Orthorexia Nervosa or ON is an eating disorder that involves an obsessive interest in healthy eating. Unlike other eating disorders such as anorexia and bulimia, orthorexic people rarely target losing weight. But their main focus is on food quality rather than quantity. People with orthorexia nervosa tend to avoid foods that do not meet their nutritional standards. Also, they avoid foods prepared by someone else.

In many situations, orthorexia nervosa starts as an innocent attempt to live a healthy life. But it may progress into problematic preoccupation with the perceived quality of food. There are not enough research that has been performed to identify orthorexia Nervosa causes. Researchers suggest orthorexia is mainly a product of modern food culture trends.

However, orthorexia Nervosa does not have a separate entry in the bible of psychiatry, the diagnostic and statistical manual of mental disorders ( DSM-5). Therefore it is hard to get treatment covered by insurance. Also, the absence of the ON in the DSM listing makes it hard for researchers to get funds for their further research.

Orthorexia Nervosa symptoms can usually go undetected because it does not seem strange to be obsessed with healthy eating. People with orthorexia Nervosa may also have an increased risk for developing co-occurring psychological disorders. It can also cause significant disruptions in someone’s physical well being and social life. But effective treatments, self-help and a good support network can help develop a healthier relationship with food.

The term orthorexia Nervosa was first coined by Dr Stephen Bbratman in 1997 to describe people whose health-oriented extreme diets cause malnutrition and impairment of daily functioning. Studies have estimated that ON impacts between 1 – 7% of the general population. Also, this condition is more common in females than in males.

 

Orthorexia Nervosa

 

Orthorexia Nervosa symptoms

Orthorexia refers to an obsession with pure or clean eating that hyper-focus on the nutritional quality of your diet. A healthy eating plate contains fruits and vegetables of all colours, a variety of whole grains, healthy animal protein sources and water. Also, health-conscious consumers pay more attention to labels of food products during grocery shopping. However, problems may arise when the enthusiasm for clean eating transform into an unhealthy obsession. If someone is showing any of the following ON symptoms, that person should be seen by a mental health professional immediately.

 

  1. Preoccupation with healthy meal planning
  • Obsessed with the nutritional value of their diet
  • Constantly examine the food labels and ingredients
  • Irrational concern about food preparation techniques
  • Obsession with consuming supplements and vitamins
  • Avoid going out to eat
  • Avoid eating food prepared by others
  • Food preparation takes hours on end
  • Shopping at certain acceptable food stores

 

  1. Inflexible dietary rules

Extreme limitation of food in certain groups. Such as sugar, fat, salt, and dairy products.

 

  1. Changes in mood and emotional distress.

Unrealistic expectations of healthy food choices can cause severe emotional imbalance and mood fluctuations. It can also cause :

  • Anxiousness if they do not have access to food that meets their diet standards
  • Express anger if anyone prevents them from their routine exercise and eating schedule
  • Extreme feelings of guilt and shame by consuming unhealthy food
  • Self-loathing
  • Self-isolation
  • Depression
  • Lack of attention for daily responsibilities because they are thinking about food

 

  1. Strained social relationships

Those who struggle with orthorexia Nervosa may experience damaged social relationships with parents, siblings, friends and partners. The following are some of the possible reasons for impaired social interactions.

  • Self-isolation
  • Inadequate communication
  • Rigid eating patterns
  • Food avoidance
  • Avoid social events involving food or making excuses to leave such events early to prepare their food at home.
  • Criticize others eating habits when they do not follow a strict diet.

 

  1. Constant worry about sickness or diseases.

Many individuals with orthorexia Nervosa may find themselves categorizing foods as “good” and “bad” concerning the nutritional quality. Orthorexics will experience an irrational concern with health consequences when they consume these “bad” food. On the contrary, they consider eating good food as the highest satisfaction of their lives.

