Orthorexia nervosa
Encyclopedia
Orthorexia nervosa is a term used by Steven Bratman to describe people who have developed a fixation with healthy or righteous eating and has been referred to as a mental disorder. It is not a medically recognized term.
Bratman claims that in rare cases, this focus may turn into a fixation so extreme that it can lead to severe malnutrition or even death. Even in less severe cases, the attempt to follow a diet that cannot provide adequate nourishment is said to lower self-esteem as the orthorexics blame themselves rather than their diets for their constant hunger and the resulting cravings for forbidden foods.
The term orthorexia derives from the Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...

 ορθο- (ortho, “right" or "correct”), and όρεξις (orexis, "appetite"), literally meaning a correct diet. It was introduced in 1997 by Colorado Doctor of Medicine
Doctor of Medicine
Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...

 Steven Bratman, to be used as a parallel with other eating disorder
Eating disorder
Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...

s, such as anorexia nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...

.

History

Bratman coined the term in 1997 from the Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...

 orthos, "correct or right", and orexis for "appetite". Literally "correct appetite", the word is modeled on anorexia
Anorexia (symptom)
Anorexia is the decreased sensation of appetite...

, "without appetite", as used in definition of the condition anorexia nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...

. Bratman describes orthorexia as an unhealthy fixation
Fixation (psychology)
Fixation: 'concept originated by Sigmund Freud to denote the persistence of anachronistic sexual traits'. Subsequently '"Fixation" acquired a broader connotation...

 with what the individual considers to be healthy eating. The subject may avoid certain unhealthy foods, such as those containing fat
Fat
Fats consist of a wide group of compounds that are generally soluble in organic solvents and generally insoluble in water. Chemically, fats are triglycerides, triesters of glycerol and any of several fatty acids. Fats may be either solid or liquid at room temperature, depending on their structure...

s, preservative
Preservative
A preservative is a naturally occurring or synthetically produced substance that is added to products such as foods, pharmaceuticals, paints, biological samples, wood, etc. to prevent decomposition by microbial growth or by undesirable chemical changes....

s, man-made food-additives, animal product
Animal product
Animal product, or animal by-product, is a term used to describe material taken from the body of a non-human animal. Examples are fat, flesh, blood, milk, eggs, and lesser known products such as isinglass and rennet....

s, or other ingredients considered by the subject to be unhealthy; if the sufferer does not eat appropriately, malnutrition can ensue. Bratman claims Orthorexic sufferers have specific preferences about the foods they are eating and avoiding. Products that are preserved with additives can be considered dangerous. Industrial products can be seen as artificial, whereas fruits and vegetables can be seen as healthy. Bratman asserts that "emaciation
Emaciation
Emaciation occurs when an organism loses substantial amounts of much needed fat and often muscle tissue, making that organism look extremely thin. The cause of emaciation is a lack of nutrients, starvation, or disease....

 is common among followers of certain health food diets, such as rawfoodism, and this can at times reach the extremes seen in anorexia nervosa." In addition, he claims that "anorexic orthorexia" can be as dangerous as anorexia. However, he states, "the underlying motivation is quite different. While an anorexic wants to lose weight, an orthorexic does not desire to become thin but wants to feel pure, healthy and natural. Eating disorder specialists may fail to understand this distinction, leading to a disconnect between orthorexic and physician."

According to the Macmillan English Dictionary, the word is entering the English
English language
English is a West Germanic language that arose in the Anglo-Saxon kingdoms of England and spread into what was to become south-east Scotland under the influence of the Anglian medieval kingdom of Northumbria...

 lexicon
Lexicon
In linguistics, the lexicon of a language is its vocabulary, including its words and expressions. A lexicon is also a synonym of the word thesaurus. More formally, it is a language's inventory of lexemes. Coined in English 1603, the word "lexicon" derives from the Greek "λεξικόν" , neut...

.

