Obsessed by eating right – Orthorexia nervosa
Orthorexia nervosa – definition
= the compulsive fixation on the exclusive consumption of foods that are subjectively assessed as healthy, while at the same time avoiding "unhealthy" foods.
The consequences can be distress, malnutrition, underweight and mental instability.
Orthorexia nervosa is not listed in the ICD-10 international classification system or the United States DSM-5 classification system.
Orthorexia nervosa – clinical picture
Orthorectics suffer from exaggerated worries, that food could be contaminated, follow strict nutritional and food preparation rules, and spend a lot of (mental) time and effort on getting the „right“ food. This behavior has a compulsive nature.
Bratman assigned orthorexia nervosa to the avoiding / restrictive eating disorders, and in 2016 proposed the following diagnostic criteria:
|Criterion A:||Compulsive preoccupation with „healthy food“, focusing on questions regarding the quality and composition of the food (two or more of the following items must be present):|
• Adhering to an unbalanced diet due to compulsive preoccupation with the „purity“ or „quality“ of the food.
• Worries about eating unclean or unhealthy food, dealing with the impact that the quality of food has on physical and emotional health.
• Strictly avoiding „unhealthy“ foods such as fatty foods, preservatives, food additives, animal foods, or other ingredients that the person concerned considers unhealthy.
• Occupation well above average in time (e.g. three or more hours a day) reading about, procuring or preparing specific foods based on their assumed quality and composition – without professional reason.
• Feelings of guilt and worry after consuming “unhealthy” or “impure” food.
• Intolerance to other views on food.
• Excessive financial expenditure on food in relation to income due to its assumed quality and composition.
|Criterion B:||Compulsive occupation with food leads to problems (at least 1):|
• Impairment of health due to an unbalanced diet (malnutrition).
• Intense personal suffering, or impairment of private or professional functioning due to obsessive thoughts and compulsive actions that revolve around healthy eating.
|The behaviour is not a symptom of another disorder (OCD, schizophrenia, or other psychiatric illness).|
|The behavior is also not explained by strict adherence to other diet restricitions (e.g. traditional religious diet regulations or a medically prescribed diet).|
Due to the lack of uniform diagnostic criteria for the disease, there is no information about its frequency or on psychosocial, genetic, neurobiological and psychophysiological components.
Orthorexia nervosa – society
Orthorexia nervosa is closely related to certain nutritional trends in society, such as paleo-diet and veganism, to which their proponents regularly ascribe health benefits, while scientific studies on the claimed health effects are often missing. As with orthorexia, loudly advocating certain diets is – interestingly – not only about healthy eating, but often also about self-expression and increasing self-esteem while devaluing “non-believers”. What and when we eat, where we eat, with whom we sit together at the table says more about us than our clothes and our car would. „Food“ becomes a vehicle of individual style and the expression of an idea about the self.
In addition, suspicious control of parents over their children’s nutrition, zealously watching over „healthy eating“ and the division of foods not only into healthy and unhealthy ones, but – above all – also morally good or bad foods, contributes to the development of a eating disorder. Such a parenting style relentlessly walls up unforgiving superego structures with immovable values and norms. An indisputably useful healthy diet becomes the touchstone of the distinction between good and evil itself, and the choice of food becomes a substitute religion in the service of self-optimisation and -enhancement.
Orthorexia nervosa – self-image
The disorder has a striking proximity to anxiety disorders and obsessive-compulsive disorders. Anorexia and orthorexia have also different characteristics and behaviours in common. Those affected are characterized by perfectionism, are self-controlled but fearful, follow strict nutritional rules and consider breaking these rules as a lack of self-discipline which in turn is penalised by even stricter rules and self-punishment. (However, while the concerns of patients with eating disorders primarily relate to their body image and weight, orthorectics mostly worry about their health.) Common to all is a powerful unconscious defense against equally unconscious conflicts.
During the development of every child occur needs, that seem to contradict each other completely: attachment and detachment, dependence and autonomy, security and urge for exploration, selfishness and altruism, submission and control, identity and loss of identity, desire and renunciation, etc. Conflicts that arise from these contradictions, as well as their successful or unsuccessful solutions, shape the personality of an individual as conscious and unconscious memories, and determine the development of his psychic self-representations (picture of himself), his object representations (picture of others) and his relationship representations (own experiences in relationships and of relationships of others).
