‘Orthorexia’ in the running to be classified as a mental disorder as more people become obsessed with ‘clean eating’

Whether it’s a ‘real’ or imagined mental illness, the behaviors and consequences are definitely real, says author of new study

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Is the obsession with “healthy eating” a real mental disorder deserving of its own diagnosis in the official psychiatry manual on mental illness?

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A flurry of new studies and reviews are breathing new life into so-called orthorexia nervosa, loosely defined as a pathological fixation on eating “pure” foods. At the extreme, adherents avoid all sugar, all carbohydrates, all dairy, all meat and animal products, gluten, starch, pesticides, herbicides – anything unnatural, organic or “clean”.

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According to a new article, orthorexia is “cyberpathy,” a condition of digitally transmitted privilege. Whether it is a “real” or imagined mental illness, the behaviors and consequences are certainly real, according to the author.

“Phenomenologically, orthorexia seems quite real, although it may be culturally linked and have an upcoming expiration date,” Cristina Hanganu-Bresch, an associate professor at the University of Science, wrote in the journal Medical Humanities.

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“As cyberpathy, orthorexia attracts digital loafers seeking unconventional health advice and colonizes their imaginations with promises and coaxing, micronutrient formulas and “biohacks” and aspirational/inspirational content “, she writes.

“Memes, images of ‘healthy’ and colorful meals and tans, muscular bodies in yoga poses, enthusiastic product recommendations and sage dietary and life advice are proliferating in unknown numbers, evangelizing people in the world. Health Gospel.”

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Instagram and other social media channels have become the “conveyors” of transmission and recovery, said Hanganu-Bresch, who described orthorexia as the most unhealthy manifestation of “healthism” – the idea that people are entirely responsible for their own health and that individuals who do not strictly adhere to healthy behaviors have only themselves to blame if they become ill.

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“The orthorexic will eliminate harmful or potentially unsuitable substances from the diet according to a logic that oscillates according to the food craze of the day”, she writes, “hence the obsession with cures, juices, veganism , or raw and organic food”. .”

Gwyneth Paltrow’s 2019 book The Clean Plate: Eat, Reset, Heal, for example, promotes “super clean eating.” For the Goop Goddess, that means no alcohol, caffeine, dairy, nightshades (tomatoes, eggplant), processed foods, red meat, or other “toxic triggers.”

There is an element of complacency in orthorexia, although Hanganu-Bresch is wary of moral judgments. Patient “zero”, writes Hanguna-Bresch, was holistic physician Steve Bratman, who in a 1997 article he published in a yoga journal described his own obsession with eating pure and clean. “Most (orthorexics) have to resort to iron self-discipline reinforced by a strong sense of superiority over those who eat junk food,” he writes. Bratman later wrote, 20 years later, that when he coined the term “orthorexia nervosa,” he had no intention of proposing a new eating disorder.

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“The concept went from a joke to a pun in a yoga magazine,” Hanganu-Bresch said, then slowly spread via websites and bloggers until researchers (mostly Europeans) take it up.

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Today, although not officially recognised, orthorexia vies for a place in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, an influential guide used by doctors around the world.

However, much of the research is still anecdotal or based on case studies, there is no universally shared definition of orthorexia nervosa and no consensus on how to diagnose it.

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“We don’t know what it is yet,” said clinical psychologist Dr. Jennifer Mills, associate professor at York University and co-author of an article on orthorexia in the September issue of the journal Appetite. .

Without formal diagnostic criteria, it is difficult to get an idea of ​​its prevalence. Estimates “are all over the place,” Mills said, from less than 5% to 80% or more.

For their study, Mills and Sarah McComb, a graduate student in Mills’ lab and the study’s first author, reviewed peer-reviewed articles published through the end of 2018. Gender and Self-Esteem Doesn’t were generally unrelated to orthorexia nervosa. Surprisingly, they found equal rates of men and women experiencing symptoms, even though eating disorders have traditionally tended to be 10 times more common in women.

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Being vegetarian or vegan puts people at a higher risk of developing orthorexia. The condition also overlaps with anorexia nervosa, although the focus is often on “health”, not thinness or body dissatisfaction. But even then, the line can be blurred, Mills said.

“If someone has this apparent obsession with eating ‘clean’ or healthy food, what is the motive behind this behavior?” she asked. “Are they trying to reduce their fear of getting sick? Is it more of a socially sanctioned eating disorder, where it becomes a socially acceptable way to restrict what you eat in an attempt to lose weight. Or is it a completely different reason?

It could be a form of OCD (obsessive compulsive disorder). According to Mills and McComb’s study, orthorexics tend to have certain personality traits, such as perfectionism, anxiety, poor body image, and a history of eating disorders. Still, it’s hard to define what is “normal” and “abnormal” eating, said Mills, who isn’t convinced orthorexia needs its own separate, standalone diagnosis in the DSM.

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“The results of our review suggest that there may be different types of people who exhibit these types of behaviors and that they may already fall into established categories of psychopathology,” she said.

Although there may be a significant number of people who show signs of the problem, what matters is whether it causes severe distress or physical consequences, such as malnutrition.

“I think we should have a very high threshold to call this really abnormal or a mental disorder,” Mills said.

What she hopes is that medical professionals will be more aware of the behaviors.

“When they ask someone, ‘How do you eat?’ and the person says, ‘I eat really healthy’, maybe you should ask a few more questions,” she said.

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