Orthorexia Nervosa

The term orthorexia nervosa is an invention of Steven Bratman, MD, a specialist in alternative medicine. Orthorexia is essentially an obsession with healthy eating. The emphasis is on the presence of an obsession: A commitment to eating well is not orthorexia. Orthorexia is present when eating healthy food dominates a person to such an extent that the person lets other areas of life suffer.

Orthorexia is not an officially-recognized disorder. Whether it deserves this status is open for debate.

Symptoms of Orthorexia

According to Bratman, orthorexia may look like anorexia nervosa, but it has significant differences. Maintaining an obsession with health food may cause a restriction of calories merely because available food isn't "good enough." Those with orthorexia may lose enough weight to give them a body mass index consistent with someone with anorexia (i.e., less than 18.5).

Eating only the "right foods" (and perhaps only at the "right times") can give those with orthorexia a sense of superiority to others. Relationships suffer as they become less important than holding to dietary patterns.

Is Orthorexia a Form of Obsessive-Compulsive Disorder?

Orthorexia certainly has some of the features of obsessive-compulsive disorder (OCD). As with OCD, those with orthorexia take actions that are "aimed at preventing or reducing distress or preventing some dreaded event or situation" according to the American Psychiatric Association. A key part of the definition of OCD is that the person struggling with the disorder recognizes that the repetitive behaviors or recurrent thoughts he has affect him in negative ways. Whether this occurs for those with orthorexia is unclear.

Vegetarians and Vegans Need Not Be "Orthorexic"

It's true that, based on some societal norms, vegetarian and vegan diets are restrictive. But if a person on such a diet does not allow it to become a dominant obsession, orthorexia is by definition not present.

On the other hand, vegetarian and vegan diets have been starting points for some who have developed eating disorders. Someone with orthorexia will naturally have strong dietary restrictions. Such restrictions can adhere to vegetarian or vegan standards, among many other possibilities.

An Example of Orthorexia

One dietary plan that may be a form of orthorexia is calorie restriction, an organized plan in which participants reduce their calories by 20 to 40%, but make sure they get all required nutrients. The plan rigidly enforces reducing calories and getting the necessary nutrients. Proponents of the plan have a powerful allegiance to it.

Controversy

Some believe that orthorexia is a myth and that Bratman is out to make a buck (he's written a book on the topic that is now out of print). The reality is that very little peer-reviewed research exists on orthorexia. Researchers are attempting to come up with more formalized diagnostic criteria, and a couple of studies have attempted to validate a new questionnaire called the ORTO-15 as a screening tool. But the questionnaire is not yet as effective as desired in identifying the obsessive parts of orthorexia.

Of course, the phenomenon of food purity dominating a person's thoughts and life is not far-fetched. We know that eating disorders exist and that there are various kinds of obsessions. The question is whether this proposed disorder can stand on its own as an independent diagnosis in the future.