 

  1. Spend a lot of time and money on their meals

People with orthorexia Nervosa devote a lot of their time to researching, meal scheduling and planning. These individuals frequently consult a calorie reference guide to track their every bite. They consume food from the same container every day and eat the same measured thing every day. Moreover, these meals can be expensive as the ingredients are of high value.

 

  1. Weight loss

Weight loss is typically not intentional in orthorexia Nervosa. It occurs as a result of an unbalanced diet by elimination of several food groups.

 

  1. Experiencing other health problems including,
  • Fatigue,
  • Sleep problems,
  • Poor concentration,
  • Dizziness,
  • Low heart rate,
  • Hair loss,
  • Weakness,

 

Orthorexia nervosa causes

There is little research on the ON causes. However, several different factors combined to trigger this condition.

  • Modern food culture trends

The general public’s view of a healthy diet has undergone drastic changes with evolving food trends. Nowadays, some food movements have enforced many people to follow some extreme food trends. For example, vegetarian and vegan diets are promoted in an attempt to help the environment and animals. Unfortunately, support and encouragement from these passionate communities can cause someone to become obsessed with clean eating that has several adverse effects on their health.

 

  • Fear of illness or health consequences

People with orthorexia Nervosa constantly worry about being sick. According to them, even consuming a small amount of carb and fat can increase the risk of sickness and disease. Also, Individuals focused on health for their carriers like health care workers, musicians, ballet dancers, and athletes may also feel pressure to pick the right foods to avoid getting sick.

 

  • Possessing certain obsessive-compulsive personality traits

Studies have shown that clinical presentation of orthorexia nervosa shares some features with obsessive-compulsive disorder (OCD). Obsessions, compulsions, doubting, and perfectionism are the main features of OCD that can substantially affect orthorexia tendencies. Just as those with OCD need to have things lined up in a certain way, individuals with orthorexia set a very high standard regarding their diet.

 

These are some common personality traits of orthorexia Nervosa that have OCD characteristics.

  • Constantly examine the food labels and ingredients
  • An increase in concern about the nutritional value of food ingredients
  • Cutting out certain food groups. (sugar, carbohydrates, dairy, meat, animal products,etc.)
  • Unusual interest in the health of what others are eating
  • Spending most of their time thinking about what food might be served at upcoming events.
  • Become anxious when “good” or “healthy” foods are not available
  • Obsessive following of food blogs and healthy lifestyle blogs on social media.

 

  • Family history of eating disorder

Genetical influence plays a significant role in the development of many eating disorders, Including ON.

 

Risk factors

As with most mental disorders, there is not one specific reason to develop Orthorexia nervosa.

Exposure to psychological, physiological and social risk factors at greater levels increases the chance of developing this condition. These risk factors may include,

  • History of trauma
  • Life-changing stressful events
  • Sexual abuse in childhood
  • Unhealthy relationships
  • Unresolved personal conflicts
  • Low self-esteem
  • Perfectionist personality
  • Substance abuse
  • Obsession with exercise
  • Overwhelming society pressures
  • Depression
  • Anxiety
  • Body relevant insults and teasing
  • Poor support network
  • Social media obsession
  • An intense need to “fit in”.
  • Need for extreme control

 

Orthorexia nervosa complications

Physical complications

Negative physical consequences of ON often result from strict dietary regimens in this condition. Individuals who suffer from orthorexia nervosa avoid consuming specific food groups that they may feel unhealthy. As a result, nutritional and mineral deficiencies may occur over time to a harmful extent.

