Not every preoccupation with healthy food should immediately be considered an eating disorder. In the condition known as orthorexia nervosa, sufferers suffer from an exaggerated obsession with healthy food and also proselytize those around them. In cases of obvious underweight, family members should think of this disorder and encourage the sufferer to take countermeasures.
What is orthorexia nervosa?
Orthorexia nervosa is an eating disorder first described by Dr. Steve Bratman in 1997. Sufferers strive to eat as healthfully as possible, and as the disorder progresses, they forbid themselves to eat more and more foods that they consider unhealthy. It is not so much the quantity of food as its composition that is important. However, patients with orthorexia nervosa can still suffer from deficiencies because they abstain from more and more foods, so that as a result, life-threatening weight loss, similar to anorexia, can occur. Patients feel superior to anyone who exhibits normal eating behavior and spend more and more time choosing and preparing and eating their meals. Sometimes they spend several hours a day preoccupied with food, so that they also neglect their social environment. In the composition of their meals, they set themselves increasingly narrow limits.
Causes
People with orthorexia nervosa are obsessed with the idea of food and its categorization into healthy and unhealthy. Often, the disorder begins insidiously as a process to cure another condition or improve overall well-being. Reports from the media about factory farming, various food scandals and the discussed use of genetic engineering for the production of food can become the trigger for this disorder. However, in orthorexia nervosa, health consciousness goes far beyond the normal level of avoiding certain foods for a period of time.
Typical symptoms and signs
- Eating disorders
- Malnutrition
- Weight loss
- Obsessive-compulsive disorder and/or personality disorder, if applicable.
Diagnosis and course
The diagnosis of orthorexia nervosa is made by a doctor or a psychologist after a detailed conversation with the patient. It is possible that deficiency symptoms are already noticeable in the process. However, since those affected consider themselves to be particularly healthy, there is usually no realization that they are ill. In the course of the disease, patients may experience concentration problems, lack of drive and underweight. It is also noticeable that those affected try to proselytize their social environment and encourage them to adopt healthier eating habits. Often, those affected by orthorexia nervosa bring their own food to celebrations under certain pretexts, as they are no longer able to participate in a communal meal.
Complications
Orthorexia nervosa may promote an unbalanced diet. Possible physical complications that may result include underweight and deficiency symptoms such as iron or vitamin B-12 deficiency. Although orthorexia nervosa is not a definable and diagnosable eating disorder, it may co-occur with other eating disorders. For example, an anorexic person may not only restrict the amount of calories they eat, but also banish all unhealthy foods from their diet. Orthorectics often do not view their condition as a disease, but as a free choice. In this respect, they resemble many anorexics. As with anorexics, treatment for orthorectics is often very difficult at the beginning when there is a lack of disease awareness. Various mental illnesses and syndromes may develop as complications of or accompany orthorexia nervosa. Among the most common are depressive disorders. However, orthorexia nervosa can also progress without physical or psychological complications. The differences between individual sufferers and their eating habits are too great to make a general statement. The most common complication is social isolation, which may develop intentionally or unintentionally. Orthorectics often withdraw from others because they feel misunderstood or encounter ridicule because of their eating habits.
When should you see a doctor?
The time to see a doctor, as with all other eating disorders, is when eating behaviors begin to harm the body.With orthorexia nervosa, this can happen just as quickly as with any other eating disorder, even if those affected paradoxically try to prevent exactly that. Most of those affected by orthorexia nervosa will not visit the doctor at the beginning, because they themselves do not yet see that their eating behavior is anything but healthy. Often, deficiency symptoms and physical symptoms are first caused by the diet; psychological effects are also conceivable. If the affected persons are still minors, their legal guardians must consult the doctor as soon as they get the feeling that the striving for a (supposedly) healthy diet is taking on compulsive features and harming the affected person. In the case of orthorexia nervosa, it is sufficient to contact the family doctor, who will refer the patient to a specialist. Ultimately, only a psychologist can treat orthorexia nervosa in the long term. If a person with orthorexia nervosa puts himself in an acutely dangerous situation, i.e. refuses to eat completely or to such an extent that his health is seriously threatened, there is also the possibility of compulsory hospitalization. This would give the sufferer rapid help, but such extreme conditions rarely occur with orthorexia nervosa. Rather, at some point, the affected person realizes for himself that his diet does not contribute to his health and consults the doctor first to find out why his expectations do not coincide with his health condition.
