The disordered “healthy eating” of Orthorexia

Eating disorders (EDs) are complicated, in every sense of the word. There are different categories, behaviours, causes and triggers. Sufferers can be overweight, underweight or a normal weight. Increasingly, we recognise that EDs come in all shapes and sizes.

But while each person is unique, there are commonalities between sufferers too. That’s why finding an ED community can be so valuable and important to recovery. And this is as true for individuals dealing with Orthorexia, a lesser-known but equally serious condition, as for any other sufferers.

What is Orthorexia?

Orthorexia, or Orthorexia Nervosa, is definitely part of the ED landscape. However, it’s not as well-defined as Anorexia, Bulimia or Binge-Eating Disorder. In fact, the DSM-5 (the manual professionals use for assessing and diagnosing mental disorders) doesn’t officially recognise it as an ED. Neither does the American Psychiatric Association.

Nonetheless, Orthorexia is gathering interest as a proposed diagnosis among medical and psychiatric professionals. The term was coined by American physician Dr Stephen Bratman in the 1990s. He used it to describe the fixation on healthy foods and eating that he saw in many of his patients. The word is a combination of the Greek “orthos” and the Latin “orexic”.

“Orexic” means appetite, and is the basis for the word Anorexic which means “without appetite”. Dr Bratman added “orthos”, meaning right, to create Orthorexic. The name works because Orthorexics are pathologically obsessed with eating food that they consider healthy or correct, and also because it sounds similar to Anorexia. The conditions can appear similar, and some professionals don’t consider Orthorexia a separate diagnosis. Instead, they assert that sufferers of Anorexia can present with Orthorexia symptoms.

Issues with quality, not quantity

Anorexia and Orthorexia are both about a sufferer’s need for control. For Anorexics, this manifests as an obsessive need to eat tiny amounts of food only. For Orthorexics, the obsession is about food quality, rather than food quantity.

Clinically, the symptoms of Orthorexia and Anorexia can look virtually identical. Sufferers feel spiritually pure and physically powerful when they manage to stick to their self-imposed rules around food. They might also feel a sense of superiority to the people around them who don’t follow these restrictions. In turn, this increases the sense of isolation that both EDs create by making eating with others virtually impossible.

Often, an Orthorexic won’t be able to find foods that meet their rigid rules. In these cases, they simply won’t eat. They might be avoiding meals for different reasons to the Anorexic peers, but they’re at the same risk of malnutrition, being severely underweight, osteoporosis and other serious effects on the body. The physical consequences of not taking in enough food are the same, no matter how diverse the reasons might be.

Anorexia and Orthorexia also share several psychological symptoms. Sufferers begin to think about meals obsessively, devoting more and more time to planning how to meet their self-imposed restrictions. Depression, Obsessive-Compulsive Disorder, and other mental conditions commonly co-occur with both types of ED too.

In addition, elaborate rituals around eating and citing undiagnosed allergies as the rationale for avoiding certain foods are frequently seen in both types. Essentially, daily normal functioning can be severely affected in each case of either ED.

Good intentions gone awry

The other thing that Orthorexia and Anorexia have in common is that they can start with good intentions. At some point, these healthy behaviours or lifestyle changes get out of hand. For example, someone might decide to start eating more nutritious food or exercising regularly. They might even start a diet to lose a sensible amount of weight. Then, after seeing positive results, they go to extremes.

The behaviours are no longer healthy, and the results are almost certainly no longer positive. Before they know it, vulnerable individuals have crossed the line from normal habits to disordered eating, and then from disordered eating to an eating disorder. Happily, for both Anorexics and Orthorexics, there is hope.

By working hard with a dedicated treatment team, they can identify and start to deal with the underlying causes of their ED. At the same time, they can learn how to manage their mental states, their reactions to situations and their daily lives. Psychologists, dieticians, psychiatrists, other professionals and connection to a community of individuals in recovery from the disorders are all invaluable. Ultimately, the business of living while dealing with Orthorexia can get easier.