Orthorexia Nervosa: The Healthoholic

In the last few decades, eating disorders have been on the rise worldwide. From Anorexia Nervosa to obesity, food has found a way to harm our bodies in various unique ways. As a result, it comes as no surprise that in 1997, another eating disorder arose: a disorder that falls in the middle of this eating spectrum, Orthorexia nervosa. Orthorexia nervosa is a condition defined by the unhealthy habit of solely consuming healthy foods. This article will explore the earliest diagnosis of this condition, its signs and symptoms, and its similarities and differences with other eating disorders. 

In 1997, Dr. Steven Bratman coined the term Orthorexia nervosa in response to the need to diagnose individuals who were taking healthy eating to such a harmful extreme that it was ultimately leading to “malnutrition and/or the impairment of daily functioning” (Dunn and Bratman, 2016). This obsession with healthy eating consumed those individuals as they constantly experienced paranoia about the foods they were eating, its nutritional value, and its impact on their body. However, although Orthorexia nervosa was initially diagnosed in 1997, the condition went unnoticed in the American population until 2015 when Jordan Younger, a popular American lifestyle blogger, “pushed Orthorexia [to] the forefront of social media” (Bresch, 2019). In her memoir “The Blonde Vegan”, Younger spoke truthfully about her experiences with Orthorexia and how her obsession with healthy eating, dieting, and exercising was “pathological and resulted in malnutrition” (Dunn and Bratman, 2016). Capitalizing on Younger’s experience, news outlets brought attention and raised awareness about Orthorexia to reveal the way in which an obsession with healthy eating can be harmful for an individual. 

Figure 1. Common characteristics displayed in individuals with Orthorexia

With rising cases of eating disorders worldwide, the ability to accurately diagnose individuals with Orthorexia nervosa has become pivotal. As such, there are distinctive signs and symptoms that physicians and nutritionists look for such as “[eliminating all] products containing preservatives, color additives, food flavoring, pesticides, excessive fat, sugar, salt, or genetically modified food” (Niedzielski, 2021). In addition, individuals also pay very close attention to the medium from which their food arises, relying mostly on “ecological farming and natural materials.” (Niedzielski, 2021).  

Furthermore, in order to confirm a diagnosis of Orthorexia Nervosa, physicians primarily rely on two screening tests: the Bratman Questionnaire and ORTO-15. Both of these instruments determine if and to what extent an individual suffers from Orthorexia nervosa by asking participants a series of questions related to their “dietary choices, [food] shopping, and preparation and storage of the foods perceived by orthorexic individuals as healthy” (Zanko, 2020). The two diagnostic tests also question individuals about their emotional and mental perspectives regarding food in order to account for the psychological toll that an eating disorder can have on an individual. For example, Orthorexia nervosa can result in mental health issues ranging from a “fear of disease, anxiety, [and] shame” to “negative physical sensations” (Strahler, 2018). Overall, Orthorexia nervosa can be distinguished from other eating disorders by the obsessive manner in which individuals identify and prepare their meals. 

Figure 2. Questionnaire used to identify if an individual suffers from Orthorexia Nervosa

As Orthorexia has only recently become a diagnosable condition, it is important to understand its relationship with other prevalent eating disorders. Orthorexia nervosa is a condition that falls in the middle of the eating disorder spectrum. On one end of the spectrum lies Anorexia nervosa which is characterized by individuals who have a “restrictive diet and nutritional deficiencies” (Koven, 2015). On the other end, there is obesity which is defined as when an individual is “taking in more calories than they are burning through daily activities” (Koven, 2015). However, unlike these two other conditions, Orthorexia does not focus on the quantity of food an individual eats, but instead the type and nutritional value of the food. In addition, there are also similarities between these eating disorders which arise solely from mental and psychological effects. For example, all three of these conditions can cause the “intensification of emotional states, reduction in effortful coping, and impairment in task performance” that have the ability to severely disrupt an individual’s daily activities. As such, Orthorexia nervosa draws similarities and differences between other prevalent eating disorders.

Figure 3. Venn Diagram displaying the similarities and differences between Orthorexia nervosa, Anorexia nervosa, and OCD

Overall, Orthorexia Nervosa is a condition marked by a pathological obsession of healthy eating. The onset and ultimate impact of this condition is widespread and multi-faceted as it has the ability to result in a series of detrimental emotional and physical effects. As a result, the information presented in this article is pivotal in order for people to be cognizant of this eating disorder and provide assistance for individuals diagnosed with Orthorexia nervosa.

Edited by Edward Xue

References

Abry, Alexandra., Koven, Nancy. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease and Treatment, https://doi.org/10.2147/NDT.S61665.

Bresch, Christina., (2019). Orthorexia: eating right in the context of healthism. Medical Humanities, https://doi.org/10.1136/medhum-2019-011681

Dunn, Thomas., Bratman, Steven., (2015). On Orthorexia Nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors, 21, 11-17. https://doi.org/10.1016

Gilmartin, Brianna. (2021). Common characteristics displayed in individuals with Orthorexia. What is Orthorexia?. VeryWellHealth. Retrieved January 24, 2022, from https://www.verywellhealth.com/what-is-orthorexia-5092109. 

Green, Steph. (2020). Questionnaire used to identify if an individual suffers of Orthorexia Nervosa. 

What is Orthorexia? The importance of avoiding overthinking and stress. Ketogenic. Retrieved January 24, 2022, from https://ketogenic.com/what-is-orthorexia/.

Koven, Nancy. (2015). Venn Diagram displaying the similarities and differences between Orthorexia, Anorexia, and OCD. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease and Treatment. Retrieved January 24, 2022, from https://doi.org/10.2147/NDT.S61665

Niedzielski, Antoni,. (2021). Prevalence of Orthorexia Nervosa and Its Diagnostic Tools-A Literature Review.” International journal of Environmental Research and Public Health,. 18, https://doi/10.3390/ijerph18105488

Zanko, Adrianna., Mielech, Anita., Plyton, Tapak. (2020). How Does Orthorexia Nervosa Assessment Tools Can Differ – Comparison of Two Questionnaires: BOT and ORTO-15. Sciendo,. 60, 33-48.  https://doi.org/10.2478/slgr-2019-0043

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