While a child is e.g. learning to walk, on the one hand it is still very dependent on the mother and wants to be close to her, on the other hand it wants to savour its freedom and move away. Therefore, it keeps checking: „How does my mom react? Am I allowed to do that? Is she worried? Is she afraid for me? Does she find it good? ”A forbidding, strict or very fearful attitude of the caregiver prevents the successful solution of the dilemma between autonomy and dependence through unsettling relationship experiences, and can later, in adulthood, lead to a compulsive need for security or pedantic accuracy as a defence against chaos, uncertainty and fear.
This is closely linked to the development of the self-value system, i.e. a knowledge and feeling about the value and meaning of one’s own being. A person’s self-value system is an internal regulatory system that includes self-image, body image, and self-esteem. It develops from relationship experiences. The self-value system is threatened in its balance by offenses, conflicts, disappointments, but also by strokes of fate, advancing age, illness and death. Ensuring self-esteem is a constant task. And this regulation is sometimes more, and sometimes less successful. Maintaining and restoring sufficient self-esteem is one of the basic motivations for humans.
If the self-value system remains unstable and threatened by constant questioning, conflicts, frustrations, rejections, disappointments or even losses (e.g. of beauty, skills or recognition) can be endured poorly or not at all. The world is experienced as failing and hostile. And own needs, as well as own anger and shame need to be hidden from the world and from others. If no stable self-objects are available, a lasting stable and independent of self-value is missing. Whoever feels unconsciously constantly threatened in his self ,will try to stabilise himself through compensation mechanisms, e.g. overconfidence and self-idealisation, devaluation of others, through constant self-aggrandisement, search for recognition, but also by hostility and withdrawal. The arrogant and zealous attempts of preaching about food choices to others, who are neither acknowledging nor willing to share an orthorectic idea of health and moral superiority, can be traced back to such attempts to stabilise self-esteem.
Unrelenting internalised norms also contribute to this attitude: “What do I think my parents expect from me, how I should be or what I should do? Ho do I want to be? Am I good enough? Am I disappointing my parents? ”A child expects a punishment for what he does, in adults unconscious feelings of guilt and fear will arise in a conflict between ego and super-ego. With fanatical pickiness about food, pollution, contagion, danger, disorder or evil shall be avoided. Character traits such as exaggerated orderliness, cleanliness, economy, rigidity, over-correctness are building the framework for this development. Anxiety, psychosomatic illnesses, failure to perform, burnout due to persistent overwhelming oneself, but also social phobias and depression are possible consequences.
Instead of „tasting“ foods, deliberately tasting them in their fullness, food becomes a vehicle of self-optimisation fuelled by the media: if you want to belong, you have to fit into certain ideal of beauty, have a certain percentage of body fat and a certain appearance. Self-affirmation no longer arises from enjoyable self-experience, but from renunciation and an imagined triumph over supposed underclass behaviours, such as unrestrained greed and obesity.
Orthorexia nervosa – treatment
Since orthorexia is associated with deep conviction of “eating right“, the main obstacle to treatment will be a completely unwillingness to change from the outset. Treatment will become necessary though, in the event of malnutrition and personal suffering. As of today, there are no treatment recommendations. Information and nutritional advice are available for those who want more information. Mindfulness, active listening and the building of confidence are essential for developping insights, overcoming the conflict between one’s own behaviour, and the desire for change in psychotherapeutic work. Unconscious conflicts, black-and-white thinking, catastrophising and other distorted thoughts and attitudes, or perfectionist performance claims can be the possible focus of such a process.
Research must show whether orthorexia nervosa is just a current social lifestyle phenomenon or an independent disease with significant distress and functional impairment.
In the meantime, without any reticence, parents can certainly be invited, to convey a healthy body feeling to their children, instead of devaluing their own reflection the mirror (and especially that of their children) as flawed and unacceptable. We don’t live to eat well, we eat to live well!