What is orthorexia? 

Here is how this term is described by the Office québécois de la langue française:

« A neurotic behavior characterized by an obsession with healthy eating.»

The term orthorexia is a neologism combining the Greek wordsorthos andorexis which mean correct and appetite respectively. The term was proposed in 1997 by American physician Steven Bratman. Orthorexia is usually described as an unhealthy obsession with healthy eating. This is actually quite a recent phenomenon. We hear more and more about it in recent years. However, orthorexia is not an eating disorder listed in the le Diagnostic and statistical manual of mental disorders fifth edition (DSM-V), a manual that defines and categorizes mental disorders, along with anorexia and bulimia. Indeed, it is not classified in the DSM-V, because there is no official definition of orthorexia, nor standard diagnostic criteria and the tools used to measure it have limitations.

The phenomenon is most likely due to the important place that food takes in the media, on the internet and on social media. Without mentioning that the opinions or information conveyed are sometimes extreme.

This results in some becoming anxious about eating anything unhealthy. And unhealthy encompasses a very broad spectrum: processed, too sweet, too salty, too fat, junk food, containing artificial substances, dyes, herbicides, pesticides, preservatives, non-organic, etc. They aim for the best quality.

Aiming for quality is not a problem in itself. But obsessing over it, until it becomes the center of their universe, is problematic. This often leads to isolation, because eating in restaurants or elsewhere than at home becomes impossible. Planning and preparing their meals becomes the main activity of these people.

« Eating well is important, but keeping a good balance is just as important.»

Assessment tools

There are different tools to measure orthorexia. The two most used tools are the Bratman test and the ORTO-15. The Bratman test is the first tool developed to screen for orthorexia. This is a test consisting of ten questions to which the individual answers yes or no. According to this test, the severity of orthorexia increases with the number of positive responses.ves.

The second test, the ORTO-15, was created from the Bratman test. This is also a quiz, but it includes fifteen multiple-choice questions. Each answer is weighted to obtain a final score. The result of this score makes it possible to diagnose orthorexia. However, these two tests have limitations, particularly in terms of reliability and validity. Indeed, the Bratman test has not been validated and the ORTO-15, validated only with Italian subjects, tends to overestimate the prevalence of orthorexia symptoms.

If you have concerns about your own behavior with regard to your diet, we invite you to answer the test questions below. Despite its limitations, it can guide you on whether you should consult a professional if you are too concerned about your diet.

Bratman's test

• Do you spend more than 3 hours a day thinking about your diet?
• Plan your meals several days in advance?
• Do you feel that the nutritional value of your meal is more important to you than the pleasure of eating it??
• Do you perceive that the quality of your life has deteriorated, while the quality of your food has improved?
• Have you recently become more demanding of yourself??
• Do you feel your self-esteem is boosted by your desire to eat healthy??
• Have you given up foods you used to love in favor of healthy foods» ?
• Does your diet get in the way of your outings, alienating you from family and friends??
• Do you feel guilty when you deviate from your diet??
• Do you feel at peace with yourself and think you have good control over yourself when you eat healthy??

If you answered yes to 2 or 3 of these questions, you should pay attention to having a more relaxed attitude regarding your diet.

When you answer yes to 4 or more of these questions, it shows that you are obsessed with the quality of your diet and that you may have orthorexia. In these cases, it would be better to consult a nutritionist in conjunction with a psychologist. These health professionals will know how to help you adopt a more relaxed attitude towards food.

*This test was extracted from the EXTENSO.ORG website

A good way to relax about your diet, you can check out the article:Intuitive Eating, what to eat in winter?. This approach to food is completely different.

Similarities and differences with TCAs and TOCs

In order to better define orthorexia, studies have looked at the similarities and differences between this new disorder and disorders recognized by the DSM-V. This research has observed associations between the symptoms of orthorexia and those of eating disorders (ED), such as anorexia and bulimia, as well as those of obsessive-compulsive disorders (OCD). Among the common symptoms, studies identify anxiety, perfectionism, preoccupation with food, feelings of guilt in the event of deviation, the need for control, rigidity, the feeling of superiority, egocentrism, distortions cognitive skills, as well as the restriction and avoidance of certain foods.

These studies also observe differences between orthorexia and TCA and OCD. On the one hand, orthorexia aims for quality, and EDs for quantity.

Otherwise, among the symptoms unique to orthorexia are the obsession with being healthy and the absence of the desire to be thin or to lose weight, present in anorexic symptomatology.

One of the issues is therefore to determine whether orthorexia is a true diagnosis, whether it should be considered a separate eating disorder, a subcategory of an existing ED or OCD, or simply a disturbed eating behavior.

Proposed diagnostic criteria

Still with the aim of better understanding orthorexia, a literature review published in 2018 assessed the state of research in terms of diagnostic criteria used to assess orthorexia. Among the studies analyzed, three main diagnostic criteria are proposed:

1. An obsessive or pathological preoccupation with healthy eating.
2. Emotional consequences, such as anxiety and distress, of not adhering to self-imposed nutritional rules.
3. Psychosocial impacts in important spheres of life, as well as malnutrition and weight loss.

The treatment

Currently, there are no official recommendations for the management of orthorexia, since it is not a recognized pathology. Therefore, more research is needed to develop a consensus definition, standard diagnostic criteria, and reliable and valid assessment tools. This will make it possible to better understand this new potential pathology and possibly be able to prevent and treat it.

On the other hand, the trend wants the consultation of a nutritionist, as well as a psychologist in behavioral therapy could be very useful, if you judge after reading this article, that you need help.

References:

1. Cena, H., Barthels, F., Cuzzolaro, M., Bratman, S., Brytek-Matera, A., Dunn, T., Varga, M., Missbach, B., & Donini, L. M. (2019). Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature.Eating and weight disorders: EWD,24(2), 209246. https://doi.org/10.1007/s40519-018-0606-y
2. Costa, C.B., Hardan-Khalil, K., & Gibbs, K. (2017). Orthorexia Nervosa: A Review of the Literature.Issues in mental health nursing,38(12), 980988. https://doi.org/10.1080/01612840.2017.13718166
3. Dajon, M., Sudres, J.L., & Bouchard, J.P. (2021). Orthorexia: news and treatment of a modern-day pathology [Orthorexia: News and treatment of a modern-day pathology].nurse's review,70(267), 3739. https://doi.org/10.1016/j.revinf.2020.11.0133
4. Donini, L. M., Marsili, D., Graziani, M. P., Imbriale, M., & Cannella, C. (2005). Orthorexia nervosa: validation of a diagnosis questionnaire.Eating and weight disorders: EWD,10(2), e28e32. https://doi.org/10.1007/BF03327537
5. https://www.passeportsante.net/fr/Maux/Problemes/Fiche.aspxdoc=orthorexie-pm-mesures-medicaux#:~:text=L'orthorexie%20am%C3%A8ne%20une%20v%C3%A9ritable ,food%20(anorexia%2C%20bulimia)).