You may have heard of anorexia nervosa or bulimia nervosa, but orthorexia nervosa is likely to be something new to many. Orthorexia nervosa is not yet listed in the ICD-10 (the International Classification of Diseases) – the ‘bible’ used by mental health professionals to diagnose mental health conditions – but it is an increasing issue in western societies, in particular.
Orthorexia nervosa differs from other eating disorders in that it is not about the quantity of food consumed or about weight gain or loss, it is about the quality and purity of the food consumed. Sufferers of orthorexia nervosa are focused entirely on consuming a pure and healthy diet of ‘clean’ foods, which may mean the exclusion of particular food groups or eating only foods sourced or prepared in a particular way. Taken to its extreme, this can become dangerous for both mental and physical health.
Sufferers of orthorexia nervosa become obsessed with what they eat – thinking about food, planning meals, where and how their food is sourced and prepared – leaving little time for anything else in life. Above all the food must be pure, healthy and ‘clean’. This can be taken to such an extreme that anyone who does not share these ideas and rituals is seen by the person with these obsessions as inferior, making it difficult for them to mix socially with friends and family and impossible to eat outside of their own home. This can lead to isolation, and in extreme cases even panic attacks if they are placed in a situation where they are unable to follow their strict regime. In this respect, there are also similarities to OCD (Obsessive Compulsive Disorder).
In their mind, any deviation from these set ideas of food consumption can be corrected by self-enforced periods of detox and abstinence as a means of punishment for any ‘cheating’ behaviour. Someone with orthorexia nervosa feels cleansed and virtuous – and even superior to others – by following their self-imposed, pure diet.
As with other eating disorders, orthorexia nervosa can be a reaction to or co-exist with other mental health conditions such as depression, stress and anxiety. Sometimes, the condition can be linked to anorexia and is seen as a way of staying thin without raising the immediate concerns of those close to them. There are certainly similarities, such as elaborate food rituals and control over food intake, however a fundamental difference is the obsession with eating healthily and the focus on the quality and not the quantity of food.
Whilst minding what we eat can be beneficial to physical health, if taken to extremes, it can be very damaging. The key is everything in moderation. If left untreated, an extreme obsession with following specific food rituals or diets can cause serious physical health problems as well as affect mental health. Severe orthorexia can lead to malnutrition and then the associated physical health problems such as extreme weight loss, heart problems, anaemia, osteoporosis, hair loss, to name a few – and even death.
It is important that the condition and any other co-existing mental health condition is diagnosed by a mental health professional, who can then tackle the psychological causes of the illness and develop coping strategies for the sufferer so that food is no longer the centre of their life. This treatment should then be combined with ‘re-educating’ the patient, perhaps with the assistance and guidance of a dietician, on the importance of consuming a balanced diet with all the essential nutrients necessary to re-gain and maintain mental and physical health.
Dr Adrian Winbow and Prof Tony Hale have many years’ experience in treating a variety of eating disorders. If you or someone close to you is showing signs of an eating disorder such as orthorexia nervosa, then please get in touch.