What is orthorexia?
Orthorexia responds to an obsessive desire to feel pure through healthy diet, total restriction of some foods, and compulsive behaviors. It can lead to serious psychological and physical problems, such as malnutrition. The obsession with healthy food is encompassed within eating disorders and is closely related to anorexia and bulimia.
The inner purity, the beauty, the health, the well-being … Many values of the society in which we live can impel to lead a healthier life. Diet is a fundamental element in health, but sometimes becomes an obsession that can lead to serious health problems such as malnutrition, anemia, lack of vitamins or minerals, or even death.
Orthorexia is the obsession with healthy food, and the desire to feel ‘pure’ through food. Advertising and the media can greatly influence the development of orthorexia. It was described at the end of the 1990s, coinciding with the rise of the culture of healthy life: light foods, miracle diets … The majority of those affected by orthorexia are young women (90%), who are usually more sensitive to values of the healthy diet.
The person with orthorexia restricts whole food groups from their diet, and only opts for those with certain characteristics: ecological, without additives, without preservatives, without pesticides, non-transgenic. It can present compulsive behaviors, such as calories and weighs food, and carries out obsessive rituals with food, related to cooking or shopping. Usually schedules the meals of each day and dedicate a minimum of 3 hours to the day to the planning of its feeding.
Because of this strict behavior, it often suffers consequences such as social isolation which causes not eat outside the home and usually alone. In addition, food is placed above other aspects of daily life, such as family or work. Food is not perceived as a food action, not even as an enjoyment, but is lived as a spiritual experience by which the individual ‘purifies’. In fact, it can become self-punishing if it breaches the programmed diet.
Orthorexia is closely related to anorexia nervosa or bulimia. If the obsession of anorexia focuses on the amount of food, in the orthorexia focuses on quality. Many people with orthorexia suffer or have also suffered anorexia, and vice versa.
But, unlike other eating disorders, the person with orthorexia has a very good opinion of itself, both external and internal. They even feel superior to other people because they considers their behavior to be the most healthy and appropriate.
Normally, until the first physical symptoms of orthorexia occur, such as malnutrition, lack of energy, vitamin deficiencies. the affected person does not decide to go to a specialist. The treatment of orthorexia requires that the affected person accept that he has a problem, and that he learns healthy habits of life.
Food is necessary for good health, but it should not become an obsession. It is best to follow a balanced diet, eating a variety of foods in the right proportion, without restricting any.
What is the definition of orthorexia?
Ortorexia can be classified as a type of eating disorder, although it is not clinically defined as a disorder with its own entity. The term ortorexia is a term that comes from the terms ‘ortos’ (correct) and ‘orexia’ (appetite). It is defined as an exaggerated concern for healthy eating, choosing only fresh, organic products with a certain nutritional load and a certain caloric content.
Concern for health can become pathological at the moment when the affected person gets ‘punished’ if he does not follow his meal planning accurately or if foods that are considered ‘prohibited’ are included in the diet. Orthorexia responds to an exaggerated desire to feel ‘pure’, and you experience stress and anxiety if this is not achieved.
Ortorexia was first described by the American physician Steven Bratman in 1996, who observed that some of his patients tried to cure or avoid some disease through a given diet, or they had obsessively fond of a certain style of eating by agreement with ethical values, by the search for a weight loss or by feeling ‘clean’.
Orthorexia usually has very serious consequences for health, since it restricts groups of foods that are essential for a balanced diet. It tends to lead to severe malnutrition. Therefore, the intention to maintain a healthy diet becomes with orthorexia, in the opposite.
Orthorexia responds to a pathological concern for food. However, orthorexia has nothing to do with vegetarians, vegans, macrobiotics because of a personal decision. On the other hand, orthorexia is an obsessive, extreme, limiting, and psychologically and physically dangerous behavior, since the selection of certain foods and the avoidance of others can lead to nutrient deficiency or malnutrition.
