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Orthorexia nervosa, while not an officially recognized diagnosis of mental health, is an increasingly disturbing disorder. Evolving from a food culture and social emphasis on “clean” and “healthy” foods, orthorectic trends are viewed as socially acceptable due to a lack of understanding of the disorder and its risks. Read what is characterized by orthorexia, what are its symptoms and can it be treated?
Orthorexia – what is it?
The term orthorexia was coined in the 90s by Steven Bratman, an alternative medicine practitioner, and referred to “the near pathological fixation and obsession with healthy eating.” People who struggle with orthorexia tend to focus on the quality, not the quantity, of food.
It is important to clarify that Orthorexia Nervosa is not an official diagnosis of mental health as classified in the Manual for the Diagnostics and Statistics of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-10).
Steven Bratman proposed possible criteria for the diagnosis of neural orthorexia in 2016, including:
- obsessive focus on “healthy” eating and avoiding “unhealthy” foods,
- mental preoccupation with eating practices, and
- very rigid dietary rules with violations that cause excessive emotional stress (fear of illness, anxiety, shame and negative physical sensations).
Many people debate whether orthorexia is a lifestyle phenomenon or a disease, but reports of the physical (malnutrition and weight loss), psychological (fatigue and emotional instability) and social (social isolation, reduced quality of life and stigmatization) consequences of orthorexia are consistent with current concepts of mental disorders in force.
Despite this, orthorexia is more of a term used to describe certain disturbed eating tendencies and pathologies, but cannot be considered an independent mental disorder or an official diagnosis.
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Orthorexia – causes
As with other eating disorders, various biological, psychological and social aspects contribute to the development of orthorexia nervosa. Unlike other eating disorders, orthorexia can develop not only with the approval of others, based on social beliefs about food and the body, but it can be perpetuated for the same reasons.
The causes of orthorexia – biological factors
Many biological factors that drive anorexic beliefs and behaviors also drive orthorexia, such as perfectionist tendencies. In other respects, mental orthorexia has similar neurological aspects to obsessive compulsive disorder (OCD) such as obsessions.
Biological factors that contribute to orthorexia nervosa include:
- family history of eating disorder behavior,
- perfectionist and rigid personality traits,
- obsessive personality traits,
- childhood disease is related to diet or digestive problems,
- medical problems that some believe can be cured with “clean” food.
The causes of orthorexia – psychological factors
Much of what contributes to orthorexia nervosa lies in psychology because the disorder itself stems from a cognitive obsession with the “cleanliness” and “health” of the food you eat. Other psychological factors that contribute to the development of orthorexia nervosa include:
- low self-esteem / self-esteem,
- going through a trauma in the past,
- diagnosed with generalized anxiety disorder and / or obsessive-compulsive disorder,
- having used an incorrect diet in the past,
- disturbed family beliefs about the “cleanliness” and “health” of food,
- tendency to be obsessed,
- feeling of perfection,
- the need for constant control.
While society may not be causing the orthorectic trend, broadcasting about the body, food and exercise via TV and social media unfortunately does not help. For example, one study found that people who follow the “healthy eating” community in this type of media have a high incidence of orthorectic trends. The aspects of dietary culture, the wellness and beauty industry, and social media that contribute to orthorexia include:
- emphasis on Eurocentric beauty standards,
- photoshopping and filters that change the appearance without the consumer’s awareness,
- conveying that appearance is associated with success in life,
- no regulations regarding published information on laxatives / diuretics,
- perpetuating the concept that there are “quick solutions” to change the appearance,
- lack of awareness of reality in social media,
- reduced consumer awareness,
- an increased sense of unworthiness or worthlessness or ‘measuring’ false representations of life and ‘highlighting rolls’ via social media.
Read also: The female brain promotes depression and eating disorders, the male brain breaks the law. What’s next with gender theory?
Orthorexia – symptoms
Nervous orthorexia-related behaviors can become serious diagnostic problems and cause problematic long-term outcomes if not recognized and treated early. The following are warning signs that a person’s eating behavior may have been affected:
The physical warning signs of orthorectic behavior are more difficult to see than other eating disorder diagnoses, but there are several indications:
- weight fluctuations,
- reduced concentration,
- difficulty sleeping
- insomnia,
- constipation
- dehydration,
- symptoms of malnutrition caused by dietary rules that reduce the amount of food consumed,
- hair thinning.
The possible behaviors of mental orthorexia nervosa may be clearer when we consider the following behavioral and emotional symptoms:
- obsession with the origin of food (where / how it was prepared),
- obsessive concerns about food
- increased consumption of supplements,
- care for the preparation of food and techniques and control over these things,
- reluctance to eat food that was not prepared by the person himself or the preparation of which was not supervised by that person,
- the judgment of those who do not follow the dietary rules,
- combining self-esteem or self-esteem with adherence to nutritional principles,
- obsessive checking of nutrition labels,
- everyday life revolves around preparing meals,
- withdrawal from social life.
