Understanding ‘orthorexia’, a neglected eating disorder

Although not formally recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-10), the term 'orthorexia' was first coined in 1997 by Dr Steven Bratman, who observed patients displaying an unhealthy fixation on healthy eating.

Orthorexia nervosa is a relatively new and evolving concept in the field of eating disorders. (Source: Freepik)

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Most of us might be aware of the terms ‘anorexia’ and ‘bulimia’ which are common eating disorders, however, there is another eating disorder that is often overlooked and neglected called orthorexia.

Although not formally recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-10), the term ‘orthorexia’ was first coined in 1997 by Dr Steven Bratman, who observed patients displaying an unhealthy fixation on healthy eating.

While healthy eating is essential for overall well-being, an unhealthy obsession with it can develop into orthorexia, also known as orthorexia nervose.

According to Prachi Jain, Chief Clinical Nutritionist & HOD (Nutrition & Dietetics), CK Birla Hospital, Gurugram, unlike anorexia and bulimia, which focuse on the quantity of food eaten by the individual, orthorexia is an eating disorder that focuses on pure quality of food, healthy and safe eating, along with excessive restriction on unhealthy food choices.

“People suffering from orthorexia practice complete cutting off of important food groups such as carbs, fats, sugars and dairy, by considering them unhealthy or bad for health. An over-concern for healthy eating with restrictive behaviour can make it a behavioural change and turn into an obsession known as obsessive-compulsive disorder or OCD,” she said.

Highlighting the new and evolving concept through an Instagram post, Nutritionist Lovneet Batra shared, “Orthorexia is when healthy eating goes wrong. It is an unhealthy obsession with healthy food. Well, something that has started with good intention, how do you know it is working against you now?”

“If healthy eating is cause for anxiety, fear or shame, then you need to reevaluate. If due to your health goals or concern with healthy food availability, you are skipping social events, meeting your friends and family, then you need to ask yourself — is it really worth it? Or if it is making you skip food groups and natural real food, then again you need to strike for better balance,” she added.

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A post shared by Lovneet Batra (@lovneetb)

Symptoms and causes of orthorexia

The causes of orthorexia nervosa are multifactorial and complex, involving a combination of psychological, social, and cultural factors.

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Dr. Priyanka Rohatgi, Chief Nutritionist, Apollo Hospitals said that while research on this specific eating disorder is ongoing, several potential contributing factors have been identified as:

*Perfectionism: Individuals with orthorexia often exhibit perfectionistic tendencies, seeking an idealised and pure diet.

*Media influence: The pervasive influence of social media, health blogs, and wellness influencers can play a significant role in the development of orthorexia.

*Health concerns: Some individuals may develop orthorexia as a response to legitimate health concerns or medical conditions.

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*Diet culture: Society’s emphasis on dieting, weight loss, and the pursuit of an ideal body shape can contribute to the development of orthorexia.

*Psychological factors: Underlying psychological factors such as anxiety, obsessive-compulsive tendencies, and a history of trauma may increase the risk of developing orthorexia.

*Peer and family influence: Family dynamics and peer pressure can also influence an individual’s relationship with food.

*Genetic and biological factors: While research is ongoing, there may be a genetic predisposition to developing eating disorders, including orthorexia.

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Orthorexia can be characterised by an obsession with healthy eating to the point where it becomes detrimental to an individual’s physical and mental well-being.

“It exhibits several symptoms such as obsessive focus on food quality, strict dietary rules, intolerance of “unhealthy” foods, social isolation, weight loss, malnutrition, fatigue, or psychological distress,” Dr Rohatgi noted.

The health condition is harmful from a medical perspective as it can cause nutritional deficiencies, malnutrition, electrolyte imbalance, digestive issues, hormonal disruptions, cardiovascular complications, anxiety, depression, OCD, decreased quality of life, and risk of developing other eating disorders.

Treatment and prevention

The causes of orthorexia nervosa are multifactorial and complex, involving a combination of psychological, social, and cultural factors. (Source: Freepik)

While orthorexia poses significant health risks, Dr Rohatgi said that a comprehensive treatment approach can help.

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“The first step in treatment is a thorough medical evaluation to assess the individual’s physical health, including nutritional deficiencies and any related complications. Addressing these immediate health concerns is crucial,” she said.

Further, nutritional rehabiliation with the help of registered dietitians, psychological interventions like cognitive behavioural therapy (CBT), support groups or group therapy and in some cases, medications such as antidepressants or anti-anxiety drugs may be prescribed.

At the same time, prevention of orthorexia is possible by fostering a healthy relationship with food and promoting a balanced approach to nutrition.

ALSO READ | ‘Eating disorders are not lifestyle choices’: Why many people share a complicated relationship with food

“Prevention efforts should focus on promoting balanced eating habits, media literacy, and a positive body image, while also being vigilant for early signs of orthorexia and providing appropriate support when needed,” Dr Rohatgi concluded.

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