Orthorexia nervosa (also known as orthorexia) (ON) is a proposed
eating disorder characterized by an excessive preoccupation with eating healthy food.
The term was introduced in 1997 by American
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
Steven Bratman, M.D. He suggested that some people's dietary restrictions intended to promote health may
paradoxically lead to unhealthy consequences, such as
social isolation
Social isolation is a state of complete or near-complete lack of contact between an individual and society. It differs from loneliness, which reflects temporary and involuntary lack of contact with other humans in the world. Social isolation ...
;
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
; loss of ability to eat in a natural, intuitive manner; reduced interest in the full range of other healthy
human activities
Humans (''Homo sapiens'') are the most abundant and widespread species of primate, characterized by bipedality, bipedalism and exceptional cognitive skills due to a large and complex Human brain, brain. This has enabled the development of ad ...
; and, in rare cases,
severe malnutrition or even death.
In 2009, Ursula Philpot,
chair of the
British Dietetic Association
The British Dietetic Association (BDA) is a professional association and trade union for dietitians in the United Kingdom. It was founded in 1936 and became a certified union in 1982: it is affiliated to the Trades Union Congress and the Scott ...
and
senior lecturer
Senior lecturer is an academic rank. In the United Kingdom, Ireland, New Zealand, Australia, Switzerland, and Israel senior lecturer is a faculty position at a university or similar institution. The position is tenured (in systems with this conce ...
at
Leeds Metropolitan University
Leeds Beckett University (LBU), formerly known as Leeds Metropolitan University (LMU) and before that as Leeds Polytechnic, is a public university in Leeds, West Yorkshire, England. It has campuses in the city centre and Headingley. The univ ...
, described people with orthorexia nervosa as being "solely concerned with the quality of the food they put in their bodies, refining and restricting their diets according to their personal understanding of which foods are truly 'pure'." This differs from other
eating disorders, such as
anorexia nervosa
Anorexia nervosa, often referred to simply as anorexia, is an eating disorder characterized by low weight, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. ''Anorexia'' is a term of Gr ...
and
bulimia nervosa
Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging or fasting, and excessive concern with body shape and weight. The aim of this activity is to expel the body of calories eaten ...
, where those affected focus on the quantity of food eaten.
Orthorexia nervosa also differs from anorexia nervosa in that it does not disproportionally affect one gender. Studies have found that orthorexia nervosa is equally found in both men and women with no significant gender differences at all. Furthermore, research has found significant positive correlations between ON and both narcissism and perfectionism, but no significant correlation between ON and self esteem. This shows that high-ON individuals likely take pride over their healthy eating habits over others and that is the driving force behind their orthorexia as opposed to body image like anorexia.
Orthorexia nervosa is not recognized as an eating disorder by the
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involv ...
, and so is not mentioned as an official diagnosis in the widely used ''
Diagnostic and Statistical Manual of Mental Disorders'' (DSM).
Signs and symptoms
Symptoms of orthorexia nervosa 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."
Cause
There has been no investigation into whether there may be a biological cause specific to orthorexia nervosa. It may be a food-centered manifestation of
obsessive-compulsive disorder, which has a lot to do with control.
Diagnosis
In 2016, formal criteria for orthorexia were proposed in the peer-reviewed journal ''Eating Behaviors'' by Thom Dunn and Steven Bratman.
These criteria are as follows:
Criterion A. 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. (Footnotes to this criterion add: Dietary practices may include use of concentrated "
food supplement
A dietary supplement is a manufactured product intended to supplement one's diet by taking a pill, capsule, tablet, powder, or liquid. A supplement can provide nutrients either extracted from food sources or that are synthetic in order ...
s". Exercise performance and/or fit body image may be regarded as an aspect or indicator of 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.
Criterion B. 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.
A diagnostic questionnaire has been developed for orthorexia sufferers, similar to questionnaires for other eating disorders, named the ORTO-15.
However, Dunn and Bratman critique this survey tool as lacking appropriate internal and external validation.
