Orthorexia nervosa, the “health food eating disorder”, gets its name from the Greek word ortho, meaning straight, proper or correct. This exaggerated focus on food can be seen today in some people who follow lifestyle movements such as “raw”, “clean” and “paleo”.
American doctor Steven Bratman coined the term “orthorexia nervosa” in 1997 some time after his experience in a commune in upstate New York. It was there he developed an unhealthy obsession with eating “proper” food:
All I could think about was food. But even when I became aware that my scrabbling in the dirt after raw vegetables and wild plants had become an obsession, I found it terribly difficult to free myself. I had been seduced by righteous eating.
Bratman’s description draws parallels with many modern dietary fads that promise superior health by restricting whole food groups without a medical reason or even a valid scientific explanation.
Raw food followers might meet regularly to “align their bodies, minds and souls” by feasting on “cleansing and immune-boosting” raw foods. Such foods are never heated above 44˚C, so “all the living enzymes in the food remain intact”. No gluten, dairy or “sugar” is allowed.
Clean eaters may follow similar regimes, removing gluten, dairy and even meat from their diets. You might overhear a discussion about “superfood green smoothie” recipes after a yoga class that also happened to “cleanse your gall bladder”.
And finally, around the corner, paleo pushers may “beef up” together with a Crossfit class, followed by a few steaks. Again, with paleo, there is no gluten – or any grains for that matter – and no dairy or other such “toxins” are allowed.
How common is orthorexia?
There is a blurry line separating “normal” healthy eating and orthorexia nervosa, but one way to define the condition is when eating “healthily” causes significant distress or negative consequences in a person’s life.
They may be “plunged into gloom” by eating a piece of bread, become anxious about when their next kale, chia or quinoa hit is coming, or eat only at home where “superfood” intake can be tightly controlled.
Such behaviours can have a significant impact on relationships with family members and friends, let alone on their mental health.
Orthorexia nervosa is not a clinically recognised eating disorder but researchers have developed and tested questionnaires in various populations to get an idea of its prevalence.
Italian researchers developed the ORTO-15 questionnaire in 2005, with a cut-off score below 40 to signify orthorexia nervosa. Scores above 40 can still signify a tendency to pathological eating behaviours and/or obsessive-phobic personality traits.
Questions include: “Does the thought about food worry you for more than three hours a day?” and “Do you feel guilty when transgressing your healthy eating rules?”
Using this questionnaire and cut-off value of 40, another Italian research group reported a prevalence of orthorexia nervosa of 57.6%, with a female-male ratio of two-to-one. However, using a cut-off value of 35, the prevalence reduced to 21%.
Orthorexia nervosa is not listed in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), which psychologists and psychiatrists use to diagnose mental disorders. The DSM-5 currently lists anorexia nervosa, bulimia nervosa, binge-eating disorder, “other specified feeding or eating disorder” and “unspecified feeding or eating disorder”.
Others disagree and argue that it falls in current eating disorder or other mental disorder categories. As Bratman explained in 2010:
At times (but not at all times) orthorexia seems to have elements of OCD (obsessive compulsive disorder). It may also have elements of standard anorexia. But it is often not very much like typical OCD or typical anorexia.