Orthorexia - the new eating disorder

Orthorexia is "a fixation on righteous eating". Basically healthy eating gone overboard. DietDoc investigates.

Having done some further research into the scientific literature, I found that Italian researchers have also dubbed orthorexia "a maniacal obsession for healthy food" (Donini et al, 2004).

Definition
The name is derived from "orthos" meaning "straight or proper" and "orexia" meaning "appetite". Spanish researcher Catalina Zamora and her coworkers define orthorexia as being characterised by "the pathological obsession for biologically pure food, which leads to important dietary restrictions".

According to Zamora and her fellow researchers, patients suffering from orthorexia exclude foods from their diets that they think are impure, because they may contain herbicides, pesticides or artificial additives such as colourants, flavourants, MSG, or any other ingredient used in food processing about which they are suspicious.

These patients also worry excessively about food processing techniques and processes. Because of these obsessions, orthorexic patients tend to neglect social relationships and become dissatisfied, which will in turn, increase their obsessive concern with food.

What may start out as a perfectly normal endeavour to improve health, treat a disease, or lose weight, eventually makes these patients the slaves of their dietary beliefs. Eating a single item of food that is 'forbidden' causes panic reactions and tremendous guilt.

Finally, the restrictive diet with its rituals of only containing foods that the patient regards as pure, can lead to excessive loss of weight, dietary imbalances, deficiencies and, in extreme cases, even death.

Research studies
As Zamora and coworkers point out, at the present moment, orthorexia nervosa is not yet officially recognised as a separate eating disorder, but its incidence is increasing in western countries.

Researchers at the University of Rome under Donini set out to determine the prevalence of orthorexia nervosa. More than 400 subjects were enrolled in their study. The researchers used the presence of an obsessive-compulsive eating behaviour pattern to identify patients with orthorexia nervosa. Twenty-eight of the subjects (6,9%) were found to be suffering from this new eating disorder.

Interestingly enough, the incidence of orthorexia was higher in men. Subjects with lower levels of education were also more prone to orthorexia.

These subjects described conserved products as 'dangerous' and commercially produced foods as 'artificial', only approving of biologically produced foods as 'healthy'.

Not only did their psychological behaviour centre on avoiding all foods they regarded as 'impure', but they demonstrated a strong and uncontrollable desire to eat when feeling nervous, excited, happy or guilty.

Thus, orthorexia nervosa is also characterised by abnormal eating patterns as is the case in anorexia nervosa and bulimia.

In a second study that throws some light on the eating behaviour of individuals with eating disorders like orthorexia nervosa, researchers at the Institute of Psychiatry, at Kings College in London, set out to determine whether obsessive-compulsive personality childhood traits lead to the development of eating disorders later in life.

In 44 women with anorexia nervosa, 28 women with bulimia and 28 healthy female controls, Anderluh and coworkers found that childhood obsessive-compulsive traits had a high predictive value for development of eating disorders in adulthood.

The odds that an individual with more than one obsessive-compulsive behavioural characteristic in childhood would develop an eating disorder when they grew up, increased by a factor of 7, for each additional behaviour. Characteristics such as rigidity and perfectionism in childhood predisposed these subjects to eating disorders in adulthood.

In view of the obsessive characteristics of orthorexia nervosa, it is possible that patients with this eating disorder also suffered from childhood obsessive-compulsive behaviour.

Solutions
If you are obsessed about eating only foods that you regard as 'pure' or 'good' or 'wholesome' and if your diet is consequently lacking in variety, you need professional help. As is the case with other eating disorders, orthorexia nervosa requires a team approach. You will need the help of a clinical psychologist to treat your obsessive-compulsive behaviour and a clinical dietician to assist you to learn to eat normally again.

For those readers who have not yet developed full-blown orthorexia nervosa, please keep in mind that taking any eating habit to the extreme is potentially dangerous. The most sensible approach is to eat a varied diet and not to place extreme emphasis on any one food or type of food.

Remember that one of the functions of food and eating is enjoyment – something sufferers of orthorexia nervosa certainly do not experience. – (Dr Ingrid van Heerden, DietDoc)

(References: Anderluh MB et al (2003). Am J Psychiatry, 160(2):242-7; Donini et al (2004). Eat Weight Disorders, 9(2):151-7; Health24.com/dietnfood/Food_causing_disease, 31/01/06; Zamora C, et al (2005). Actas Esp Psiquiatr, 33(1):66-8.)

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