They are not concerned with the “how much” of their food, like the anorexics, but with the right quality. And to get this right, hours of the day may be spent ruminating about the content of the food ingested. What is seen by some doctors rather as a fad, is made out by others as a precursor of anorexia or as an obsessive-compulsive disorder; some even see it as an independent clinical picture.
Orthorexia nervosa
The “new disease” was discovered in 1997 by alternative medicine practitioner Steven Bratman. He derived the name from the long-known clinical picture of the eating disorder anorexia. This exists in two forms, but both have in common a preoccupation with the quantity of food: whether in the form of pubertal anorexia (anorexia nervosa), food intake is drastically reduced, or in anorexia bulimia, phases of compulsive fasting alternate with bouts of ravenous hunger.
Orthorexia: diet and symptoms
In orthorexia (orthos= right; orexis = appetite), however, the focus is now not on the quantity but on the quality of the food. Affected people are pathologically fixated on healthy food and try to avoid unhealthy. And this can take on absurd proportions: They spend hours of the day poring over nutrition tables, checking the vitamin content of the foods they eat, and trying to get ever “healthier” foods – even if, for example, they have to order their millet in Africa.
As a result of this excessive scrutiny – further exacerbated by the frequent food scandals in the media (such as BSE, acylamide, etc.) – more and more foods are falling through the cracks because they no longer meet the quality criteria on which they are based, for example because they are allegedly contaminated with harmful substances, are carcinogenic or allergenic, or are unhealthy for other reasons. At the end of this “nutritional career,” which is geared toward the “healthy,” those affected usually live vegan lives, i.e. they only eat vegetables and fruit – and buy their food from health food stores or order it on the Internet.
Orthorexia: consequences of the disease
Not only does the desire to eat fall by the wayside, but there are also significant deficiency symptoms – and, of course, underweight. If those affected turn to a doctor, then with symptoms such as sleep and concentration disorders, listlessness and a reduced performance.
The extreme fixation on healthy food also has social consequences. For those who eat in such an extreme way can no longer join in social gatherings or have to bring their own food. Those affected also marginalize themselves by trying to convert those around them to a healthier life with a great sense of mission.
Orthorexia: cause need for control
Some medical experts do not see the eating disorder known in specialist circles as orthorexia nervosa as an independent clinical picture, but rather as an obsessive-compulsive disorder, which may well lead to a manifest eating disorder (such as anorexia). Others consider the fixation on healthy food to be a partial symptom of a pre-existing eating disorder. Because of these difficulties in classification, orthorexia nervosa is not (currently) included in either the international or the German classification of diseases. It is therefore not officially recognized as an independent clinical picture.
As with anorexia patients, the need for control is seen as a possible cause. By regulating food intake, this control, which has been lost in other areas of life, is restored. In this way, anxiety and a general reduction in self-esteem can be compensated for. Affected are – also here a parallel to anorexia – mainly young, mostly educated women between the second and fourth decade of life. They often get into the vicious circle of healthy eating via a diet for weight reduction or a dietary measure in connection with a (chronic) illness.
Orthorexia: therapy and treatment
Orthorexia is treated like an eating disorder. The aim is to return to a “normal” eating behavior and to be able to live out food intake in a relaxed manner again. Those affected must learn to “treat” themselves to something again that simply tastes good, without asking about health aspects or nutritional values. If the weight loss is very pronounced, psychotherapy for orthorexia nervosa may be necessary.
