Healthy eating is a good thing, right? Absolutely – unless it becomes a compulsion. The obsession with ‘clean eating’ has veered into dangerous territory for some, known as an eating disorder called orthorexia nervosa (ON) from the Greek ortho, meaning correct, and orexi, meaning appetite. The term was coined by Stephen Bratman, MD, in 1997, though it remains a proposed diagnosis and is not listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as an official eating disorder. People with ON have a rigid focus on eating only healthy food. They don’t starve themselves or purge, but as with other eating disorders, there is a strong desire for control.

In some respects, ON is easier to identify than hidden disorders like anorexia and bulimia. People with orthorexia often evangelize their puritanical dietary habits and criticize others who don’t eat like they do. They tend to be perfectionists with high levels of anxiety who consider dieting to be an important form of self-discipline. There are similarities with obsessive-compulsive personality disorder (OCPD) including a preoccupation with details and rules, and rigid thinking.

“ON is associated with low self-esteem and a lack of confidence in social situations. ”

The pursuit of perfection is another feature, linked to a desire for acceptance. People with ON want to be healthy, but an obsession with restrictive dieting can reduce their quality of life. They may choose not to eat out with friends or family if their preferred foods are not available, impacting their relationships. Cutting out entire food groups and restricting calories in an effort to ‘eat clean’ can lead to vitamin and mineral deficiencies, resulting in malnourishment and reduced energy. If they deviate from their diet, feelings of extreme shame and guilt are common.

Recovery from ON is about embracing balance and moderation as a healthier, replacement form of self-care than extreme dietary restrictions. Understanding the basic nutritional requirements for a truly healthy diet is a good start. Counselling can assist with identifying the underlying causal factors and developing alternative coping strategies. For some, inpatient residential treatment can be beneficial.

“What are the warning signs of orthorexia? ”

There are lots of tests available on the internet, but this is the official self-test designed by Stephen Bratman MD, republished with permission. If you or someone you love shows signs of the disorder, further reading and support can be accessed at the links below.

The Bratman Orthorexia Self-Test

If you are a healthy-diet enthusiast, and you answer yes to any of the following questions, you may be developing orthorexia nervosa:
I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.
When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.
My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.
Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply.)
Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.
Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.

Reference: https://www.orthorexia.com/the-authorized-bratman-orthorexia-self-test/

A "Healthy" Habit to Kick

The Bratman Orthorexia Self-Test

If you are a healthy-diet enthusiast, and you answer yes to any of the following questions, you may be developing orthorexia nervosa:

I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.

When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.

My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.

Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.

Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.

Elizabeth O’Driscoll