But something was wrong. Younger’s extreme dedication to planning, preparing, and consuming the “pure” diet she espoused — no animal products, no cooked food, no oil, no wheat, no sugar — was making her ill. Younger had become so restrictive and unbalanced in her diet that she began to experience physical health issues. Her hair was falling out in clumps, her period had stopped, her hunger pangs were intensifying, and instead of feeling happy, she felt anxious, irritated, and isolated. That’s when Younger came across the term orthorexia nervosa, which had been coined by a doctor named Steven Bratman, MD, MPH, to describe some patients whose preoccupation with “healthy," “pure,” or “clean” eating had spiraled out of control and become an eating disorder. Symptoms include not being able to relax one’s “good food” rules for special occasions, and feeling guilty, anxious, and impure if “unhealthy” food is consumed. “They had reduced the dimensionality of their human lives by assigning excessive meaning and power to what they put in their mouths,” Dr. Bratman explained in the September 2017 issue of the journal Eating and Weight Disorders. (1) “Their exuberant pursuit of physical health had spawned a rigid, fearful and self-punishing lifestyle that caused more harm than good.” RELATED: What Is a Vegan Diet? A Comprehensive Guide to Following the Meat-Free, Plant-Based Eating Approach
Fear of Not “Eating Right” Is a Growing Problem
Disguised as a virtue, “orthorexia makes someone so fearful of not eating ‘right’ that it begins to interfere with everyday functioning,” explains Mia Holland, a doctor of education and an assistant professor of psychology at Bridgewater State University in Massachusetts. If people are not meeting their caloric requirements or getting enough variety in their diet, malnutrition, severe weight loss, or other medical complications may follow. (2) As Younger recalled in her book Breaking Vegan: One Woman’s Journey From Extreme Dieting and Orthorexia to a More Balanced Life, she suddenly realized that, like Bratman’s patients, “food was an obsession for me just as the intense avoidance of certain foods was an obsession. The more I emphasized food avoidance, the more I obsessed over food.” Unlike other eating disorders, such as anorexia, bulimia, and binge eating disorder, orthorexia is not recognized in the current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). But that didn’t prevent the association from devoting a workshop to the condition at its annual meeting last year. “Clearly there is more interest in this diagnosis and more case reports coming forward,” explains Steven Crawford, MD, a session moderator and the codirector of the Center for Eating Disorders at Sheppard Pratt in Baltimore.
When Does a Focus on Healthy Eating Become Unhealthy?
Orthorexia is especially easy to “contract” nowadays given the never-ending parade of books and programs purporting to help people “Crush cravings!” “Stay lean for life!” “Prevent and reverse disease!” “Enjoy high energy!” — and, presumably, enjoy optimal health, through “clean” eating. When the benefits are heralded this way, it doesn’t take much for someone who is vulnerable to an eating disorder to view strict adherence to the diet’s rules as a path away from illness instead of a path toward it, says Cortney Warren, PhD, an assistant professor of psychology at the University of Nevada in Las Vegas. “There’s a lot of social reinforcement for becoming obsessive about food.” Clearly, not everyone who buys these books develops an eating disorder. So at what point does it cross the line? Bratman, the author of the book Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession With Healthful Eating, says it evolves in two stages. “The first is innocent, generally laudatory: choosing to eat a healthy diet. The second involves an intensification of that pursuit into an unhealthy obsession. It is only this subsequent stage that implicates pathology.” (1) In other words, simply having some weird eating habits, wanting to avoid the chemicals in processed foods, or even cutting out certain food groups by following, say, a vegetarian, vegan, or gluten-free diet does not mean you have orthorexia, says Dr. Holland. Constantly thinking about what you eat or developing rigid rituals and rules around food might, though. Frequently fasting or going on radical elimination diets to “cleanse” (partial fasts) is another red flag, because those “purifying” or “detoxifying” behaviors can actually be evidence of a punishing desire to lose weight. “The real difference between a person who just wants to be healthy and someone with an affliction worthy of a diagnosis and some intervention is that it impairs their interpersonal functions, their interactions with friends and family, and their emotional well-being,” Holland explains. “When someone won’t go to social functions because they’re afraid of being exposed to foods that may not be healthy, it’s a problem.”
Do You Have Orthorexia?
If you’re a healthy-diet enthusiast who wonders if you have a problem, you can get a preliminary idea by taking this simple self-test devised by Bratman. (3) If you answer yes to any of the following questions, you may be developing orthorexia. RELATED: How to Spot Eating Disorders in Men
The Path to Wellness
The dilemma doctors and mental health professionals face when treating orthorexia is how to convince their patients to step back from what they view as a righteous, ideal behavior. “To ask a patient to relax her diet is tantamount to suggesting she embark on a life of crime,” Bratman says of his experience with some of these patients. “I might as well advise, ‘Go and commit some larceny. Drive drunk a little. It will be good for you.’” That’s why Holland favors a multilayered approach to treatment: educating patients about healthful eating, behavioral interventions (such as having them test eating A, B, and C and asking, “What were the side effects? Were there any symptoms that you can relate directly to the food?”) and using psychotherapy and mindfulness practices to address contributing issues, such as anxiety, obsessive compulsive disorder (OCD), or mood disorder. After realizing that her “pure” diet was doing more harm than good, Younger announced on her blog that she was easing up on it and changed the blog’s name to The Balanced Blonde. The reaction was swift and overwhelmingly hostile. She lost tons of followers overnight and even received a few death threats. But she also quickly gained new followers (202,000 now and counting), drawn to her fresh, less rigid approach to eating. As Younger explained to her followers, “It’s time to advocate a lifestyle that doesn’t involve restriction, labeling, or putting ourselves into a box. I am extremely passionate about eating ethically and eating whole, plant-based foods from the earth. My original passion for health stemmed from learning about real foods and how they affect our bodies versus chemically produced and factory farmed disgustingness that is not food. But that doesn’t mean that living life in moderation is a sin. It’s a beautiful thing.” (4)
