Dr. Steven Bratman, a general physician and contributor to the natural eating movement, first coined the term orthorexia nervosa in 1997. The disorder is defined as a pathological obsession for biologically pure foods. This fixation on a healthy diet and intense fear of eating anything contaminated can result in elimination of entire food categories, malnutrition, weight loss, and intense social isolation. It is important to note that the desire to eat healthy goods is not pathological itself; the disorder lies in the obsessive, persistent approach to diet along with the withdrawal from life this food habit causes. Orthorexics dedicate a large amount of time to the planning, purchase, preparation, and consumption of food considered to be healthy. Their eating behavior generates a feeling of superiority, and they may refuse to eat away from their home. Ultimately the quality of food consumed is more highly valued than social relationships, personal values, or career plans. Although the term has existed for almost twenty years, studies on orthorexia are not sufficient enough for it to have valid diagnostic criteria. Therefore, it is not included in the DSM or ICD-10. Two diagnostic tools do exist, Bratman’s Orthorexia Test (BOT) and the ORTO-15; however, there is a need for increased reliability in these instruments to allow for a more thorough investigation of the disorder.
Orthorexia in comparison to anorexia nervosa
Patients with orthorexia, like those with anorexia, give food an immensely disproportionate place in the scheme of life. Orthorexics and anorexics share obsessive personality traits as well as the denial of feelings, conflicts, and bodily signs of fatigue and weakness. Despite these similarities, there are key distinctions between the two disorders.
In order to treat orthorexia, a multidisciplinary team must be in place. This team should include physicians, dietitians, and therapists. Clinicians should work with orthorexic patients to help them realize their behavior is problematic, learn to eat without becoming obsessive, and understand that overall health is determined by more than the quality of food consumed. On the one hand, treatment can be difficult because those with orthorexia may reject weight-gain aids due to their artifical ingredients or medications because they consider them to be unnatural. On the other hand, patients with orthorexia tend to respond better to treatment than other eating disorder patients due to their concern about their health and self-care.
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Ramacciotti, C. E., Perrone, P., Coli, E., Burgalassi, A., Conversano, C., Massimetti, G., & Dell’Osso, L. (2011). Orthorexia nervosa in the general population: A preliminary screening using a self-administered questionnaire (ORTO-15). Eating and Weight Disorders- Studies on Anorexia, Bulimia, and Obesity, 16(2).