The focus on quality and purity can deteriorate into orthorexia, a term coined in 1996 by physician Steven Bratman to describe a “fixation on righteous eating.” Like anorexia and bulimia, it can wreak serious damage on the health of someone trapped in the obsession.
“Orthorexia boils down to someone who is very, very concerned with eating what they consider the perfect diet,” says Joy Jacobs, a psychologist with the University of California at San Diego School of Medicine. “This is someone who takes healthy eating to an extreme and feels good about it. These people often have a sense of moral superiority.”
Orthorexia is not a formally recognized psychiatric diagnosis or eating disorder, although most experts agree it blends elements of both. Though an anorexic or bulimic person is fueled by a desire to lose weight, someone with orthorexia single-mindedly pursues health through food. Some with the condition eat only raw or organic foods. Some may follow a strict vegan or fruitarian diet. And others may eliminate sugar, processed ingredients, artificial flavors and colors, or anything that contains additives.
“As it becomes more and more restrictive, it begins to interfere with your quality of life and your wellness,” says Sondra Kronberg, co-founder and nutritional director of the Eating Disorder Treatment Collaborative Nutrition Counseling Specialists in New York.
As the list of unacceptable foods lengthens, going hungry rather than eating something “unhealthy” seems increasingly reasonable. A 2004 study at the University of Rome reported that of 400 students surveyed, nearly 7 percent — more than the percentages of anorexic and bulimic students combined — suffered from orthorexia. Those students, wrote researchers, “prefer to starve themselves rather than eat food they consider impure and harmful to their health.”
Most experts agree the condition is becoming more common, encouraged by a rising volume of messages about the perils of obesity and the virtues of a selective, choosy way of eating.
But eliminating entire classes of food, such as carbohydrates or fats, can lead to nutritional deficiencies and malnourishment, Kronberg says, throwing off the balance of electrolytes to the extent of threatening the heart. And cutting out too many types of food can lead to significant weight loss.
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As with obsessions and addictive behaviors in general, the first step in conquering the condition is to admit to the problem — which is especially hard with orthorexia because of the pride in adhering to stringent, positive limits. Treatment options mimic those of other eating disorders.
Cognitive behavioral therapy teaches how to replace obsessive thoughts with healthier alternatives. Instead of fearing that going out to eat with friends will destroy his health, for example, an orthorexic learns to think, “I can eat at a restaurant and remain healthy.”
A gradual-exposure strategy, reintroducing a bit of chocolate and other forbidden foods one by one, is another common approach.
Experts suggest working with an array of professionals, including a therapist and a nutritionist, to begin to see food more realistically and rebuild a healthier, more balanced diet.
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