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Orthorexia Nervosa – an Eating Disorder, Obsessive- -Compulsive Disorder Or Disturbed Eating Habit?

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Orthorexia Nervosa – an Eating Disorder, Obsessive- -Compulsive Disorder Or Disturbed Eating Habit? Archives of Psychiatry and Psychotherapy, 2012; 1 : 55–60 Orthorexia nervosa – an eating disorder, obsessive- -compulsive disorder or disturbed eating habit? Anna Brytek-Matera Summary The purpose of this article was to describe the phenomenon of a new disorder called orthorexia nervosa. This paper proposes a theoretical framework for the definitions, prevalence, diagnostic criteria, method and treatment of orthorexia. This disturbing behaviour concerns the pathologic obsession for healthy nu- trition. In contrast to eating disorders, people with orthorexia are obsessed with food quality rather than quantity and they do not care excessively for thin silhouette like in the case of patients with anorexia and bulimia nervosa. Individuals with orthorexia nervosa are obsessive about healthy food, leading to dietary restrictions and to a variety of negative psychological and social outcomes. The results of previous re- search show that on the one hand orthorexia is related to anorexia and bulimia nervosa, and on the oth- er hand this syndrome is more closely allied with obsessive-compulsive disorders. In view of the studies presented here we could treat orthorexia as a disturbed eating habit which is connected with obsessive- -compulsive symptoms. food restriction / health food / eating attitude INTRODUCTION affective dissatisfactions and intense social iso- lation [2, 5, 6]. There is relatively little information availa- This is not a weight loss regimen but an im- ble about orthorexia nervosa (ON) [1] because mense phobia about eating only “pure” food. it is a new term and does not have a universally Having orthorexia nervosa not only means that accepted definition or valid diagnostic criteria. people are obsessed with eating “healthily”, but This disturbing behaviour is not present neither also that they have a specific attitude to food, in DSM-IV-TR nor in ICD-10. Orthorexia nervosa they prepare their food in a certain way [1] as is a new concept about eating behaviour disor- well as avoid consumption of some foods or all ders [2] and is composed of pathologic obsession of a some group of foods since they consider for biologically pure foods [3], which can cause them to be harmful for their health. The quali- substantial dietetic limitations [4] and which is ty of the foods they consume is more important able to lead to obsessive thoughts about foods, than personal values, interpersonal relations, ca- reer plans and social relationships [7]. In fact, the desire to consume healthy foods is not a disturb- Anna Brytek-Matera: Warsaw School of Social Science and Hu- ing behaviour in itself, and it is only defined as manities, campus in Katowice, 9 Kossutha Str., 40-844 Kato- orthorexia nervosa when it causes a person to wice, Poland. correspondence address: Anna Brytek – Mat- era, Warsaw School of Social Science and Humanities, cam- give up his or her normal lifestyle [1]. pus in Katowice, 9 Kossutha Str., 40-844 Katowice, Poland. Orthorexia nervosa could be considered as a E-mail address: [email protected] disorder connected with behaviour and person- The publication was created with financial support from the ality due to paying too much attention to con- Foundation for Polish Science suming healthy food, spending an excessive 56 Anna Brytek-Matera amount of time with this preoccupation, and ex- proposed for orthorexia [12]. However, Bratman periencing associated dysfunctions in everyday and Knight [13] propose a test that allows to es- life [1]. Orthorexia nervosa can be regarded as tablish whether expression of feeding behaviour a harmful behaviour, because healthy eating is in health education ought to be considered as connected to fear and worries about health, eat- pathological or not. Authors [14] have suggest- ing and quality of food [8]. ed a short Bratman’s Orthorexia Test (BOT) as a screening tool useful for early diagnosis of the disorder. This diagnostic test for orthorexia con- DEFINITIONS OF ORTOREXIA sists of ten questions (e.g. “Do you spend more The term “orthorexia” has been produced from than 3 hours a day thinking about your diet?”, “orthos”, which literally means “accurate, straight, “Has the quality of your life decreased as the right, valid or correct” and “orexis” meaning hun- quality of your diet has increased”, “Do you feel ger or appetite. This term is used for “obsession guilty when you stray from your diet?”). If the with healthy and proper nutrition” [1, 6, 9]. Steven person answers “yes” to 4 or 5 questions, this Bratman [6] defined this concept for the first time means that it is necessary for her/him to relax in 1997. The author used orthorexia nervosa to de- more in regard to their food (unless it is a pre- fine a pathological fixation on the consumption of scription