When he coined the term Orthorexia Nervosa in 1997 to describe an unhealthy obsession with eating healthily, Dr Steven Bratman ignited a debate that continues today. Is it an obsessive-compulsive disorder like anorexia nervosa or bulimia nervosa or not?
It is not recognised as such by the American Psychiatric association and is not included in its Diagnostic and Statistical Manual of Mental Disorders (DSM). Indeed, acknowledging that he is not an eating disorder specialist, Bratman himself does not claim that it should be included. He does, however, say that Orthorexia Nervosa is an obsession in which some individuals become so fixated on healthy eating that in rare cases it can lead to malnutrition or death.
Orthorexia Nervosa is an apparent eating disorder in which people focus on the quality of food they eat, as opposed to disorders like anorexia nervosa and bulimia nervosa in which sufferers are concerned with the quantity. It begins with a rejection of processed foods and those with artificial colouring and flavouring, foods that have been treated with chemicals like pesticides and may also include animal products. Those with the “disorder” will eventually limit themselves to eating only fresh foods they have bought (or grown) themselves and that which they have prepared themselves. This results in them withdrawing into a world dominated by their obsession with “pure” foods and can lead to their withdrawal or exclusion from society and to dietary habits that are in fact harmful.
Dr Bratman’s book “Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating” (published by Random House, 2004) analyses the problem and offers solutions for those afflicted. In the book, he identifies Orthorexia Nervosa as an obsession with the quality of food eaten rather than the quantity and claims that sufferers adopt increasingly rigid diets that lack essential food groups and nutrients leading to poor health and emotional well being and to breakdowns in personal relationships.
The symptoms include:
- Avoidance of: preservatives, artificial flavours and colouring; food treated with herbicides and pesticides; fat, salt and sugar; and diary or meat.
- Drastic restriction of food choices.
- Increased consumption of herbal remedies and supplements.
- Irrational concerns over food preparation and food hygiene.
- Over-concern about the relationship between food and health.
- Guilt feelings after straying from a diet regime.
- Avoidance of food prepared by others.
- Criticism of others who do not follow a rigid diet.
- Self-satisfaction from “healthy” eating.
- Distancing from others with different views on food.
- Excessive time devoted to thinking about food and diet.
According to Dr Bratman, Orthorexia Nervosa usually begins innocently enough with a desire to eat healthily for any number of reasons. These can be psychological like body image, irrational fears, spiritual satisfaction, self-punishment and escapism. But there are also more practical reasons such as allergies to certain food groups or physical intolerance of certain foods. Taken to the extreme, the result is Orthorexia Nervosa.
Dr Bratman’s contention is that some individuals become so fanatical about eating healthy food that they become obsessed. They restrict their diets to the extent that they virtually withdraw from social interaction in case they are exposed to unhealthy foods and, more dangerously, eschew all other foods, not recognising that their own food choices are failing to provide all the nutrients their bodies need, leading to ill-health and, in extreme cases, death.
But there are many advocates of healthy eating who disagree with the notion of Orthorexia Nervosa being an obsessive-compulsive disorder, and some who even scoff at the idea. How, they argue, can someone be defined as having an illness simply because they prefer to eat simple healthy food as opposed to processed or artificial foods or foods they believe to have a toxic affect on the body?
The answer, of course, is that there is nothing wrong with choosing to eat healthy food. However, that is not what Dr Bratman is suggesting; indeed, he admits that he was once himself an enthusiast of eating healthy food to the exclusion of non-natural and treated foods. Rather, he is suggesting that some people go too far.
There has been limited scientific examination to determine the prevalence of Orthorexia Nervosa. Dr Bratman devised a simple yes/no questionnaire to decide if a subject had Orthorexia but the most quoted test is the ORTO-15 multiple-choice questionnaire (based on Dr Bratman’s) devised by an Italian team headed by L M Donini. Using this test in a survey, the results of which were published in “Eating Weight Disorders” in 2005, the team found that 6.9% of subjects might have Orthorexia Nervosa while just over 17% were defined as being “health fanatics”. A similar study in Turkey among doctors in Turkey found that some 45% were overly sensitive in their eating habits.
The concept of Orthorexia Nervosa is relatively new and what research that has been done suggests that it is a very real condition and that it is related to anorexia nervosa and bulimia nervosa, but that it is also closely allied to obsessive-compulsive disorders and could be treated as such. However, as yet there is neither a universally accepted definition for Orthorexia Nervosa nor are there sufficiently verified diagnostic criteria.
While the experts continue to debate the status of Orthorexia Nervosa, the fact is that some people do succumb to an overwhelming and eventually irresistible urge to maintain what they perceive to be a healthy diet at any cost. To the layman this would appear to be obsessive-compulsive behaviour that requires treatment. And, in fact, medication and cognitive behavioural therapy has proved to help sufferers effectively overcome their problem.