In addition, social isolation of the affected person may occur. Many people even decide to live in the countryside to grow their own products, thus moving away from their surroundings.
Other eating disorders have common features and are very close to orthorexia. In the case of anorexia nervosa, concern is given by the amount of food, while in orthorexia by quality. Since the concern for healthy food may respond, not only to a desire to feel healthy, but also to lose weight, many orthorexia patients also suffer from anorexia and via versa.
It is common for many people to begin to manifest symptoms of orthorexia after recovering from anorexia. In addition, both conditions imply a loss of control in the individual: the person with orthorexia feels a compulsive need to ‘cleanse’ their body through feeding.
What causes to orthorexia?
According to the World Health Organization (WHO), health is a state of complete physical, mental and social well-being. Good health depends on many factors and nutrition is only one of them. While healthy food can help prevent even some diseases such as cardiovascular diseases, there is no guarantee that we will have perfect health.
On the other hand, people with orthorexia are convinced that their eating pattern ensures complete health, emotional well-being and even a spiritual experience.
Those affected by orthorexia usually begin with the intention of slightly improving their diet for good health until they begin to become obsessed little by little about what to eat.
People with orthorexia may become obsessed with food quality for different reasons:
- Fear of disease transmission, such as anisakis or ‘mad cows’
- The ethical implications of the food industry, which lead to avoid eating animal products or processed foods
- Fear of non-natural components, such as chemicals, additives, pesticides and transgenics
- Concern for the image, such as fear of gaining weight, or developing aesthetic problems (often because of unproven beliefs, such as milk produces acne). Therefore, some cases of orthorexia are related or accompanied by an anorexia
- In addition, one of the causes of this disorder also lies in the belief that healthy and organic foods provide a state of purity and well-being of the body and mind
It should be noted that the fashion of healthy eating, which began at the end of the twentieth century can influence the decision of many people to move to an extreme style of food: light food and drinks, organic products and food with ‘miraculous’ properties encourage a certain diet.
While maintaining a healthy and balanced diet is essential, obsessing with healthy foods or with certain health advice may cause a malnutrition process, as well as an obsessive psychic state, instead of being healthy.
There are a number of circumstances that make a case of orthorexia more likely to occur. Generally, young women from industrialized countries who have a social and advertising model of body worship are more likely to suffer from this eating disorder.
In addition, certain personality traits, such as perfectionism, or some obsessive traits may encourage orthorexia. Finally, the obsession with healthy food involves behaviors that require high income from the person who suffers. For example, organic products, or the way to get to them are often expensive.
The risk factors for orthorexia are as follows:
- To be a woman
- Be between 15 and 35 years old.
- Have a medium / high economic level
- Obsessive personality, controlling or perfectionist
- Fear of death and / or illness
What are the symptoms of orthorexia?
Orthorexia manifests itself through certain physical, psychological and behavioral symptoms. They can all occur at the same time, or appear gradually. Typically, physical symptoms occur in a process of advanced orthorexia, in which the person suffers the consequences of limiting for a prolonged time the intake of certain foods, necessary for their health.
Since orthorexia systematically selects certain foods with certain characteristics and radically eliminates others, it is possible that important nutritional deficiencies may occur in people suffering from this pathology.
It is frequent vitamin deficiency, or excess of vitamins, problems of lack of essential minerals, such as iron (anemia), lack of trace elements, hypotension and osteoporosis.
- Obsessive thoughts. The affected person feels an irresistible desire to be purified through healthy food
- Lost of control. Visualize feeding as a kind of ‘cerebral parasite’ that makes decisions and has control over your life
- Feeling guilty and / or anxiety if the diet deviates minimally from what is programmed
- Eating healthy causes the person to develop a feeling of superiority towards the people in their environment. She feels better than others and feels that her decision to eat healthy food is the right one. The person with orthorexia is usually convinced that he has no problem
- Food is lived as a spiritual experience that gives you inner peace
- The person with orthorexia stops enjoying food, and even stops eating foods that he likes, to worry only about quality
- Minimum of 3 hours a day employed in scheduling meals or thinking about diet
- Social isolation. The affected usually eat alone, since they can not fulfill their extreme diet outside the home. The person with orthorexia may eventually move to the countryside to grow their own products
- The person with orthorexia neglects their daily responsibilities to dedicate themselves to fulfilling their food expectations. As a consequence, their environment is affected (work life, family)
- Healthy food is taken not only as a source of food, but as a way of escape from anxiety, and not only eating but also practices related to healthy food: cooking, shopping, etc.