Epidemiology
Results across scientific findings have yet to find a definitive conclusion to support whether nutrition students and professionals are at higher risk than other population subgroups, due to differing results in the research literature. There are only a few notable scientific works that, in an attempt to explore the breadth and depth of the still vaguely-understood illness, have tried to identify which groups in society are most vulnerable to its onset. This includes a 2008 German study,
which based its research on the widespread suspicion that the most nutritionally-informed, such as university nutrition students, are a potential high-risk group for eating disorders, due to a substantial accumulation of knowledge on food and its relationship to health; the idea being that the more one knows about health, the more likely an unhealthy fixation about being healthy can develop. This study also inferred that orthorexic tendencies may even fuel a desire to study the science, indicating that many within this field might suffer from the disorder before commencing the course. However the results found that the students in the study, upon initial embarkation of their degree, did not have higher orthorexic values than other non-nutrition university students, and thus the report concluded that further research is needed to clarify the relationship between food-education and the onset of ON.
Similarly, in a Portuguese study on nutrition tertiary students, the participants' orthorexic scores (according to the ORTO-15 diagnostic questionnaire) actually decreased as they progressed through their course, as well as the overall risk of developing an eating disorder being an insignificant 4.2 percent. The participants also answered questionnaires to provide insight into their eating behaviours and attitudes, and despite this study finding that nutrition and health-science students tend to have more restrictive eating behaviours, these studies however found no evidence to support that these students have "more disturbed or disordered eating patterns than other students".
These two aforementioned studies conclude that the more understanding of food one has is not necessarily a risk factor for ON, explaining that the data gathered suggests dietetics professionals are not at significant risk of it.
However, these epidemiologic studies have been critiqued as using a fundamentally flawed survey tool that inflates prevalence rates.
Scholars have questioned both the reliability and validity of the ORTO-15.
Most scientific findings tend to agree, however, young adults and adolescents are extremely susceptible to developing eating disorders. One study found that there was no relationship between BOT score and college major, which may indicate the prevalence of mental health issues and eating disorders on college campuses and that health and science majors are no longer the only ones affected. More studies have also been conducted on the link between increased Instagram use and Orthorexia nervosa. The social media based healthy community has recently grown in popularity especially on platforms such as Instagram. The hashtag #food is one of the top 25 most popular hashtags on Instagram. A study that investigated this relationship found that increased use of Instagram correlated between symptoms of ON with no other social media platform having the same effect. With young adults and adolescents making up the majority of social media users, exposure to this type of content can lead to developing unhealthy behavior.
History
In a 1997 article in the magazine ''Yoga Journal'', the American physician Steven Bratman coined the term "orthorexia nervosa" from the
Greek
Greek may refer to:
Greece
Anything of, from, or related to Greece, a country in Southern Europe:
*Greeks, an ethnic group.
*Greek language, a branch of the Indo-European language family.
**Proto-Greek language, the assumed last common ancestor ...
ορθο- (''ortho'', "right" or "correct"), and όρεξις (''orexis'', "appetite"), literally meaning 'correct appetite', but in practice meaning 'correct diet'. The term is modeled on ''anorexia'', literally meaning "without appetite", as used in the definition of the condition anorexia nervosa. (In both terms, "nervosa" indicates an unhealthy psychological state.) Bratman described orthorexia as an unhealthy
fixation with what the individual considers to be
healthy eating
A healthy diet is a diet that maintains or improves overall health. A healthy diet provides the body with essential nutrition: fluid, macronutrients such as protein, micronutrients such as vitamins, and adequate fibre and food energy.
A h ...
. Beliefs about what constitutes healthy eating commonly originate in one or another dietary theory such as raw foods veganism or macrobiotics, but are then taken to extremes, leading to disordered eating patterns and psychological and/or physical impairment. Bratman based this proposed condition on his personal experiences in the 1970s, as well as behaviors he observed among his patients in the 1990s. In 2000, Bratman, with David Knight, authored the book ''Health Food Junkies'', which further expanded on the subject.
Following the publication of the book, in 2004 a team of Italian researchers from
La Sapienza University of Rome
The Sapienza University of Rome ( it, Sapienza – Università di Roma), also called simply Sapienza or the University of Rome, and formally the Università degli Studi di Roma "La Sapienza", is a public research university located in Rome, Ita ...
, published the first empirical study attempting to develop a tool to measure the prevalence of orthorexia, known as the ORTO-15.