  • Malnutrition
  • Anaemia
  • Slow heart rate
  • Hormonal imbalances
  • Electrolyte imbalances
  • Metabolic acidosis
  • Reduced bone mineral density
  • Stunted growth
  • Vision problems
  • Delayed wound healing
  • Stomach problems
  • Thyroid gland enlargement
  • Menstruation irregularities
  • Loss of weight
  • Recurring illness
  • Poor working capacity

 

Psychological complications

  • Devote much of their time to planning, scheduling, purchasing and preparing foods.
  • Violation of a personal food rule by consuming bad foods make them punish themselves.
  • Anxiety and stress
  • Intense worry about food and food ingredients including, pesticides, herbicides and artificial flavours
  • Suicidal thoughts and self-harming behaviours
  • Poor problem-solving skills
  • Exhaustion from maintaining the routine

 

Social complications

Important social consequences also have been noted regarding orthorexia nervosa. These problems may include,

  • Avoid social gatherings
  • Make judgements of others based on their eating behaviour
  • Bringing their food and decide not to eat with others
  • Feeling too tired to participate in social activities
  • Social friction when diet rituals are interrupted
  • Academic failures due to poor concentration on studies
  • Relationship failures

 

Diagnosis and tests

Orthorexia nervosa is not officially recognised as an eating disorder by the American psychiatric association. Therefore, It is not included in the diagnostic and statistical manual of mental disorders(DSM-5). This condition can sometimes be seen as an eating disorder and, in other cases, as an obsessive compulsive disorder. Hence, the available literature provides unclear data regarding the prevalence of orthorexia nervosa. However, in 2016 formal diagnostic criteria for orthorexia nervosa were proposed by Thomas M. Dunn and Steven Bratman.

 

Criterion A

Overly obsessed about eating healthy foods and consume a nutritionally unbalanced diet due to an unlogical set of beliefs about food choices; severe emotional distress by consuming certain food groups they considered to be “unhealthy”; unintentional weight loss caused by poor dietary choices. As evidenced by the following:

  1. Psychological fixation regarding affirmative and restrictive dietary practices believed by the individual to achieve optimum health.
  2. Feeling guilty and anxious after violation of self-imposed dietary rules.
  3. Dietary restrictions progress and become more frequent over time. It can lead to leaving out entire food groups as well as severe cleanses regarded as detoxifying. As a result, weight loss can happen but, the desire to lose weight is not prominent.

 

Criterion B

The compulsive behaviour and mental preoccupation lead to clinical impairments as a result of,

  1. Physical infirmity due to malnutrition and weight loss
  2. Severe emotional distress or socio-behavioural malfunctioning due to obsessive thoughts and beliefs about clean eating.
  3. Body image concerns, self-worth and feelings of satisfaction unduly dependent on compliance with self-defined “healthy” eating behaviour.

 

Orthorexia nervosa tests

  1. ORTO-15 questionnaire

A diagnostic questionnaire has been developed to identify those at risk for orthorexia nervosa. It is a 15 item multiple-choice questionnaire designed to assess the severity of orthorexic behaviour. The questionnaire includes cognitive, emotional and clinical aspects of the disorder.

2. Eating attitudes test-26 ( EAT-26 )

EAT-26 self-assessment test and screening tool to detect eating disorder symptoms in general population

3. Health consent scale (HCS)

HCS is used to evaluate the following factors

  • Attention paid by the participants on their health
  • The relationship of excessive consumption of certain food products with certain diseases.

 

After considering the above diagnostic methods, your clinician will run several examinations and tests to identify other related medical complications caused by ON.

Physical examination to check,

  • Body mass index
  • Mid upper arm diameter
  • Heart rate
  • Blood pressure
  • Temperature

 

Lab tests such as,

  • Complete blood count
  • Urine test
  • X-ray
  • Ultrasound
  • Electrocardiogram

 

Treatment and medications

Mental health care professionals often treat orthorexia nervosa similarly to other mental disorders such as anorexia and obsessive-compulsive disorder. The treatment plan includes a combination of medications and psychological therapies. It generally consists of psychiatrists, nutritionists, medical specialists and family members. Also, immediate hospitalization may be required if your life is in danger due to the following complications.

