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Proper nutrition and diet enhance wellness and health. However, in case “healthy” eating becomes an unhealthy fixation in quest of a ‘pure’ and ‘super healthy ‘ diet (and exclusion of everything else), it is a form of disordered eating.
Orthorexia nervosa (ON) is derived from the Greek ortho, meaning correct, and orexic, meaning appetite (Steven Bratman 1997). Anorexia nervosa (AN) and bulimia nervosa (BN) are well known eating disorders. Orthorexia nervosa is a form of disordered eating, which is still relatively unknown with no uniform diagnostic criteria.
It is an extreme preoccupation with healthy eating, with self-made criteria for how ‘pure and clean ‘the food should be, associated with restrictive behaviours due to the same. There may be some overlap with obsessive compulsive disorder (OCD), and anorexia nervosa (AN), and yet there are many differences.
There are certain risk factors.
Although most people with orthorexia have a normal to low normal body weight, if symptoms are severe leading to restriction of several food groups and calories, it may lead to malnourishment and physical complications and hospitalization. Moreover, it also affects their mental health. It leads to guilt, anxiety, social avoidance, preoccupation with nutrition of ‘pure’ foods, mood swings and depression, obsessive compulsive behaviours etc.
In this, there is a danger of symptoms being easily missed/ unnoticed and a ‘healthy lifestyle’ can mask underlying issues and obsessive behavior. Moreover, those with ON may not consider themselves ill. They think they are on the path to perfect health. This may create a resistance to initiating treatment. The first step is for them to accept that they need help and have a goal of healthy eating, with no obsession.
Once there is acceptance, ON is easily amenable, given their pursuit of wellness. There should be a multidisciplinary team approach, consisting of a physician, psychotherapist and nutritionist.
Physical examination and blood tests should rule out any medical complications. Cognitive behavior therapy addresses perfectionism and cognitive distortions. Exposure and response prevention helps with obsessive and compulsive behaviours. On the other hand, relaxation therapy helps with meal time anxiety.
ON patients may refuse medications, deeming them to be ‘unnatural’ substances. SSRIs may be useful for obsessive tendencies.
Psychoeducation by the nutritionist is important to correct accurate beliefs about food groups, purity and preparation.
Orthorexia nervosa is an obsession with healthy eating with associated restrictive behaviours. It is an attempt to obtain optimum health through ‘pure’ diets, which may impact the overall physical and mental health, relationships and quality of life. It is little understood with imprecise etiology, and diagnostic criteria. Its prevalence is not yet accurately known. ON characteristics vary from normal to pathological, and relies mainly on clinical judgement.
More research is required to determine if in our society, healthy behaviours are becoming pathologically unhealthy.