomes more of a chore than a pleasure

Diagnosis:

If any two or more of the above said signs are present it indicates that the person may have a mild case of orthorexia. Orthorexia Nervosa should only be characterized when it is in the long-term (paying attention to healthy food for a few weeks where it becomes a normal and healthy routine not obsessed over, would not be considered a disorder), when it has a significant negative impact on an individual's life (thinking about food to avoid the stresses of life, thinking about how food is prepared to avoid negative emotions, thinking about food the majority of each individual's day), and where food rituals are not better explained by something like religious rites (such as in the Orthodox Jewish religion).

Risks:

Because orthorexics don’t always look underweight, the condition can remain hidden for years. Physical risks associated with orthorexia nervosa are very few, if any, most risks and complications of orthorexia nervosa are social and emotional. These include:

· Loneliness

· Spending too much time buying and planning out meals

· Eating alone, isolation

· Poor relationships

Treatment:

Although one may not think that “healthy eating” is an actual eating disorder, such extreme concentration on food is unhealthy and should be treated before certain consequences take place. Effective eating disorder treatment centers in few areas treat the emotional and social aspects of an eating disorder as well as the physical. These eating disorder residential centers desire to help their residents and give them hope and advice.

Barriers for Treatment of Orthorexia:

· Society pushes healthy eating and thinness, so it is easy for many to not realize how problematic this behavior can become.

· Even more difficult is that the person doing the healthy eating can hide behind the thought that they are simply eating well (and that others do not).

· Further complicating treatment is the fact that motivation behind orthorexia is multi-faceted.

For an effective treatment:

· First, the orthorexic must admit there is a problem, then identify what caused the obsession.

· They must also become more flexible and less dogmatic with their eating.

· There will be deeper emotional issues, and working through them will make the transition to normal eating easier.

· While orthorexia is not a condition that a doctor will diagnose, recovery can require professional help.

· A practitioner skilled at treating those with eating disorders is the best choice.

Recovery:

The recovered orthorexic will still eat healthfully, but there will be a different understanding of what healthy eating is. They will realize that food will not make them a better person and that basing their self-esteem on the quality of their diet is irrational. Their identity will shift from “the person who eats health food” to a broader definition of who they are – a person who loves, who works, who is fun. They will find that while food is important, it is one small aspect of life and, often, there are things that are more important!

REFERENCES:

1. Bratman, Steven (4 June 2009). What is Orthorexia?. Retrieved July 03, 2011, from http://www.orthorexia.com/.

2. Getz, L. (June 2009). Orthorexia: When eating healthy becomes an unhealthy obsession. Retrieved July 01, 2011, from http://www.todaysdietitian.com/newarchives/060109p40.shtml.

3. Rochman, B. (2010). Orthorexia: Can Healthy Eating Be a Disorder?. Retrieved July 03, 2011, from TIME.com.

4. Mike Adams, the Health Ranger (29 June 2010).Choosing healthy foods now called a mental disorder. Retrieved July 03, 2011, from http://www.naturalnews.com/029098_orthorexia_mental_disorder.html#ixzz1RhVT2WIf

5. Something fishy: website on eating disorders. Other types of eating disorders. Retrieved July 06, 2011,from http://www.something-fishy.org/whatarethey/other.php

6. Casa palmera-Del Mar, California. Orthorexia Nervosa: A Healthy Obsession?. Retrieved July 06, 2011, from http://www.casapalmera.com/articles/orthorexia-nervosa/

7. Karin Kratina. Orthorexia Nervosa. Retrieved July 06, 2011, from http://www.nationaleatingdisorders.org/uploads/file/Orthorexia%20Nervosa.pdf

Received on 15.07.2011 Modified on 09.09.2011

Asian J. Nur. Edu. & Research 1(2): April-June 2011; Page 48-50