  • severely low BMI,
  • malnutrition,
  • heart rhythm disturbances,
  • electrolyte imbalances,
  • severe dehydration,
  • persistent refusal to eat or other complications due to inadequate food intake.

 

Medications

Antidepressants are prescribed to treat concurrent mood disorders such as anxiety and

depression. Apart from psychiatric medications, medical complications are also needed to be addressed by a specialist to restore physical fitness and vitamin and mineral supplements are used to resolve micro nutritional deficiencies.

 

Psychological treatments

  1. Cognitive-behavioural therapy

The primary focus of the treatment is to address the way our thoughts influence by our behaviours.

  1. Dialectical behavioural therapy

This method is an evidence-based psychotherapy that provides patients with new skills to manage emotional conflicts and stress. It helps people with ON to accept their unusual behaviour and work towards changing them.

 

Coping and support

Changing your eating behaviours might be difficult. But with good coping skills and a support system, you can achieve some degree of control over them. Here are several coping strategies

That may help with recovery.

  • Think about the impact of your eating habits on your life
  • Think how you would like them to change
  • Engage in activities that do not revolve around food
  • Do activities to reconnect with friends
  • Meet your physician and ask for a blood test to assess current nutritional deficiencies
  • Talk to a dietitian and make adjustments to the current diet plan
  • Keep track of the progress you are making
  • Avoid strict dietary choices by adding one new food to your diet each week

 

Support from parents and family members is also essential to control the compulsive behaviour of the person with ON. Here are the things family members can do.

  • Always be affectionate and encouraging to the person with the disorder.
  • Help the patient to avoid contributing factors such as social media
  • Paying attention to what the patient is eating and notice when they try to eliminate certain foods.

 

Lifestyle and home remedies

The following healthy lifestyle changes are important to achieve your recovery goals.

  • Go out with friends to eat
  • Make changes to your rigid workout schedule with the help of a physician
  • Incorporate feared foods into your diet
  • Leave out inflexible food choices and make decisions based on what you want
  • Try meditation and yoga to reduce stress
  • Keep a journal
  • Learn to manage anger by writing down your emotions
  • Try to boost Your self-esteem by using your talents
  • Find some hobbies to improve your creativity
  • Join new clubs and groups
  • Take your medicines as advised

 

Preparing for your appointment

With the help of friends and family members, you can seek medical advice to begin a treatment program as soon as Possible. It is normal to feel nervous or fearful about your first appointment. You may feel more relaxed and confident talking to your therapist by writing down points you want to discuss.

  • Feelings about food and their nutritional values
  • Feelings about shape and weight
  • Frequency of calculating calories
  • Time spent on food preparation
  • Emotions when someone prevents you from completing eating schedules
  • Exercise habits
  • Past or current substance abuse
  • Sexually active level
  • Past experiences about depression, anxiety and OCD

 

Prevention strategies

  • Learn everything you can about orthorexia nervosa; it will help you to learn the signs.
  • Cut back on social media time and become a critical viewer of their messages.
  • Allow room in your diet for all kinds of food in moderation
  • Find ways to handle stress
  • Stop judging others
  • Get enough sleep
  • Get regular medical checkups
  • Avoid alcohol and other recreational drugs
  • Spend more time with family and friends

 

References

  • Psychometric properties of a new measure for orthorexia nervosa; the orthorexia nervosa scale by Rebecca corners
  • Orthorexia nervosa: validation of a diagnosis questionnaire by LM Donini&D.Maesili
  • Orthorexia nervosa: Real construct or newest trend by Erin Michelle Mcineneyerinst

 

  • https://doi.org/10.1007%2Fbf03327537
  • https://doi.org/10.1016%2Fj.eatbeh.2015.12.006
  • https://www.enlightenedsolutions.com/orthorexia-nervosa-fear-of-eating-unhealthy/
  • https://nourisheveryday.com/overcoming-orthorexia-beginnings/
  • https://www.psycom.net/eating-disorders/orthorexia/