The 14-year-old patient sitting in front of me insisted that her decision to become a vegan was unrelated to being bullied and called “chubby” in elementary school. Instead, she cited reasons related to animal rights and a desire to become “healthier.”
Nothing about the straight-A student with severe muscle wasting, skeletal limbs, and a protruding abdomen heralding liver failure was healthy. She brought to my mind images from global health posters depicting starving children. This local teen was unlike any eating disordered patient I had ever encountered.
That was nearly 10 years ago. Since that time, I have encountered a number of patients at the Loma Linda Behavioral Medicine Center’s Eating Disorders Program with orthorexia—an eating disorder driven by an obsession with healthy eating. The Diagnostic and Statistical Manual doesn’t formally recognize this as a separate eating disorder. By understanding the warning signs, symptoms and health consequences, mental health professionals can better treat patients who present with orthorexia.
The term orthorexia was coined by Stephen Bratman, M.D., in 1996 to better express the obsession with eating healthy. Over time, vigilant focus on proper nutrition evolves into an increasingly restrictive diet. Patients with orthorexia can no longer eat out with others, must rigidly shop for food ingredients, and have ritualized patterns of food preparation and eating. These individuals spend a substantial amount of time researching food, preservatives or additives. Their diet eventually becomes so restrictive that their physical health becomes compromised.
There is significant crossover between orthorexia, anorexia, and obsessive compulsive disorder (OCD). Of patients with anorexia, up to 30 percent simultaneously have OCD. A recent study of patients with orthorexia showed limited abilities to process information and problem solve on neuropsychological testing. Additionally, like patients with anorexia and OCD, those with orthorexia struggled with memory, planning, and being able to transfer from one task to another (“set shifting”). As the field of psychiatry advances, we hope to better understand the underlying neurobiologic causes of orthorexia.
People who have an obsession with eating healthy are likely to compulsively check the ingredients of each thing they eat, being overly concerned with the health of the ingredients they’re consuming, They avoid eating things they do not deem “healthy” or “pure,” and become visibly distressed when healthy foods aren’t available. Malnutrition is a possibility because those with orthorexia restrict the amount and type of foods consumed.
Warning signs of orthorexia may include rigid eating patterns and extreme inflexibility with diet, serious emotional distress when firm eating rules are broken, and extreme and drastic weight loss.
Potential health consequences of the disorder include permanent health damage, such as osteoporosis, kidney failure or infertility; a lowered immune system and nutritional deficiencies; and emotional instability and a low sense of self-worth.
I still remember my first orthorexic patient’s response to seeing the health consequences of her mental illness. As we reviewed her lab results together, she began to cry. “I never meant for this to happen,” she said. “I just wanted to be healthy.”
By learning to understand and respond to signs of an eating disorder, you can help the people in your life who may be struggling with orthorexia, anorexia, or bulimia.
— Melissa J. Pereau, M.D., is a medical director and psychiatrist at the Loma Linda University Behavioral Medicine Center; this article originally appeared on the Loma Linda University Health website.