- Compulsive behaviors (weigh food, measure calories …)
- The affected person is able to travel great distances to obtain healthy food (organic food, without additives …)
How is orthorexia diagnosed?
The Diagnostic and Statistical Manual of Mental Illness does not include orthorexia as a pathology. However, it could be encompassed within eating disorders. Orthorexia can be identified by a series of characteristics that are manifested in all people who suffer.
The doctor who first described orthorexia in the late 1990s, Steven Bratman, has also worked to define a guideline to accurately define and diagnose orthorexia. In 2016 he published an article (On orthorexia nervosa: A review of the literature and proposed diagnostic criteria) in which he defined specific criteria.
Criterion A : An obsession centered on healthy food, based on dietary principles and established in beliefs, whose details may vary. The obsession is marked by an exaggerated emotional stress, in relation to the choice of meals. It may be accompanied by weight loss, but this will not be the main goal. The obsession will be evidenced by the following behaviors:
- Compulsive behavior or concern regarding restrictive diets, due to the individual’s belief in having optimal healt
- Violation of imposed dietary routines can cause exaggerated fear of illness, personal impurity or negative emotions, accompanied by anxiety and guilt
- Dietary restrictions increase over time, and may include the elimination of whole food groups, and involve more frequent and aggressive purifications or detoxification
Criterion B : The compulsive behavior and the preoccupation cause some of these physical pathologies:
- Malnutrition, severe weight loss, or other medical complications due to dietary restriction
- Personal anguish and impairment of healthy diet beliefs
- Positive body image, self-confidence and excessive satisfaction, derived from the belief that the followed diet is the most appropriate for health
In many cases, when diagnosing a case of orthorexia, traits of anorexia are also observed, and vice versa. Even some people who recover from anorexia nervosa can evolve by developing orthorexia. Orthorexia has many features in common and is often related to other eating disorders, such as anorexia or bulimia.
People with orthorexia will even have an overly positive self-image, based on the belief that the diet he has chosen to follow is the best possible. On the other hand, there are common traits, such as feelings of loss of control, obsession and escape from anxiety.
Because orthorexia manifests obsessive thoughts (need to feel pure) and compulsive behaviors, orthorexia also has features in common with Obsessive-Compulsive Disorders (OCD).
How is orthorexia treated?
The goal of treating orthorexia is to get the person who has it back into a normal relationship with food. It is necessary to banish obsessive ideas, to gradually eliminate compulsive or ritual behaviors related to food and to treat health problems that may have been caused by nutrient deficiency.
Many orthorexia patients come to the doctor for a physical health problem caused by the eating disorder. There have been cases of malnutrition, or people in very low weight states, even at risk of death. Therefore, for a comprehensive treatment of orthorexia, it is necessary to have two specialists: a nutritionist and a psychologist or psychiatrist.
The first step in treatment is for the affected person to be able to accept their condition. You are given information about orthorexia disorder and also about what a healthy life consists of. The essential thing is for the individual to understand that diets do not need to be ‘perfect’ to lead a healthy life.
Thus, you can be introduced some food thatare prohibited. This introduction of new foods should be progressive which it is not advisable to suddenly switch to eating many greasy or sugary foods. Modification of behaviors is a very difficult process, and must be carried out in accordance with the individual’s values, and gradually. With the introduction of small changes, the patient may be acquiring new behaviors, and gradually internalizing them.