Treatment and therapy
Treatment for orthorexia nervosa is that of an eating disorder and is done as an outpatient or, in severe cases, as an inpatient. If the underweight is life-threatening, a feeding tube may need to be placed to provide nutrition. Once the affected person has stabilized, psychological care should follow. The patient is encouraged to first come to an understanding of the illness and then to learn normal eating behavior. The main aim is to enable the affected person to experience meals in a relaxed manner again and to enjoy them. The patient’s thinking about nutritional value tables and the health aspects of individual foods must also change in such a way that he or she also treats himself or herself to formerly forbidden foods because they taste good to him or her. Inpatient therapy is an option here. However, there are also outpatient options. Psychological support or psychotherapy can consolidate the success of the treatment and effectively change old thought patterns. Basically, in orthorexia nervosa, the patient must absolutely cooperate in his recovery, otherwise all measures to gain weight will fizzle out and he will return to the usual thinking patterns immediately after discharge from therapy.
Outlook and prognosis
A prognosis in the condition called orthorexia nervosa is not easy to make. Those affected eat a decidedly healthy diet. However, the health value of the food eaten is evidenced by a fanatical attitude and unhealthy behaviors toward food. Anything that is not considered healthy based on ingredients or other criteria is not consumed as food. The narrow selection of foods considered healthy can lead to suffering. It can cause psychological distress to those affected. Orthorexia nervosa often leads to hours of preoccupation with healthy foods. In this respect, medical experts do not agree whether orthorexia nervosa can be put on a par with eating disorders such as anorexia nervosa and bulimia nervosa. The fact is that orthorexia nervosa often causes no damage to health on the physical level. However, the self-imposed food taboos and rules can severely limit food choices. If pathologization of food choices occurs due to orthorexia nervosa, there is at least a psychological disorder. It is difficult to communicate the pathological value of their behavior to the affected persons. The prognosis is positive in itself if psychotherapy can uncover and correct the causes of the eating disorder. However, the fixation on healthy foods is controversially discussed among experts. The decisive factor for orthorexia to be recognized as a disease is the degree of suffering.
Prevention
Measures for the prevention of orthorexia nervosa exist only to a limited extent. As soon as preoccupation with eating exceeds a normal level and affects, for example, the performance of daily duties or leads to permanent neglect of social contacts, personal eating behavior should be assessed self-critically.The earlier orthorexia nervosa is counteracted, the easier it will ultimately be to treat in the long term.
Follow-up
In the case of orthorexia nervosa, the measures and options for aftercare prove to be relatively difficult in most cases or are not even available to the patient. The affected person should primarily see a doctor very early in this disease, so that it does not come to other complications or complaints, which can have a negative impact on the quality of life and also on the everyday life of the affected person. As a rule, self-healing cannot occur, so that a doctor should be consulted at the first signs. Often, relatives or friends also have to point out the symptoms of orthorexia nervosa to the affected person, and in some cases treatment in a closed clinic may be necessary. Most of the affected persons depend on the help and also on the support of their own family during the treatment. Psychological support is also very important, which can prevent depression and other psychological upsets. At the same time, strict control of food is very important, so that a possible relapse does not occur. The further course of orthorexia nervosa is thereby very much dependent on the manifestation of the disease, so that a general prediction can not be made thereby.
What you can do yourself
After the actual treatment of orthorexia nervosa, follow-up care is very important, so that secondary diseases can be avoided and to prevent relapses. If medical underweight is still present after acute treatment, it should definitely be treated during follow-up. A healthy body weight is important so that many bodily functions, such as body temperature and immune system, can function properly again. Psychotherapeutic therapy is very helpful in most cases during the follow-up of orthorexia. A good contact with the therapist can prevent a relapse into orthorexia. In any case, an important point for follow-up is to treat the underlying cause beforehand. If the cause is not treated beforehand, successful aftercare is not possible. Long-term deficiency symptoms may result from orthorexia nervosa. During aftercare, it is important to compensate for these deficiency symptoms even after treatment. If this is not done, the consequences of deficiency symptoms such as osteoporosis, hair loss, etc. can occur. For some patients, even after treatment, it is difficult to eat foods normally that they avoided during the disease. Here, an exchange with former sufferers can be useful for aftercare. Depending on the daily situation of the affected person, a low-stress lifestyle is recommended so that there is enough time for self-care. This is especially important in the first period. For this purpose, it may be helpful to possibly reduce the workload, avoid stressful contacts or make arrangements for any therapeutic-related absences.
