Orthorexia – the hidden eating disorder? – Sophie Nesbitt, Consultant Clinical Psychologist Rhodes Wood Hospital

Orthorexia Nervosa is an increasingly recognised eating disorder with no official diagnosis yet established in the Diagnostic Statistical-Criteria Manuel (DSM-5). It is hard to establish a consistent figure on current prevalence rates of Orthorexia due to the absence of an official diagnosis and lack of information provided on the eating disorder to date.  Regardless of this, it is important to raise awareness about Orthorexia and the impact it can have on individuals and the people around them.

Orthorexia was first introduced by physician Bratman (1998), who described it as an obsession with quality of food. Individuals with Orthorexia become so preoccupied with eating ‘healthily’, that these habits eventually become unhealthy. It begins to affect them physically, emotionally, mentally and socially. Notably, following a healthy diet or eating plan does not automatically mean an individual has Orthorexia. Although the line between healthy eating and Orthorexia may seem very fine, the distinction is how it begins to affect the individual’s quality of life, on a daily basis. The individual will spend increasing amounts of time planning what to eat, checking the quality of food and on food preparation causing disruption to daily functioning. How healthy or pure certain foods are will differ among individuals. Those with Orthorexia will often have critical judgements of the foods other people eat due to their own beliefs.

Physical symptoms of Orthorexia include weight loss, feeling weaker or fatigue and other signs of malnutrition such as hair-loss or skin problems. Cardiac complications can occur if individuals begin to become severely malnourished due to food restriction. These physical symptoms are often caused by the individual restricting important food groups or being unable to keep a balanced diet. Psychological effects of Orthorexia are equally as important. Individuals may become obsessed with their diet, having an overwhelming emotional dependency on what they eat, low mood or depression and feelings of guilt if they are not able to follow their strict requirements around food.

It is important to make the distinction between Orthorexia and other eating disorders. Particularly, this distinction must be drawn between Orthorexia and Anorexia as both of these eating disorders can physically present themselves in similar ways. Although those with Orthorexia may be underweight, views on body shape or weight may not necessarily be a primary focus. Additionally, those with Anorexia may have a desire to cut out all foods or focus on the quantity of foods, whilst those with Orthorexia focus on the quality and may not have the desire to cut foods out altogether. However, research has shown that orthorexia can commonly develop before or after the presentation of Anorexia. Segura-Garcia et al (2014) found that Orthorexia symptoms are highly prevalent amongst those with Anorexia and Bulimia Nervosa.

Due to Orthorexia receiving more attention in recent years,  evidence-based treatment is still growing. However, there are tools available to assess the risk of the eating disorder. Increasing education around Orthorexia will aid in understanding, reducing current misconceptions and preventing stigmas.

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