Orthorexia nervosa

Orthorexia nervosa is not recognized as an eating disorder by the American Psychiatric Association, and is not listed as an official diagnosis in the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in the United States. The disorder is also not listed in the latest edition of the ICD.

However, the term orthorexia nervosa – nervous orthorexia (from Greek – correct appetite) – does exist. And thanks to its introduction, a doctor from the small town of Fort Collins in Colorado, Steven Bratman, became known in medical circles; his article appeared in the Yoga Journal in the second half of the 1990s. Then his book Health food junkies was published – about an unhealthy obsession with healthy eating, where the author directly called orthorexia a disease.

[ 1 ], [ 2 ], [ 3 ]

Epidemiology

Because orthorexia nervosa is not a generally accepted diagnosis, the epidemiology of the condition is unknown.

However, it is known that about 60% of American adults (both men and women) are overweight, 34% of whom are diagnosed with obesity. In addition, obesity has been identified in 29% of American teenagers. The most common causes of excess body weight include fast food, food high in sugar and fat, and a sedentary lifestyle.

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

Thus, annually more than 13% of American women turn to nutritionists to solve problems of excess weight. And, according to the forecasts of the Bureau of Labor Statistics, the number of nutritionists in the USA by 2024 will increase by 16% – in connection with the aging and growing obesity of 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 food products the average family buys, how often they order pizza home delivery or visit a restaurant...

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

[ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]

Causes orthorexia nervosa

Analyzing his own experience - both as a supporter of healthy eating and as a certified specialist in alternative medicine, practicing in the field of rehabilitation and physical therapy - S. Bretman came to the conclusion that the external causes of orthorexia are due to the exaggerated attention to food, instilled by many nutrition consultants, as a decisive factor in good health and a means of treating and preventing most diseases.

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

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

Although the causal relationship between eating disorders and personality disorders has not yet been fully elucidated, more and more evidence suggests that the pathogenesis of orthorexia, as an unhealthy focus on eating only “healthy” or “clean” foods, may be due to comorbid conditions (i.e., caused by several simultaneously occurring diseases), obsessive-compulsive personality disorders ( obsessive-compulsive disorder or obsessive-compulsive disorder) or phobias.

Research from the American Psychiatric Association shows that:

• 1-2 million obese Americans have an eating disorder called binge eating disorder.
• About 2% of American citizens suffer from body dysmorphophobia – a fear of their unattractiveness, which leads not only to the abuse of restrictive diets, but also to unnecessary plastic surgery. And 15% of people with body dysmorphophobia have anorexia or bulimia.
• 45-82% of people with eating disorders experience depression.
• 64% of people with an eating disorder have an anxiety disorder.
• 58% of people with eating disorders have a comorbid personality disorder.

[ 10 ]

Risk factors

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

[ 11 ]

Symptoms orthorexia nervosa

Unlike anorexia, bulimia or compulsive overeating, nervous orthorexia is “masked” by good intentions, and those who focus on healthy food feel proud of caring for their health. And at the same time – they feel guilty when they have to break the rules of the diet.

The author of this term identifies the following symptoms of orthorexia:

• attitude towards food as a source of health, preoccupation with defining and maintaining an ideal diet;
• obsessive focus on the choice of food products (the main focus is on their quality);
• regular planning of your menu, grocery shopping and preparation;
• aversion to unhealthy foods;
• an exaggerated belief that certain foods can prevent or cure disease or affect daily well-being;
• periodic shifts in dietary preferences towards even more stringent restrictions;
• a significant increase in the use of dietary supplements, herbal remedies, or probiotics (without a doctor's prescription);
• condemnation of all who do not pay due attention to their diet;
• irrational concerns about food preparation methods and the cleanliness of utensils and kitchen utensils;
• refusal to eat food outside the home or food prepared by others;
• concern for improving health becomes the meaning of life (relationships with family and friends recede into the background);
• worsening depression, mood swings, or anxiety.

Complications and consequences

The consequences and complications of this type of eating disorder can include significant deficiencies in essential nutrients when self-prescribing “health diets,” malnutrition, severe weight loss, or other medical complications. The ability to sense hunger or fullness may also be lost, and mentally, orthorexia can lead to personal limitations and even social isolation.

[ 12 ], [ 13 ], [ 14 ]

Diagnostics orthorexia nervosa

The criteria on which the diagnosis of orthorexia can be based were proposed by S. Bretman and psychologist from the University of Northern Colorado T. Dunn in 2016. But back in 1997, Bretman proposed an 18-question test for orthorexia. And the Orto-15 test for determining manic obsession with healthy food, compiled in 2001 by a team of specialists from the Institute of Food Sciences of the University of Rome La Sapienza, Bretman and Dunn criticized due to the lack of appropriate testing of psychometric parameters (525 students of this university participated in the testing, and 121 in the verification).

[ 15 ], [ 16 ]

Differential diagnosis

Differential diagnosis is necessary to ensure that it is orthorexia nervosa and not anorexia nervosa. Patients with both pathologies may show similarities such as: a desire to gain control over their lives, strengthening their sense of self-worth and moral satisfaction through controlling food intake; rationalization for eliminating certain foods from the diet by referring to an undiagnosed food allergy; elaborate food rituals that can lead to social isolation.

At the same time, one of the main signs of anorexia, bulimia and other eating disorders is an obsession with one's weight, which does not happen with orthorexia. That is, the motivation for these disorders is fundamentally different.

Treatment orthorexia nervosa

There are no treatments for orthorexia nervosa as an officially unrecognized mental disorder. Obsessive tendencies in personality behavior associated with a pathological obsession with proper nutrition may indicate the presence of other disorders that should be diagnosed and treated by a psychiatrist.

Research into orthorexia is currently ongoing, as the neuropsychological aspects of the condition and the characteristics of its cognitive profile remain to be elucidated.