Thanks to Francesca Testa, biotechnology student studying medicine at Kings College London, for this article. Head to the bottom of the page to find out a little more about Francesca.
We could all agree that the last decade has seen a general enthusiasm and encouragement towards healthier and “cleaner” diet and lifestyle. Social media, internet and magazines have all been populated by nutritional and health advice, to achieve personal fitness goals and improve overall wellbeing.
Although this global campaign has undoubtedly sensitised the society towards healthier eating habits, it might have also been encouraging an unhealthy relationship with food and fuelling a new eating disorder known as “orthorexia nervosa” (ON).
What is orthorexia nervosa
Orthorexia is a combined word deriving from the Greek, where “orthos” means “right” or “proper” and “orexis” means “appetite” or “hunger”. It, therefore, can be translated with “right appetite”. ON is now defined as an obsession for and fixation with eating only what is considered “healthy food”, to an extent where it becomes compulsive.
The term was firstly introduced by the medical doctor Steven Bratman back in 1997 in his “Orthorexia essay”, where he described ON as “a disease disguised as a virtue”. In fact, ON paradoxically leads to an unhealthy relationship with food, where one becomes obsessed with consuming only “healthy” foods to overcome the anxiety and guilt brought on by not doing so.
What is considered “pure”, “clean” or “healthy” highly varies from person to person. This extremely restrictive approach to dieting often results in cutting out entire food groups, according to what is judged as “pure” or “impure”.
ON seems to be initially associated with the desire to stay fit and well, consume “pure” food or recover from an illness, rather than with problems accepting own body image – unlike other eating disorders such as anorexia nervosa (AN) or bulimia nervosa (BN).
Orthorexia Nervosa vs Healthy Eating
Does this mean that sticking to a healthy diet plan is equal to having ON? No. Similarly to all the other eating disorders, ON is not only about what one eats, but about the feelings associated with eating, such as anxiety and guilt, as well as the obsessive thoughts that the idea of (certain) foods brings on.
For example, someone with ON might feel incredibly anxious when facing meals made with ingredients which are outside the “allowed” food category, or extremely guilty after having had some. They might be unable to put aside their personal rules about eating, even if they want to. They might also feel reassured or comfortable only when eating meals that they have prepared themselves or of which they know the exact ingredient list and nutritional values.
Such degree of anxiety and guilt triggered by what is defined as “unhealthy” should not be experienced if there is a healthy relationship with food. In addition, having occasional “treats” should not generate distress.
What are the impacts of ON on the overall health
The health consequences of ON are not just physical, but emotional and psychological as well.
ON might lead to nutritional deficiencies, if an entire food group (or more) is completely cut out. It might also result in weight loss and malnutrition, if the diet is particularly low in calories. Therefore, it might trigger symptoms such as lethargy or extreme tiredness.
The anxiety and guilt brought on by “forbidden” food categories, as well as the persistent thought of food, might impact personal and work life, making it difficult to share meals or join social events. This may progressively lead to social isolation or depression.
“I might have ON or might know someone close to me with ON”
Despite the increasing awareness across the society, ON has not been recognised as a mental disorder yet (neither by the DSM-IV, the US classification of mental illnesses, nor by the ICU-10, the UK classification system). Therefore, there is neither an internationally-recognised diagnostic tool nor bespoke treatment.
At the moment, the most reliable diagnostic tool is the so-called ORTO-15 questionnaire, which is made of 15 questions that screen for the main symptoms of ON. The points assigned to each single answer are summed up to achieve an overall score, that, if above a certain cut-off number, can be indicative of ON. Because of some statistical limitations of ORTO-15, the questionnaire is not often used in clinical practice, but it might be extremely useful for symptoms awareness.
If you were concerned about showing symptoms of ON or you would like to know more about ORTO-15, you can find the questionnaire in any of the papers discussing ON in medical journal (such as http://orthorexia.com/wp-content/uploads/2010/06/Donini-Orthorexia-Questionaire.pdf). Renee Mc Gregor, eating disorder specialist dietician and author of Orthorexia, also has a useful online tool if you are concerned that you, or someone you know, has this condition – http://reneemcgregor.com/orthorexia/
If you or someone you know might be experiencing symptoms of ON, get in touch with your GP as soon as possible, or suggest them to do so. Even though there is not a specific therapy yet, there are many options available to support your/their recovery – including psychotherapy, CBT (cognitive behavioural therapy), and support groups. In some cases, ON may overlap with anorexia nervosa (AN) or obsessive-compulsive behaviour (OCB) and, if so, therapy might need to target those conditions as well.
Although it might be difficult to open up with the loved ones or a medical professional about mental health problems, seeking help is a sign of strength and courage, as well as the very first step for recovery.