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Why is orthorexia unhealthy?
When food choices become so restrictive, in terms of both variety and calories, your health suffers. The diet of a person with orthorexia nervosa, while designed to provide optimal “health”, is in fact probably unhealthy, with nutritional deficiencies specific to the self-imposed diet. These nutritional deficiencies are not always visible as the person may still “feel” healthy.
Social problems are often more visible. A person with orthorexia can easily become socially isolated, often because they plan their life around eating. They may have little room in life for anything other than thinking about food intake and planning its consumption. Orthorexics lose the ability to eat intuitively – know when they are hungry, how much they need and when they are full. Instead of eating naturally, they are doomed to “fall off the wagon”, a feeling of failure known to supporters of any diet. In the long run, obsessions with healthy eating will start to crowd out other activities and interests, weaken relationships, and become physically unsafe.
See: Experts: multivitamins not for healthy children
Is it orthorexia or anorexia?
While the external motivation of orthorexia nervosa is different from that of anorexia nervosa, both eating disorders share the same thing: the desire to control life and the unpleasant emotions associated with eating. Moreover, many people try to lose weight on the pretext of improving their health.
Someone with orthorexia may choose wild salmon over a low calorie smoothie or dietary supplements over diet pills, but the goal remains the same. So, while the pursuit of healthy eating is more socially acceptable than artificially cleansing the body or drastically restricting calories, it is important to consider your true intentions about how to manage your diet.
If you have anorexia, you may feel ashamed and try to hide any changes in your eating habits. People with orthorexia usually take their diet as a badge of honor. If you have orthorexia, you may be more likely to encourage your friends to follow a similar path.
People with anorexia focus on avoiding all food, while those suffering from orthorexia eat what they consider healthy. Do you pay close attention to the ingredients or the way you prepare your food? If you have anorexia, you’ll likely be more concerned with caloric intake than with any specific nutritional value.
Read: Those born in spring are slightly more prone to anorexia
Orthorexia and obsessive-compulsive disorder
Along with anorexia, orthorexia also has symptoms of obsessive compulsive disorder (OCD). Similar trends include recurrent thoughts about food and health that interfere with everyday life, excessive stress from contaminating food, and having to prepare meals in a certain way. If you have orthorexia, your ritualized eating style also leaves little time for other activities.
Orthorexia — diagnosis
The ORTO-15 test is the most commonly used agent for detecting the signs and symptoms of orthorexia. It is a 15-point Likert scale test where the respondent must answer “always”, “often”, “sometimes” or “never”. The scale is then scored from 1 to 4, with 1 indicating orthorexia behavior and 4 indicating normal eating behavior. The cut-off point for suspicion of orthorexia is usually 40 points.
The tool was identified as having some psychometric limitations, including a lack of standardization and intercultural diversity, with relatively little work done to establish the functioning of elements that differ between different cultures. There are also concerns that a high cut-off point may lead to a high false-positive rate and therefore is not suitable for use in a diagnostic tool. Here are the questions in the ORTO-15 test:
- Do you pay attention to the caloric value of the food you eat?
- Do you feel confused at the grocery store?
- Have you thought about food particularly often in the last 3 months?
- Do you choose your food products based on your health?
- Is taste more important to you than quality when evaluating food?
- Are you willing to spend more money to eat healthier?
- Does thinking about food bother you for more than 3 hours a day?
- Do you allow yourself to break your dietary rules?
- Do you think your current mood influences your eating behavior?
- Do you think that belief in healthy eating increases your self-esteem?
- Do you think that healthy eating influences your lifestyle (frequency of going out to restaurants, to friends … ..)?
- Do you think eating healthy foods can improve your appearance?
- Do you feel guilty when you deviate from dietary rules?
- Do you think there are unhealthy foods on the market?
- Are you currently eating alone?
Orthorexia – treatment
Treatment for mental orthorexia nervosa differs slightly from treatment for other eating disorders as it is not yet a formal diagnosis. Consequently, people who struggle with orthorexia may be misdiagnosed with anorexia nervosa or diagnosed with other eating disorders. While it does allow people to be treated, it often leads to confusion about their symptoms. Despite this, the clinical community has yet to decide whether orthorexia is a type of anorexia nervosa.
As researchers and treatment specialists find out, people struggling with problems don’t have to wait for support. Evidence-based treatments recommended for most eating disorders, such as cognitive behavioral therapy (CBT), family-based therapy, or dialectical behavioral therapy (DBT), show promise for the treatment of orthorexia as well.