What is orthorexia?
Here is how this term is described by the Office québécois de la langue française:
« Neurotic behavior characterized by an obsession with healthy eating.»
The term orthorexia is a neologism associating 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. It is indeed quite recent as a 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 most likely stems from the prominence of food in the media, on the internet and on social media. Not to mention 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 much 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, then that's problematic. This often leads to isolation, as eating out 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 healthy balance is equally important.»
There are different tools for measuring orthorexia. The two most widely used tools are the Bratman test and the ORTO-15. The Bratman test is the first tool developed to screen for orthorexia. It is a test consisting of ten questions to which the individual answers with a yes or no. According to this test, the severity of orthorexia increases with the number of positive responses.ves.
The second test, ORTO-15, was created from the Bratman test. This is also a quiz, but it has fifteen multiple choice questions. Each answer is weighted in order to obtain a final score. The result of this score is used 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 in Italian subjects, tends to overestimate the prevalence of symptoms of orthorexia.
If you have concerns about your own eating behavior, we invite you to answer the test questions below. Despite its limitations, it can guide you as to whether you should go see a professional if you're too concerned about your diet.
The Bratman 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 tasting 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 that your self-esteem is enhanced by your desire to eat healthy??
- Did you give up foods you loved in favor of healthy foods» ?
- Does your diet interfere with your outings, pulling you away from family and friends?
- Do you feel guilty when you stray from your diet??
- Do you feel at peace with yourself and do you think you are in control of yourself when eating healthy??
If you answer yes to 2 or 3 of these questions, you should pay attention to have a more relaxed attitude about 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 be suffering from orthorexia. In these cases, it would be better to consult a nutritionist in conjunction with a psychologist. These health professionals can help you adopt a more relaxed attitude towards food.
* This test was taken from the EXTENSO.ORG site
Two great ways to relax from your diet, you can read the article:Intuitive Eating, what do you eat in winter?. This approach to food is completely different.
Otherwise, it is quite possible that theThe ChopChopMenu Planner by Isabelle Huot - Annual Subscription you would also be very helpful. A weekly menu developed by a team of nutritionists, sent each week to your email. A quality menu, but without the obsession.
Similarities and Differences to TCA and OCD
To better define orthorexia, studies have looked at the similarities and differences between this new disorder and disorders recognized by DSM-V. This research has found associations between symptoms of orthorexia and those of eating disorders (ADD), such as anorexia and bulimia, as well as those of obsessive-compulsive disorder (OCD). Among the common symptoms, studies note anxiety, perfectionism, preoccupation with food, feelings of guilt in case of deviation, need for control, rigidity, feelings of superiority, self-centeredness, distortions. cognitive skills, as well as the restriction and avoidance of certain foods.
These studies also find differences between orthorexia and ACT and OCD. On the one hand, orthorexia is about quality, and TCA is about quantity.
Otherwise, symptoms unique to orthorexia include the obsession with being healthy and the lack of desire to be slim or lose weight, which are present in anorexic symptomatology.
One of the challenges is therefore to determine if orthorexia is a true diagnosis, if it should be considered as a distinct eating disorder, a sub-category of an existing ACT or OCD, or simply as a disturbed eating behavior.
Proposed diagnostic criteria
Also with the aim of better understanding orthorexia, a review of the literature 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:
- An obsessive or pathological concern for healthy eating.
- Emotional consequences, such as anxiety and distress, for failing to adhere to self-imposed nutritional rules.
- Psychosocial impacts in important spheres of life, as well as malnutrition and weight loss.
Currently, there are no official recommendations for the management of orthorexia, as it is not a recognized condition. Therefore, more research is needed to develop a consensus definition, standard diagnostic criteria, as well as reliable and valid assessment tools. This will help to better understand this potential new pathology and possibly be able to prevent and treat it.
On the other hand, the tendency is to consult a nutritionist, as well as a psychologist in behavioral therapy, could be very useful, if you feel after reading this article that you need help.
- 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
- 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
- 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 review,70(267), 3739. https://doi.org/10.1016/j.revinf.2020.11.0133
- 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
- https://www.passeportsante.net/fr/Maux/Problemes/Fiche.aspxdoc=orthorexie-pm-traitements-medicales#:~:text=L'orthorexie%20am%C3%A8ne%20une%20v%C3%A9ritable , food% 20 (anorexia% 2C% 20boulimia)).