January 25, 2009 Jeanne Rust

Metabolic Fitness

This month's Mirasol newsletter addresses a new kind of eating disorder called "orthorexia" (sometimes called "orthorexia nervosa"). Orthorexia is a condition that named by Steven Bratman, MD, in 1997.

Dr. Bratman describes orthorexia as an unhealthy obsession (as in obsessive-compulsive disorder) with what the person considers to be healthy eating. The sufferer may avoid certain foods, such as those containing fats, preservatives, animal products, or any other kinds of foods that the person considers to be unhealthy.

Dr. Bratman goes on to say that anorexic orthorexia can be as dangerous as anorexia. The main thing for everyone to know is that the underlying motivation is very different between orthorexia and anorexia. An anorexic wants to lose weight, while an orthorexic wants to feel pure, healthy and natural. Orthorexia is not a recognized diagnosis and is not listed in the DSM-IV, but it can be a dangerous diagnosis nevertheless.

People with orthorexia often have much in common with anorexic patients. They are very careful, detailed and tidy persons with an exaggerated need for self-care and protection.

As of January 2007, two peer-reviewed studies had been published on the condition. In the studies, Donini et. al. define orthorexia nervosa as a "maniacal obsession for healthy foods." Sufferers often display symptoms similar to those of obsessive-compulsive disorder.

Dr. Bratman proposes an initial self-test consisting of two questions:

  1. "Do you care more about the virtue of what you eat than the pleasure you receive from eating it?"
  2. "Does your diet socially isolate you?"

Dr. Bratman tells the story of Kate Finn, a young woman who died in December, 2003, of orthorexia. He relates:

Kate was a wonderful woman who contacted me just prior to the publication of Health Food Junkies and influenced my writing of it. Later, she gave media interviews about orthorexia, and posted an article on www.beyondveg.com discussing her recovery from it. Sadly, this recovery was not as complete as she hoped. She recently died of heart failure brought on by orthorexia-induced starvation.

In her article, Kate tells of a time when doctors diagnosed her with anorexia. She resisted the diagnosis and their recommended treatment. It just didn't seem to fit. She wasn't afraid of being fat. She didn't want to be thin. She just wanted to eat healthy food.

Nonetheless, she brought her weight down so low she ultimately died from it.

Most often, orthorexia is merely a source of psychological distress, not a physical danger. However, emaciation is common among followers of certain health food diets, such raw foodism, and this can at times reach the extremes seen in anorexia nervosa.

Such "anorexic orthorexia" is just as dangerous as anorexia. However, the underlying motivation is quite different. While an anorexic wants to lose weight, an orthorexic wants to feel pure, healthy and natural. Eating disorder specialists may fail to understand this distinction, leading to a disconnect between orthorexic and physician.

Whatever the motivation, there's nothing healthy and natural about starving yourself to death or becoming malnourished. If you're obsessed with making sure you're eating a healthy diet, and yet people tell you that you seriously underweight or your obsessive behavior is causing problems for you in your life, please take Kate's story to heart. You may not be anorexic in the ordinary sense, but what you have might kill you.

I am including the references in case any of you would care to do more research or reading on this topic.

  1. The Orthorexia Home Page by Steven Bratman, MD
  2. Health Food Junkies Essay by Bratman, reprinted from Yoga Journal, October 1997
  3. S. Bratman, D. Knight: Health food junkies. Broadway Books, New York, 2000.
  4. Palo Alto Medical Foundation Summary of Eating Disorders
  5. Macmillan English Dictionary entry for Orthorexia Nervosa
  6. Orthorexia nervosa
  7. Web MD report: Orthorexia: Good Diets Gone Bad
  8. Orthorexia: Too Healthy? Specialists have coined a new term-orthorexia-to describe an obsessive concern with healthy eating that often leads to social isolation, Psychology Today, Sept/Oct 2004.
  9. Observer Guardian Newspaper, Sept 9, 2001, column reporting on Orthorexia
  10. Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2004). "Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon".
  11. Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2005). "Orthorexia nervosa: validation of a diagnosis questionnaire".
  12. McCandless, David (29 March 2005). 'I am an orthorexic'", BBC News.