A rigorous diet of clean foods followed to the point of nitpicking obsession that interferes with day-to-day functioning is the reverse of a conventional eating disorder, but it is an eating disorder nonetheless. Particularly because the dangerously obsessive concern is not necessarily with outward appearance and calories like people with anorexia have. Rather, it is more on the unhealthy perception of what constitutes “pure” foods.
The condition called orthorexia nervosa can be likened to a hypochondriac reaction limited to an extreme consciousness of food quality. The Diagnostic and Statistical Manual (DSM-5) does not formally recognize orthorexia nervosa as a disorder, and yet the nonprofit organisation National Eating Disorder Association (NEDA) does its bit to help by offering an online assessment tool and providing a helpline to discuss worries.
A recent review was published in the journal Appetite upon conducting searches with keywords “orthorexia” and “orthorexia nervosa” on research papers published in PsychINFO and PubMed until Dec. 31, 2018. Researchers were careful to conduct quality assessment on the papers reviewed from around the world, so as to avoid any misinterpretation of data.
It can be confusing to diagnose or understand because restrictive eating is all the rage these days, provided it is diverse and takes into account the overall health and limitations of the person. Orthorexia nervosa follows ritualized patterns of eating with a rigid diet structure that may not be completely scientific and balanced.
There is a hyperfocus on certain varieties of food perceived to be superior than other foods, so much so that it can lead to deficiencies of vitamins and minerals. “It’s healthy eating taken to the extreme, where it’s starting to cause problems for people in their lives and starting to feel quite out of control,” said Jennifer Mills, associate professor at York University’s health department in Toronto and co-author, in an interview.
Mills and co-author Sarah E. McComb, from York University’s psychology department, tried to find common denominators among subjects suspected to have orthorexia nervosa. Self-esteem and gender were eliminated, for both males and females equally displayed the same traits of obsession while choosing food.
“Perfectionism, obsessive-compulsive traits, psychopathology, disordered eating, history of an eating disorder, dieting, poor body image, and drive for thinness were positively associated with greater ON,” the study said.
Careless expenditure on food without regard for one’s income and excessive feelings of guilt for having indulged in food with added preservatives, fat and sugar are some of the factors found to lead to social isolation.
If the obsession with clean food is on the lines of Obsessive Compulsive Disorder (OCD), going over to eat at another person’s house or trying out a new restaurant is problematic due to an unfounded fear of the food not being as healthy or “pure enough,” showing intolerance and disregard to the food preferences of other people.
Drug use, tobacco and alcohol consumption were not necessarily risk factors since the findings on having pre-existing addictions were mixed. Prior professional engagement in exercise and working in a health-related field did not specifically indicate the onset of the condition and displayed mixed results, too. However, spending more than three hours researching and reading up about “pure” and “healthy food” when one’s vocation is unrelated to the health field is a telling sign.
Manifestation of other disorders
Mills said that orthorexia nervosa could be a manifestation of other eating disorders, and at times it occurs while trying to navigate one’s way out. Seeking the help of a psychologist during this time can ensure there is a balanced route to recovery. Similarities to OCD are like the irrational fear of exposure to germs transmitted through another person, or by not washing hands, or basically not doing things a particular tested way with a rigid structure.
According to this research paper, the commonalities between anorexia, OCD and orthorexia nervosa are the following: perfectionism, cognitive rigidity, impaired functioning, trait anxiety and poor external monitoring.
The difference between anorexia and orthorexia nervosa is that the former is based on fear of becoming obese and the latter is based on unrealistic beliefs of certain foods’ purity quotient to stay healthy. Anorexic individuals tend to hide their habits in embarrassment, while orthorexia nervosa individuals do not have a problem flaunting it in public. Data on the similarities are not enough and researchers are merely drawing parallels on their own. The review does mention the limitation and suggests that further research needs to conducted for verification.