Orthorexia – An Unknown Eating Disorder

Eating disorders organisations in Ireland have recognised a rise in the number of people developing a psychological disorder centred on obsession with healthy eating, called ‘orthorexia’.

With obesity consistently hitting the headlines, we can find ourselves pestered by conflicting information about healthy eating from the media. But groups such as the Eating Disorder Resource Centre have noted increasing numbers of people with a fixation on righteous eating and avoiding food perceived to be unhealthy, so much so that they can develop orthorexia.

Orthorexia isn’t currently recognised as a medical condition but is classified under the EDNOS category, or ‘eating disorders not otherwise specified’ along with other disorders like binge eating disorder in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM). Dr Steve Bratman, a Californian doctor, first coined the phrase ‘orthorexia nervosa’ in 1997 to diagnose his overly diet-obsessed patients.

Orthorexics usually have many rules about their eating habits. Many cut out lots of ingredients at the same time in order to feel ‘pure’, like gluten, salt, caffeine, dairy, corn, alcohol, yeast and soya. But this might only be the start of their diet restrictions . Any foods that could have contact with pesticides are banned and some will only eat macrobiotic, organic or diets for a specific blood type. The disorder can change from person to person but many orthorexics become malnourished due to an incomplete diet. People suffering from this disorder often feel a sense of moral superiority about their diet, which can put stress on their relationships and isolate them from family and friends.

St Patrick’s University Hospital in Dublin is one of the only healthcare services in Ireland that treats eating disorders and does so at their day programme and inpatient Eating Disorder Service. A source at the hospital says that many orthorexia sufferers don’t feel like they have a problem until they start to notice other parts of their lives being disrupted.

“We have had only one patient attending for assessment, in the past 18 months, who might fit with the suggested criteria. One possible reason for such a low number is the fact our assessment clinic is specifically for patients with eating disorders and patients with orthorexia do not consider they have an eating disorder and hence will not attend, often only attending a GP or counsellor to help manage other areas in their lives that have been affected.”

Orthorexia, though a huge problem in the US, has only started to appear in Ireland recently. The only places in the country able to deal with this type of eating disorder are specialist clinics dedicated to the treatment of eating disorders, such as St Patrick’s University Hospital and the Eating Disorder Centre in Cork (EDCC). Although orthorexia was first diagnosed in 1997, it has only been recognised in recent years in Ireland and only a few are diagnosed every year because, as Ms O’Connor says, most don’t class it as an eating disorder. Sufferers can overcome the disorder but it is difficult as it is necessary to treat the obsessive-compulsive traits seperately from the eating disorder itself. It is notoriously difficult to diagnose due to its complex nature and can combine characteristics from lots of different eating disorders. However, unlike anorexics and bulimics, Dr Bratman claims on his website the motivation isn’t to lose weight but to gain a feeling of perfection and purity. This is why opinions are divided as to whether orthorexia is an eating disorder or just a strain of obsessive-compulsive disorder (OCD).

This source added that anorexia and orthorexia have different traits but OCD is a common factor in both and is treated as a separate disorder in order to treat the overall condition successfully. “There is a marked difference between orthorexia and anorexia in terms of diagnostic criteria. DSM (Diagnostic and Statistical Manual of Mental Disorders) IV, among other criteria, frame anorexia nervosa as the refusal to maintain body weight and intense fear of becoming fat. This is not reported in people with orthorexia, where emphasis is not on body weight or shape.

“OCD is a feature often seen in eating disorders, particularly with those with anorexia, therefore we would look at treating both the eating disorder and the OCD symptoms rather than diagnosing patients with one or the other and focusing on that alone.”

Trish Shiel, Clinical Manager at the EDCC treats a whole range of eating disorders, including orthorexia and ‘night eating syndrome’. She says like any other eating disorder, it is very easy to shift from a strict diet into a disorder and although she doesn’t treat a lot of patients with orthorexia on its own, she can see the symptoms in clients with other disorders. “We wouldn’t have a lot of cases of full-blown orthorexia – we’d see maybe one a year – but I would see it creeping into other disorders with other clients. It can be the same as anorexia, there is going to be starvation and a lack of nutrition.

“You start off with a diet, cutting out ordinary food just to lose weight, then becoming vegetarian followed by vegan and I think that helps then to move onto a disorder. It’s going to feed that whole distorted thinking around the pure food, it’s just as easy as any other eating disorder,” Ms Shiel added.

With no research done in Ireland, there is little evidence of severe health risks but there can be with a diet as strict as this. The risks of orthorexia can include malnutrition, psychological harm and in severe cases, death. In ‘What is Orthorexia?’ one of the few research papers written about the disorder, published in the Journal of the American Dietetic Association, Jennifer Mathieu spoke to Bratman who wrote Health Food Junkies, a book about orthorexia that is no longer in print. Bratman spoke about a woman he was treating whose strict healthy diet led to starvation-induced heart failure and she later died. This woman had been repeatedly been diagnosed with anorexia, even though her obsession was not with losing weight but with feeling pure and healthy.

Suzanne Horgan, founder of the Eating Disorder Resource Centre of Ireland (EDRC) says that the pathological need to stay on the diet can lead to consequences like this and that a healthy diet is key to avoiding this. “The health risks are limiting the amount of nutrients that a person is getting because, you’re missing out on essential nutrients that are necessary for the body and the brain to work effectively because we need a combination of protein, fat, carbohydrate, you need that combination in order to function properly.”

Ms Horgan thinks the HSE and other governing bodies can do so much more to tackle the issue of orthorexia or just educate people about its existence. “I think highlighting awareness of what orthorexia is, of how easy a person can fall into it and just educate people around the importance of a healthy food plan, which involves all of the food groups is very necessary.

“I think it would be really good for the HSE and for governing bodies to, not just put out warnings and to talk about the perils, but to actually educate people around what is healthy, what is safe, what is necessary and to have support and structures in place for people that are struggling and feel that they need to get more information about what they’re doing,” she added.

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