At the same time, it is recommended to carry out a psychotherapeutic intervention, which helps the person with orthorexia to regain control of their emotions and their self-esteem.
At the end of treatment, the person must understand that you can eat healthily without falling into obsessive attitudes, and that food is just another aspect of life, from which health does not completely depend. It is also useful to banish false beliefs about food with a correct nutrition education.
The treatment of orthorexia is complex. Relapses can occur during the process and can last for years. However, a person with orthorexia can recover and return to normal life, if he receives the right help.
How is the evolution of disease?
The obsession with healthy eating may go unnoticed in the early stages of the disorder, especially by the affected person. A very striking feature is that the individual with orthorexia does not perceive that he or she has a problem, usually until the physical consequences of prolonged food restriction: malnutrition, and other serious physical symptoms occur. Usually, until these symptoms do not appear, the affected person does not go to the doctor.
In fact, the view that the person with orthorexia has itself is positive, unlike what occurs in other eating disorders. This makes it much more difficult for the individual to decide to seek professional help.
Even if you notice changes in your behavior and feel that restrictive diets are limiting in some aspects of your life, especially social (not usually eaten together or out of the house), the person will remain convinced that their behavior is the most appropriate for their health is more valid than that of others.
People who develop an orthorexia always start with pretensions to better health. Although the behavior that led them to have a healthier life is the one that can turn into a disorder that can put them in serious danger. Normally, orthorexia begins with media information and publicity about the goodness of a healthy diet or social conviction.
The values that promote the fashion of healthy diet are health, beauty, inner and outer purity, and commitment to the environment. In general, young women are more likely to identify with these values.
Once the person with orthorexia requests and accepts the help, the recovery process is usually slow, and may be subject to relapse. However, treatment often helps people return to a normal life. The most important is to solve the immediate health problems that can lead to orthorexia, such as malnutrition. Although, usually after a serious health process, the person with orthorexia is usually willing to undergo complete psychological treatment, so that it does not recur.
How to prevent orthorexia?
To prevent the development of a case of orthorexia, it is imperative to educate children from an early age in nutritional information, since young girls are the most affected by this disorder. It is necessary to maintain a balanced diet to eat everything in the right proportions. An example of a balanced diet is the Mediterranean diet, endorsed by nutrition specialists for the food distribution it proposes without restricting any.
People with orthorexia often restrict whole food groups and this can lead to health risks. As for people who decide to choose a style of selective feeding (vegetarianism, veganism, macrobiotic diet) should not pose any problem, as long as they eat all the vitamins and minerals necessary for a healthy life. In these cases, to ensure a balanced diet, it is advisable to consult a nutritionist.
On the other hand, while diet is fundamental to maintaining a healthy life, it is not the only criterion on which personal health is based. Regular physical activity, eliminating stress and being surrounded by satisfying personal relationships are also key elements that make up a healthy life.
A mild concern for a healthy diet does not have to be a sign of danger, as long as it does not exceed the barrier of obsession. To differentiate when we are conducting obsessive eating behaviors, Dr. S. Bratman developed a brief questionnaire.
The person who suspects that he or she can suffer from orthorexia may ask himself or herself the following questions, whose affirmative answers are likely to respond to a case of orthorexia:
- Do you consider healthy eating as a primordial source of happiness, meaning of life, and even spirituality?
- Does your diet make you feel better than others or that your food decisions are the right ones?
- Does diet interfere with your work, friendship or family relationships?
- Do you use diet as a shelter of anxiety that causes you fears about health or the insecurities of daily life?
- Do you feel that food has control over your life?
- Do you have to take an increasingly extreme diet to feel the same satisfaction as before?
- If you deviate from the programmed diet, even minimally, do you feel an irresistible need to ‘cleanse’ the body?
- Do you feel that the interest in healthy food has become a kind of ‘cerebral parasite’ that exercises control over your life and prevents the achievement of your goals?
If the affirmative answer to these questions makes suspect that there may be some degree of orthorexia, it is necessary to go immediately to a specialist.