diet). If the person answers “yes” to appropriate and healthy food [5]. The term of or- all questions, then she/he has an important ob- thorexia is used to describe an unhealthy fixation session with healthy eating and should examine with healthy eating [10]. Baĝci Boci et al. [7] de- this behavior with the help of a qualified profes- scribed orthorexia nervosa as “highly sensitive be- sional [13]. haviour with regard to healthy nutrition”. People with orthorexia are likely to shun foods which may contain pesticide residues or geneti- MEASURE OF ORTHOREXIA NERVOSA cally modified ingredients, unhealthy fatty foods having too much salt or too much sugar and other Donini et al. [12] developed the ORTO-15 test components. The methods of preparation (a partic- for the diagnosis of orthorexia based on a brief ular way of cutting vegetables) and materials (ce- 10-item orthorexia questionnaire by Bratman ramics only or only wood) are also part of the ob- [13]. They used some of the items from Brat- sessive ritual [11]. The configuration of the day- man’s test and added some new items to cre- to-day diet, which takes up a lot of time, could be ate the ORTO-15 questionnaire. The original ver- divided into four phases [2, 5]. The first section is sion of ORTO-15 was first developed in Italy. It devoted to thinking with concern and cautiously is a 15-item self-report questionnaire that deter- about what will be eaten on that day or the fol- mines the prevalence of highly sensitive behav- lowing day; a second phase pertaining to the thor- iour related to health and proper nutrition. Items ough and hypercritical acquisition of each ingredi- assess an individual’s behaviours (obsessive at- ent; a third phase referring to the culinary prepa- titudes) related to the selection, purchase, prep- ration of these ingredients, which must consist of aration, and consumption of food that they con- techniques and procedures that are not linked to sider to be healthy (e.g. “When you go in a food health hazards; the fourth stage is a stage of satis- shop do you feel confused?”, “Are you willing faction, comfort or guilt based on the appropriate to spend more money to have healthier food?”, enforcement of the three preceding phases. If any “Do you think your mood affects your eating of these phases is not attainable or it is not possible behaviour?”). Donini et al. [12] aimed to devel- to abide by these rituals, a sense of guilt and con- op items that would assess individuals in terms cern for the violation will appear. of emotional and rational aspects. For this rea- son, some items assess the cognitive-rational do- main, some the clinical domain, and others the DIAGNOSTIC CRITERIA emotional domain. Each item is answered on a 4-point Likert scale. Individuals are required to In spite of the fact that the diagnostic criteria answer with “always – often – sometimes – nev- are not yet sufficiently verified, they have been er”, to reflect how often they define themselves Archives of Psychiatry and Psychotherapy, 2012; 1: 55–60 Orthorexia nervosa – an eating disorder, obsessive-compulsive disorder or disturbed eating habit? 57 with these expressions. Items that reflected an foods, score low in ORTO-15, which points to orthorexic tendency are scored as “1”, and items the fact that they have highly sensitive behav- that reflected a tendency towards normal eat- iour about healthy nutrition. The average score ing behaviour are scored as “4”. Scores below 40 on the ORTO-15 is lower in those who do their points in the ORTO-15 test are defined as orth- shopping themselves, substitute lunch or din- orexic (having highly sensitive behaviour), eat- ner with salad/fruit, and care about the quality ing behaviour reaches more normal standards of the things they eat. Indeed, in this study 20.1% as the score increases [12]. of the male doctors and 38.9% of the female doc- tors stressed that their food selection had been affected by TV programs on healthy eating hab- PREVALENCE its. Like authors [7] emphasize, it is a compelling reason for the fact that such a large number of Donini et al. [1] investigated the prevalence people with a high level of education are able to rate of orthorexia nervosa by studying 404 peo- be so heavily impacted by the media. ple in Italy, and provided suggestions for diag- It is worth pointing out that the prevalence of nostic criteria. Participants were evaluated in highly sensitive attitudes to healthy eating at terms of their food selection behaviours, and this high socioeconomic level shows that med- obsessive-compulsive and phobic symptoms. ical doctors are also in need of education about In relation to food selection behaviour, 17.1% (n the tenets of a balanced and proper diet [7]. = 69) of the sample were defined as ´health fa- Another study [3] has found that the preva- natics´. People diagnosed with orthorexia ner- lence of orthorexia was 43.6% among medical vosa accounted for 6.9% (n=28) of their entire students (n=878) (scored above 27 in the ORTO- sample.
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