TABLE OF CONTENTS
2. What are the causes of Orthorexia?
2.1.1. Genetic factors
2.1.2. Stress and family dynamics
2.1.3. Desire to exercise control
3. Signs of Orthorexia Nervosa…
4. The Dangers of Healthy Eating Habits
5. Orthorexia and:
5.1.1. Obsessive-Compulsive Disorder
5.1.2. Body Dysmorphic Disorder
6.1.1. When to intervene
6.1.2. How to intervene
6.1.3. It may unravel itself
8.1.1. Appendix A – Atypical or eating disorders not otherwise specified
8.1.2. Appendix B – Orthorexia Self-Test
The term ‘Orthorexia’ was first coined in 1997 by Dr. Steven Bratman. The combination of the Greek words ‘orthos’ meaning correct or right and ‘orexis’ meaning appetite gives the lose definition of correct eating; prior to coining the term Bratman (2007) previously referred to Orthorexia as “righteous eating”. Predominantly, the primary focus is eating healthy food. In addition to healthy eating, Battaglia purports that orthorexics “obsess” over the quality of the food they eat more than the quantity.
Not uncommon to many ‘diet plans’, the orthorexic places high importance on large quantities of fruit and vegetables in the eating plan, but often will fixate on eliminating what they deem ‘bad’ foods; some sufferers trying to “completely eliminate fat, sodium and carbohydrates” from their diet (www.waldenbehaviouralcare.com). Dr Bratman affectionately refers to orthorexics as ‘healthfood junkies’, unfortunately this rather tongue-in-cheek term does little to relay the seriousness and potentially life-threatening nature of the disorder.
In Dr Ingrid van Heerden’s paper Orthorexia- a new eating disorder? Catalina Zamora describes this disorder as a “pathological obsession for biologically pure food”. The obsession in this disorder stems from the restrictive nature of the person’s relationship with their food. What usually begins as a healthy diet progressively becomes more and more restrictive as additional items are removed from the diet; this deprivation of food items in the diet can have adverse effects on the orthorexic.
Research was conducted at the Universita degli Studi di Roma La Sepienza in 2004; of the 404 subjects in the study, scientists concluded that 7% of them suffered with orthorexia (www.eating-disorder.com). Giving prudence to this research, Ellin (2009) explains that Dr James Greenblatt has seen an estimated 15% increase in this form of behaviour among his young patients.
One of the major complications with Orthorexia is that it is not really considered to be a medical condition and as such does not have criteria for diagnosis. It is often perceived to be another form of anorexia nervosa or possibly a sub-type of obsessive-compulsive disorder; at the very least, some medical practitioners are in agreement that the associated behaviour “explains an important and growing health phenomenon” (www.pamf.org).
What are the causes of Orthorexia?
“I eat things I don’t even like because I feel like
I should only eat what my body needs”.
(Hurt, M.: 2007)
The causes of Orthorexia are somewhat difficult to pinpoint and isolate primarily due to the very limited literature covering this topic. Researching literature on this topic, one is quickly aware that the majority of information is based around the same starting point, the literature of Dr Bratman. As the founding source, subsequent to his writing, very little has been added to the body of knowledge; a body of knowledge as emaciated as some of the Orthorexics it discusses.
The ‘fixation’ that the sufferer experiences revolves around eating only healthy food. Orthorexia is believed to begin as a relatively innocent plan to improve ones general health, an attempt to lose weight or in some cases to deal with chronic illnesses (Bratman, 2000). As a starting point, I would like to make mention of the three causes of orthorexia as outlined by Emily Battaglia; she focuses her discussion on the potential around genetic factors, stress and family dynamics, and a desire to exercise control.
