Nervous Orthorexia

Nervous orthorhexia is not recognized as an eating disorder by the American Psychiatric Association, and is not mentioned as an official diagnosis in the widely used US Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There is no such pathology in the latest edition of the ICD.

However, the term orthorexia nervosa - nervous orrexia (from Greek - the right appetite) - exists. And thanks to his introduction, a physician from the small town of Fort Collins in the state of Colorado Steven Bratman became known in medical circles, whose article appeared in the Yoga Journal in the second half of the 1990s. Then he saw the light of his book Health food junkies - about an unhealthy obsession with a healthy diet, where the author directly called ortorexia a disease.

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Epidemiology

Since the conventional diagnosis of nerve orrexia is not, the epidemiology of this state is unknown.

However, it is known that about 60% of adult Americans (both men and women) are overweight, 34% of them are diagnosed with obesity. In addition, obesity was detected in 29% of American teenagers. The most frequent reasons for overweight include fast food, foods high in sugar and fat, a sedentary lifestyle.

According to the Academy of Nutrition and Dietetics, the number of patients with eating disorders doubled between 1995 and 2005 (up to 8-10 million people). So the soil for revealing subclinical eating disorders in this country is fertile: there are a huge number of people who are too concerned about their food and weight.

So, annually over 13% of American women turn to dieticians to solve problems of excess weight. And, according to the Bureau of Labor Statistics, the number of nutritionists in the United States will grow by 16% by 2024 - due to aging and growing obesity in the population.

By the way, the US Department of Agriculture (USDA) has an economic research department that monitors what Americans eat: where, when, how much and what kind of food the average family buys, how often they order pizza at home or visit a restaurant ...

There are many non-profit organizations, corporations and food trusts that either promote certain diets, or trade "universal means" for weight loss, or fight charlatans in the field of dietetics.

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Causes of the nervous ororexia

Analyzing her own experience - both a supporter of a healthy diet and a graduate of alternative medicine, practicing in the field of rehabilitation and physiotherapy - S. Bretman came to the conclusion that the external causes of orthorhysis are due to the exaggerated emphasis on eating exaggerated attention to food as a decisive factor of good health and a means of treatment and prevention of most diseases.

However, extreme fanaticism towards healthy food and constant restrictive diets to improve one's health (according to Bretman, dietary perfectionism), instead of curing a person, lead to eating disorders. And in recent decades, this phenomenon in the US and other Western countries has become an obsession.

Medically recognized disorders in the form of anorexia, bulimia or compulsive overeating in standard medical manuals (ICD-10, DSM-5) are defined as mental disorders.

And although to date the causal relationship of eating disorders with personality disorders has not yet been clarified, more and more facts indicate that the pathogenesis of orthorexia, as an unhealthy concentration of a person using only "healthy" or "pure" products, can be caused by comorbid states (ie, caused by several concomitant diseases), obsessive-compulsive personality disorders (obsessive-compulsive thoughts neurosis or obsessive-compulsive syndrome) or phobias.

Studies by the American Psychiatric Association show that:

• 1-2 million Americans with obesity have such an eating disorder, like compulsive overeating.
• About 2% of American citizens suffer from dysmorphophobia - fear of unattractiveness of their body, which leads not only to the abuse of restrictive diets, but also to unnecessary plastic surgeries. And 15% of people with dysmorphophobia have anorexia or bulimia.
• 45-82% of people with eating disorders are depressed.
• 64% of people with an eating disorder have an anxiety disorder.
• 58% of people with eating disorders have a comorbid personality disorder.

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Risk factors

Risk factors for the formation of nervous ororexia are associated with both increased suggestibility of an individual personality or the presence of psychotic disorders, and with aggressive dieting - any regulated and controlled nutrition system aimed at either correcting body weight or treating some pathologies (which can be autoimmune, that is, in principle incurable).

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Symptoms of the nervous ororexia

Unlike anorexia, bulimia, or compulsive overeating, nervous orthorhysis is "masked" with good intentions, and those who concentrate on healthy food feel pride in taking care of their health. And at the same time - feel a sense of guilt when you have to violate diet rules.

The author of this term distinguishes such symptoms of orthorhysis as:

• attitude to food as a source of health, absorption by the definition and maintenance of an ideal diet;
• obsessive emphasis on food choices (emphasis is on their quality);
• regular planning of their menu, purchases of food and their preparation;
• aversion to unhealthy foods;
• hypertrophied conviction that certain types of food can prevent or cure the disease or affect your daily well-being;
• periodic shifts in dietary preferences in the direction of even more tightening of restrictions;
• a marked increase in the consumption of food additives, herbal medicines or probiotics (without prescribing them as a doctor);
• condemnation of all who do not pay due attention to their diet;
• irrational anxiety about the methods of cooking, as well as the cleanliness of dishes and kitchen utensils;
• refusal to eat food outside the house or cooked by others;
• caring for health promotion becomes the meaning of life (relationships in the family and with friends go to the background);
• exacerbation of depression, mood swings or anxiety.

Complications and consequences

The consequences and complications of this type of eating disorders can be manifested in a significant deficit of essential nutrients in "prescribing" themselves "health diets", malnutrition, severe weight loss or other medical complications. Also, the ability to sense hunger or satiety can be lost, and in the mental plane, orthorhysis is fraught with personal limitations and even social isolation.

[12], [13], [14]

Diagnostics of the nervous ororexia

The criteria on which ortorexia diagnostics can be based were proposed by S. Bretman and a psychologist from the University of Northern Colorado by Thom Dunn in 2016. But back in 1997, Bretman proposed an orthorhysis test of 18 questions. A test Orto-15 to determine the manic obsession with healthy food, compiled in 2001 by a team of specialists of the Institute of Food Sciences of the Roman University of La Sapienza, Brettman and Dann were criticized for lack of appropriate testing of psychometric parameters (525 students of this university participated in the testing, and check 121).

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Differential diagnosis

Differential diagnosis is necessary to make sure that it is neural orthorhysis, and not anorexia. Patients with both pathologies can show such similarities as: the desire to gain control over one's life, strengthen self-esteem and moral satisfaction by controlling food intake; a rationale for excluding from the ration of certain products the reference to not diagnosed food allergy; carefully thought out rituals in food, which can lead to social isolation.

At the same time, one of the main signs of anorexia, bulimia and other eating disorders is obsession with weight, which is not the case with ortorexia. That is, the motivation for these violations in the root is different.

Treatment of the nervous ororexia

So far, methods of treating nervous ororexia, as an officially not recognized mental disorder, have not been developed. Obsessive tendencies in the behavior of the personality associated with a pathological obsession with proper nutrition may indicate the presence of other disorders that the psychiatrist should diagnose and treat.

At present, orthorhysis studies continue, since the neuropsychological aspects of this condition have yet to be elucidated and the characteristics of its cognitive profile to be determined.