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Food selection, preparation, and its relationship with health, has been the focus of attention throughout centuries. However, this normal vigilance can become excessive, bordering on an eating disorder. This is especially so in light of today’s public emphasis on clean eating, avoidance of ‘dirty’ foods, and the growing belief that almost every disorder stems from this ‘bad’ food and can be ‘fixed’ by changing one’s diet a little more.
Orthorexia nervosa (ON) is thus very much a product of modern times. It may be defined as a form of obsession with healthy eating, featuring hypersensitive thoughts and anxieties about unsuitable food to the point of making clean eating the hub of one’s life.
Violating one’s growing list of unhealthy foods, whether because of their source, processing, or packaging, induces intense guilt and fear. It may trigger self-punishment in the form of prolonged or rigorous fasting or exercise to purge the ‘dirty’ food.
Eating outside one’s house, or eating foods prepared by others, becomes a matter of extreme gravity because of the possibility of mixing even a speck of unhealthy food with clean food.
For example, if the knife used to chop the clean food was one which is also routinely used to cut up unacceptable food, the meal becomes impossible to have, even if the knife had been washed meticulously between uses.
This inevitably takes its toll on social relationships, as does the rigidly critical attitude of the orthorexic to those who refuse to regulate their lives and eating habits in the same way.
The term orthorexia was first coined almost as a joke, by Steve Bratman, MD, to convince one of his patients of the unnecessary degree to which her life focused on cutting out foods from her permitted list. Later he became more convinced of the importance of the phenomenon of fanatical healthy food devotion when he heard of the deaths of some orthorexics.
The level of public identification with the profile of orthorexia that he described served to underline the extent to which this disorder had already spread in the larger world of clean eating.
Later, Bratman and Dunn worked on publishing criteria to make the term one which corresponded to a condition that could be screened for and diagnosed by patients and practitioners alike. This identification could lead to primary prevention by helping those in danger of becoming orthorexic to see where they are headed, and turn into the path of moderation in healthy eating rather than extremism.
It could also help to detect orthorexic tendencies or lifestyles in others and thus recommend them to get guidance in achieving balance in their eating-related cognitions and behaviors.
Today, ON is being recognized as having many other possible contributory components, such as the desire to have a good-looking body, fill one’s emotional needs, lose weight without having to admit the reality of anorexic tendencies, and to have a scapegoat in food impurity or uncleanness for all one’s physical, spiritual, and emotional ills.
The relationship between orthorexia and personality disorders, such as obsessive-compulsive disorder (OCD), is being explored and many similarities have been found. These similarities include both cognitive process identifications as well as behavioral matches.
Further work in this field will contribute to better identification of this category of psychological disorder, as well as give deeper insight into its management.