2.1 Genetic factors
One of the most common ‘gateways’ into orthorexia is issues around allergies. Many medical practitioners will encourage allergy sufferers to relieve the associated symptoms and fatigue by removing particular foods from the diet until the responsible allergen has been isolated as the cause. In some extreme cases, the allergy sufferer is restricted to a turkey, sweet potato and white rice diet, all of which are believed to be allergen free foods; gradually foods can be reinstituted into the diet identifying the ‘allergy causing’ food (Bratman: 2000, 25). Allergies to products such as soy, wheat and corn are renowned for causing extreme fatigue.
In the case of asthmatics, the attack may be triggered by an allergy to a food type. The hunt for the allergen can cause severe restrictions to the asthmatic’s diet.
There is an alarming increase in the number of people who suffer with digestive complications; the condition Irritable Bowel Syndrome (IBS) for example, is but one term thrown around when discussing bowel movements. Although there are a number of products available on the market to reduce the symptoms; along with stress as a contributing factor, the ‘diet’ of the sufferer is usually probed. It is believed that by removing certain ‘irritants’ from the eating plan of the sufferer we are able to relieve the symptoms somewhat and reduce the number of ‘attacks’.
These endeavours to reduce and relieve physical symptoms resulting from digestive complications can lead to a severely restrictive food intake in the sufferer. This could quite easily be viewed as a potential stepping-stone towards developing a fixation on eating habits, leading to orthorexia.
2.2 Stress and family dynamics
In her article “What’s Eating Our Kids?” Abby Ellin explains how the family dynamics can play a role in the development of orthorexia. It is believed that families who place great importance on eating healthily, often to the point of obsession, can be so zealous about creating ‘good’ eating habits in their children that the child can develop increasing levels of anxiety around their food intake and the restrictions imposed on them by their parents to eat healthily. It is not a far stretch of the imagination to believe that orthorexia can manifest in environments where a preoccupation with ‘healthy eating’ abounds (www.waldenbehaviouralcare.com).
Dr Ingrid van Heerden purports that children who have a particularly perfectionist or rigid personality can be predisposed to developing this disorder. In addition, Battaglia suggests that the prevalence of orthorexia is higher in males than females; as such the male sufferers tend to be less well educated than their female counterparts. It is of concern that many people displaying signs of orthorexia, or those enslaved to this disorder are unrecognized as sufferers by the health-food industry and unfortunately the idea of being “hyper-vigilant about eating healthily” has become a relatively ‘trendy’ lifestyle (Hurt: 2007).
2.3 Desire to exercise control
Dr Bratman maintains that the eating selections of the orthorexic are not controlled by choice, but rather dictated by fear (Bratman: 2000, 57). The Orthorexic begins to develop an obsession with eating healthily; they are able to focus their attention on their diet, this allows for a type of escapism from the world around them and the environment that demands so much from them. The focus of the orthorexic shifts towards being in a position to ‘control’ the type and amount of food that they consume; when all around them there may be situations and circumstances that they have no control over.
The sense of self-discipline that can develop as a result of controlling the diet can transform into feelings of superiority over those who are unable to display monastic devotion to eating healthily. The orthorexic, as is the case with anorexics, feel extreme pride (almost virtuous) in their ability to restrict their diet and to abstain from ‘bad’ foods. The need to control their intake of food can lead to bouts of punishment and increased restrictions if they ‘fall off the wagon’ so to speak.
There are however, some valid reasons to engage in an ‘extreme’ form of a healthy diet; there are cases when certain disorders can not be adequately remedied by conventional medicine, and a more ‘alternative’ form of healing may be advantageous. It is well established that changes to diet can have particularly promising effects on patients with high cholesterol levels and increased genetic risk factors for heart disease.
Extending the discussion on the possible causes of orthorexia, Dr Bratman (probably the leading authority) outlines what he terms “Hidden Agendas” (Bratman: 2000, 58). There are, in his opinion, a number of reasons (causal factors) for the downward spiral from healthy eating to orthorexia:
- The illusion of total safety
- The desire for complete control
- Covert conformity
- Searching for spirituality in the kitchen
- Food Puritanism
- Fear of other people (Bratman: 2000, 58)