Diagnostic criteria

Although Orthorexia is not recognized as a mental disorder by the American Psychiatric Association, and it is not listed in the DSM-IV
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

or planned to be included in the DSM-V to be published May 2013, it is still used as a diagnosis by some practitioners who have documented the damaging results of the condition as they have seen in their practices.

As of January 2007, only two peer-reviewed studies have been published on the alleged condition. In the studies, Donini et al. define orthorexia nervosa as a "maniacal obsession for healthy foods" and propose several diagnostic criteria. Sufferers of orthorexia often display symptoms consistent with obsessive-compulsive disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...

 and have an exaggerated concern with healthy eating patterns. Like anorexia, however, these obsessive compulsive symptoms may be an effect of starvation rather than a cause of the disorder. A diagnostic questionnaire has been developed for orthorexia sufferers, similar to questionnaires for other eating disorders. Bratman proposes an initial self-test composed of two direct questions: "Do you care more about the virtue of what you eat than the pleasure you receive from eating it?... Does your diet socially isolate you?" Other questions concerning those who may be suffering from orthorexia provided by Davis on the WebMD (2000) website are: Do they spend more than 3 hours a day thinking about healthy foods? When they eat the way they're supposed to, do they feel in total control? Are they planning tomorrow's menu today? Has the quality of their life decreased as the quality of their diet increased? Have they become stricter with themselves? Does their self-esteem get a boost from eating healthy? Do they look down on others who don't eat this way? Do they skip foods they once enjoyed in order to eat the "right" foods? Does their diet make it difficult for them to eat anywhere but at home, distancing them from family and friends? Do they feel guilt or self-loathing when they stray from their diet? If yes was answered to two or more questions, the person may have a mild case of orthorexia.

Symptoms and theory

Symptoms of orthorexia nervosa may include obsession with healthy eating, and emaciation
Emaciation
Emaciation occurs when an organism loses substantial amounts of much needed fat and often muscle tissue, making that organism look extremely thin. The cause of emaciation is a lack of nutrients, starvation, or disease....

 among other things. Orthorexic subjects typically have specific feelings towards different types of food. The obsession for healthy foods could come from a number of sources such as family habits, society trends, economic problems, recent illness, or even just hearing something negative about a food type or group, which then leads them to ultimately eliminate the food or foods from their diet.
According to the abstract of a 2004 study quoted on PubMed
PubMed
PubMed is a free database accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine at the National Institutes of Health maintains the database as part of the Entrez information retrieval system...

, a service of the National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...

, "The analysis of the physiological characteristics, the social-cultural and the psychological behaviour that characterises subjects suffering from ON shows a higher prevalence in men and in those with a lower level of education."

Biology of orthorexia nervosa

There has been no investigation into whether there may be a biological cause specific to orthorexia nervosa. However, Donini et al. link orthorexia to a food-centered manifestation of obsessive compulsive disorder, which has a lot to do with control.

See also

  • Comfort food
    Comfort food
    Comfort food is food prepared traditionally that may have a nostalgic or sentimental appeal. Comfort foods may be foods that have a nostalgic element either to an individual or a specific culture...

  • Emotional eating
  • Diet
    Diet (nutrition)
    In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management...

  • Coping (psychology)
    Coping (psychology)
    Coping has been defined in psychological terms by Susan Folkman and Richard Lazarus as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing" or "exceeding the resources of the person".Coping is thus expending...

  • Food guide pyramid
    Food guide pyramid
    A food guide pyramid is a triangular or pyramid-shaped nutrition guide divided into sections to show the recommended intake for each food group. The first food pyramid was published in Sweden in 1974. The most widely known food pyramid was introduced by the United States Department of Agriculture...

  • Chemophobia
    Chemophobia
    Chemophobia literally means "fear of chemicals", but the term may be used in various ways. It is most often used to describe the assumption that "chemicals" are bad and harmful, while "natural" things Chemophobia literally means "fear of chemicals", but the term may be used in various ways. It is...

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