Many have heard of the terms ‘Anorexia’ and ‘Bulimia,’ but few have heard of an emerging concept known as ‘Orthorexia Nervosa’. The term, which is not listed as a mental health diagnosis in the DSM-V, was coined by Dr. Steven Bratman n 1997 and further explored in his book with David Knight, Orthorexia Nervosa: Heath Food Junkies: Overcoming the Obsession with Healthful Eating (American Psychiatric Association, 2013; Bratman, 2000). Orthorexia describes someone who is overly focused on “righteous” eating. Most often this refers to someone who is focused on healthy eating and to the types of foods they put in their bodies. Often they will follow common health fads such as macrobiotics, the paleo diet, etc. They may also cut out entire food groups such as starches or certain food dyes and additives in the quest to eat righteously. Reasons for cutting out these food groups or additives may be given as allergies or intolerances. As Dr. Bratman describes in his book, people may be so overly focused on eating the ‘right’ foods that they suffer health problems or become underweight due to excessive restriction, (Bratman, 2000).
However, the mentality of someone with orthorexia is much different than someone with anorexia or bulimia. The focus is not on becoming thin, but on being pure. Their focus on food is not the amount, but the purity (Krumer, 2008). What is similar is that both are willing to go hungry to attain their goal.
It is unknown how many people suffer from Orthorexia because only a handful of studies have examined it and there is no agreed upon definition of it. Bratman named the disorder from “ortho” meaning correct or true, melding it together with anorexia nervosa as the disorder involves restriction (Bratman, 2000). Some authors have proposed that orthorexic tendencies are actually precursors of more serious eating disorders (Krumer, 2008).
The term orthorexia has been expanded to include those who restrict food to the extreme for religious purposes such as fasting. Martin Luther, the protestant reformer was known to fast until he fainted, and other Christian mystics and ascetics were praised for their extreme fasting practices. This is not to say that the practice of fasting in any religion constitutes an eating disorder, however, fasting taken to a dangerous level in the pursuit of extreme holiness has been classified by some as a form of orthorexia (Apsell and Larson, 2000).
How does one distinguish healthy or pure eating from Orthorexia? Bratman does give some guidelines. First, the amount of time spent thinking about food is excessive. Bratman defines this as three or more hours per day thinking about healthy food. He also labels planning what one will eat in the future as a red flag. Second, he focuses on one’s relationship with food. For instance, does the person care more about the virtue of the food versus enjoying the food, or finding no joy in previously enjoyed food because it has been categorized as unhealthy? In addition, if one takes pride in what they eat in a way which causes them to believe they are superior to other “unhealthy” or “impure” eaters or if a person feels extreme guilt for eating “unhealthy” or “impure” food, they might be orthorexic. Perhaps the rules for what one can and cannot eat are become stricter as time goes on and as a result of eating “healthier” the person’s quality of life has decreased, rather than increased. Lastly, Bratman states that if the diet isolates a person from others, this could be a symptom of orthorexic eating.
It is possible that one could answer yes to one of these questions and not be orthorexic. One symptom does not create a disorder. It is the accumulation of these symptoms that Bratman states is an issue. If someone believes that they have Orthorexia, they can do a few things. First, recognize the issue and objectively evaluate the justification of such a diet. Second, think about eating in a different way or about eating something “unhealthy.” If anxiety occurs, the behavior is most likely more than healthy eating. Third, if you believe you or someone you know is orthorexic, consult a mental health professional who can assist in differentiating what is health driven and what is obsession. Also see your physician to address any health issues sustained as a result of the restrictive diet.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
Apsell, P., & McPhee, Larson. (2000). Dying to be thin [motion picture]. Arlington, VA: PBS.
Bratman, S. and Knight, D. (2000). Health food Junkies: Orthorexia nervosa: Overcoming the obsession with healthful eating. New York, NY: Broadway Books.
Krumer, F.A. (2008). On the concept of orthorexia nervosa. Scandinavian Journal of Science and Sports, 18, 395-396