“I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong. The poetry of my life was disappearing. My ability to carry on normal conversations was hindered by intrusive thoughts of food. The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach. I was lonely and obsessed…I found it terribly difficult to free myself. I had been seduced by righteous eating. The problem of my life’s meaning had been transferred inexorably to food, and I could not reclaim it.” Dr. Bratman
Today I was working with young women in treatment for Anorexia Nervosa and Bulimia Nervosa, but in my private practice, I’m seeing more and more a different kind of struggle: Orthorexia.
Below is the proposed diagnostic criteria for Orthorexia Nervosa, put forth by Dunn, T.M & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors, 21, 11 -17.
Obsessive focus on “healthy” eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue, but this is conceptualized as an aspect of ideal health rather than as the primary goal. As evidenced by the following:
- Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices* believed by the individual to promote optimum health.**
- Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame.
- Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy food.
*Dietary practices may include use of concentrated “food supplements.”
**Exercise performance and/or fit body image may be regarded as an aspect or indicator of health.
The compulsive behavior and mental preoccupation becomes clinically impairing by any of the following:
- Malnutrition, severe weight loss or other medical complications from restricted diet
- Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet.
- Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined “healthy” eating behavior
In addition to these criteria, the published article also includes the following paragraph:
Other traits are commonly associated with ON in the literature. While the authors feel that these are not essential to making the diagnosis, they may help confirm it. These include obsessive focus on food choice, planning, purchase, preparation, and consumption; food regarded primarily as source of health rather than pleasure; distress or disgust when in proximity to prohibited foods; exaggerated faith that inclusion or elimination of particular kinds of food can prevent or cure disease or affect daily well-being; periodic shifts in dietary beliefs while other processes persist unchanged; moral judgment of others based on dietary choices; body image distortion around sense of physical “impurity” rather than weight; persistent belief that dietary practices are health-promoting despite evidence of malnutrition.
What’s the problem:
The orthorexic diet often leads to nutritional deficits due to the limited kinds, and quantities, of foods that the person allows. It isn’t always easy to see these nutritional deficits. Orthorexia can lead to social isolation, often because ones life is planned around food. Intuitive eating-knowing when you are hungry, how much you need, and when you are full- goes out the window. Instead, rigid rules dictate what and how much is eaten.
I’m not saying that it is unhealthy to, or that you have an Eating Disorder/disordered eating if, you eat whole, nutrient dense foods. However, if it is taking up a lot of time and attention, and if deviating from your diet causes you to feel self-loathing or guilt, or if you use your “healthy eating” as a way to avoid the difficult aspects of your life, or you find yourself isolating, then you may want to seek out the help of a professional. If you see yourself in the descriptions above, please know you are not alone. So many people are caught up in “clean eating” and paleo/vegan/keto/raw diets. And there’s lots of help out there if you need it.
I’m sure I’ll write more on this topic in the future, but I wanted to get this introductory post on Orthorexia out there. I’m seeing too many people lose their lives to “the perfect diet”. I’d like to see this trend come to an end, or at the very least, loose speed.
If you have any questions, or need support, please email me at email@example.com, or leave a comment below.