In 2015, responding to news articles in which the term orthorexia is applied to people who merely follow a non-mainstream theory of healthy eating, Bratman specified the following: "A theory may be conventional or unconventional, extreme or lax, sensible or totally wacky, but, regardless of the details, followers of the theory do not necessarily have orthorexia. They are simply adherents of a dietary theory. The term 'orthorexia' only applies when an eating disorder develops around that theory." Bratman elsewhere clarifies that with a few exceptions, most common theories of healthy eating are followed safely by the majority of their adherents; however, "for some people, going down the path of a restrictive diet in search of health may escalate into dietary perfectionism."
Karin Kratina, PhD, writing for the
National Eating Disorders Association
The National Eating Disorders Association (NEDA) is an American non-profit organization devoted to preventing eating disorders, providing treatment referrals, and increasing the education and understanding of eating disorders, weight, and body imag ...
, summarizes this process as follows: "Eventually food choices become so restrictive, in both variety and calories, that health suffers – an ironic twist for a person so completely dedicated to healthy eating."
Although orthorexia is not recognized as a mental disorder by the American Psychiatric Association, and it is not listed in the
DSM-5
The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
, as of January 2016, four case reports and more than 40 other articles on the subject have been published in a variety of peer-reviewed journals internationally.
According to a study published in 2011, two-thirds of a sample of 111 Dutch-speaking eating disorder specialists felt they had observed the syndrome in their clinical practice.
According to the ''Macmillan English Dictionary,'' the word is entering the
English
English usually refers to:
* English language
* English people
English may also refer to:
Peoples, culture, and language
* ''English'', an adjective for something of, from, or related to England
** English national ide ...
lexicon. The concept of orthorexia as a newly developing eating disorder has attracted significant media attention in the 21st century.
Orthorexia and other disorders
Orthorexia differs from anorexia and bulimia in its relationship to food. Instead of focusing on food intake in an attempt to lose weight and eat less, orthorexia is an "obsession about the quality of food intake" and is fueled by a feeling of achieving perfection and purity by only consuming "healthy" foods.
Orthorexic behaviors can often lead to malnutrition and weight loss, and it is often associated with anorexia nervosa.
Studies have also shown that obsessive-compulsive tendencies are linked to the development of orthorexia, and some researchers suggest that orthorexia should be diagnosed as OCD because it is driven by an obsession for attaining a perfect diet.
See also
*
Chemophobia
Chemophobia (or chemphobia or chemonoia) is an aversion to or prejudice against chemicals or chemistry. The phenomenon has been ascribed both to a reasonable concern over the potential adverse effects of synthetic chemicals, and to an irrational f ...
*
Clean eating
*
Comfort food
Comfort food is food that provides a nostalgic or sentimental value to someone, and may be characterized by its high caloric nature, high carbohydrate level, or simple preparation. The nostalgia may be specific to an individual, or it may app ...
*
Coping (psychology)
*
Diet
Diet may refer to:
Food
* Diet (nutrition), the sum of the food consumed by an organism or group
* Dieting, the deliberate selection of food to control body weight or nutrient intake
** Diet food, foods that aid in creating a diet for weight loss ...
*
Emotional eating
Emotional eating, also known as stress eating and emotional overeating, is defined as the "propensity to eat in response to positive and negative emotions". While the term often refers to eating as a means of coping with negative emotions, it als ...
*
Food guide pyramid
A food pyramid is a representation of the optimal number of servings to be eaten each day from each of the basic food groups. The first pyramid was published in Sweden in 1974. The 1992 pyramid introduced by the United States Department of Agri ...
*
Macrobiotic diet
A macrobiotic diet (or macrobiotics) is a fad diet based on ideas about types of food drawn from Zen Buddhism. The diet tries to balance the supposed yin and yang elements of food and cookware. Major principles of macrobiotic diets are to reduce ...
Notes
* Medical manuals that do not recognise orthorexia nervosa include;
ICD-10,
DSM-IV
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langu ...
, and
DSM-5
The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatri ...
.
References
{{DEFAULTSORT:Orthorexia Nervosa
Culture-bound syndromes
Eating disorders