Orthorexia Nervosa and Recovering from a Healthy Diet
Food fascinates me. More specifically, the relationships I develop with food fascinate me. For example, I know that healthful things like kale, avocado and wild caught, sustainable fish provide an unparalleled amount of nourishment and I eat these foods with the upmost enthusiasm and joy. The positive physical, emotional and spiritual benefits that healthy foods and healthy food relationships impart can be described as nothing short of magical.
However, relationships can develop that fail to serve my health and wellbeing and participating in these relationships can often lead to tremendous amount of growth stifling guilt and shame. One perfectly acceptable peanut butter and jelly sandwich when eaten under the wrong pretense can quickly turn into three peanut butter and jellies, an event that is immediately followed by a cascade of regret and condemnation. Not to mention days of fasting I subject myself to in order cleanse myself of my dietary indiscretions.
Stacking the deck further in my disfavor, feelings of remorse over even the smallest dietary missteps are disproportionally greater than the feelings of bliss received from the most healthful foods. One tablespoon of organic, gluten-free cookie dough when eaten out of boredom, sadness or fear can generate a stress response one hundred times greater than the delight received from a plateful of lightly steamed cruciferous vegetables taken in celebration with friends and family.
Obviously, this isn’t normal or healthy. Especially when I become so fixated on eating only foods that advance physical, emotional and spiritual enlightenment that I lose the ability to maintain a balanced perspective, moderate my enthusiasm for healthy eating and transfer a disproportionate amount of life’s meaning onto my food.
Orthorexia Nervosa, as defined by Steven Bratman M.D., author of Health Food Junkies, is an extreme fixation on eating healthy foods. A departure from a healthy enthusiasm for food sought to overcome illness or improve health, orthorexics develop highly exclusionary, extremist dietary philosophies that lack perspective, compromise health and increase the risk for nutrient deficiency, infection and, in advanced cases, death.
Beyond the physical consequences of orthorexia and poor nutrition, an extreme fixation on eating only “pure” foods is often accompanied by, “self-condemnation for lapses, self-praise for success, strict self-control to resist temptation, and conceited superiority over anyone who indulges in impure dietary habits.” Eventually, the planning, purchasing, preparing and eating routine developed by orthorexics encourage social isolation and intolerance – a physically, psychologically and spiritually disabling disorder.
The displacement of life onto the bare act of eating is what differentiates orthorexia from the better-known eating disorders: anorexia and bulimia. Where anorexics and bulimics focus on quantity, orthorexics focus on quality.
“When a sense of compulsion begins to override free choice, when you begin to judge everyone else on the basis of diet rather than on character or personality, when you spend many of your waking hours thinking about food, you are not simply making dietary choices. You are not a virtuous eater. You have an eating disorder.” -Dr. Steven Bratman
Orthorexia and Addiction
Regardless of how they manifest, the common characteristics of addiction include: compulsive use, loss of control and continued use.
Compulsive use has three elements: reinforcement, craving and habit. Addiction is reinforced when behaviors that produce a positive experience reinforce said behavior. For example, the illusion of control that complex food theories provide are used by the orthorexic as a means of escaping the uncontrollable events that take place on a daily basis. Cravings are the physiological need for a substance triggered by relevant brain activity. This can be applied to eating disorders in that withdrawals from process addiction can generate anxiety and ‘cravings’ for order. Habit refers to the compulsive patterns of behavior that stimulate pleasurable feelings, which in turn encourage continued participation in such behaviors, despite consequences that may interfere with health and wellbeing.
Loss of control embodies both the relative inability to stop participating in a certain drug or behavior once initiated and the inability to refrain from said drug or behavior after a period of abstinence. When an addict losses control, obligations may pass without notice, stopping use becomes difficult and ‘indulgence’ is not done in a socially responsible manner.
Continued use is simply the compulsive desire to participate in certain behaviors despite efforts to cut down or stop all together. Often times, negative consequences are ignored or emphasis is placed on any perceived positive effect associated with abuse.
If we look at addiction in the context of dependent behaviors instead of substance abuse it is easy to see how the three C’s can be applied to orthorexia nervosa. For example, shopping, preparing and consuming a healthy, clean food like salad can boost an individual’s perception of individual wellbeing and stimulate feelings of emotional and spiritual pleasure well beyond that which is created by the consumption of Doritos. In extreme cases, the gratification received from the salad experience may even encourage feelings of superiority over those choose to eat “junk” foods to such a degree that it motivates seeking and compulsive behavior [compulsive use].
Honestly, have you ever craved a salad so bad that you were willing to sacrifice the quality of this supposedly healthy food by visiting an all-you-can-eat, $4.99 soup and salad buffet, skipping the soup of course, while forgoing an opportunity to spend time with friends or family at a restaurant that serves potentially less healthy foods [loss of control]?
If salads then start to displace other foods whose nutrient and energy density may better support overall health without making the appropriate adjustments throughout the rest of the day, symptoms of malnutrition may surface and health will begin to decline [continued use]
For those under who participate in orthorexic behavior, food is happiness and dietary extremism is the only avenue for a meaningful existence, even when it’s done at the expense of the body, mind and spirit.
Sources of Orthorexic Behavior and the Common Offenders
Diet is most certainly a means to improve health and food can be a very powerful tool in the treatment of disease. However, orthorexics often have an ulterior motive for developing a relationship with food that may ultimately interfere with health. According to Bratman, these hidden motivations include:
- Illusions of total safety – In a world in which we are confronted with mortality on a daily basis, obsessively manipulating food becomes a diversion for the inevitable.
- Desire for complete control – Life is full of uncertainties, but managing diet allows us to avoid the unknown and satisfies our craving for control.
- Covert conformity – Most of us want to feel accepted by our peers and extreme diets can provide an avenue for participating in cultural norms of beauty without having to admit it to others and ourselves.
- Searching for spirituality in the kitchen – In the search for God or spirituality, food becomes a deity and a means of salvation.
- Food puritanism – A subtle desire for intentional self-deprivation in order to satisfy a need for the comfort received from discomfort.
- Creating an identity – An understanding of self based on how we choose to eat.
- Fear of other people – Observing complex food theories in order to insulate ourselves from the judgments of others.
There are many vehicles for orthorexia, but a few of the more common “healing diets” include: raw foods theory, macrobiotics, the Zone, eat right for your type, excessive supplementation, and even elimination diets aimed at minimizing symptoms associated with food allergies. These diets can be extremely beneficial to one’s health when undertaken rationally within a mindful routine, but when they become all-consuming and are used as a means to express dissatisfaction with ourselves or some societal norm, they can lead to evangelistic behavior that compromises one’s ability to maintain perspective concerning the importance of food in a developing a healthy, balanced life. Food displaces family, friends and a Higher Power.
Recovering from a Healthy Diet
Overcoming disordered eating is a tricky proposition. We are confronted with food practically everywhere and we must consume it in order to sustain life. This makes escaping the grip of an eating disorder exceptionally difficult. Fortunately, Dr. Bratman asserts that orthorexia tends to lose its power once we acknowledge its presence and admit that we are powerless over the obsession with healthy food. Admitting this to ourselves can be extremely powerful and it signifies a shift away from the belief that the way we eat is a mark of virtue and towards an understanding that it is actually an illness.
For most, as soon as the disease is recognized, eating behaviors normalize and fanaticism quickly fades. For others, developing such awareness may require an intentional process that helps us identify how destructive eating behaviors have caused more harm than good. Listing how our highly restrictive dietary philosophies may have harmed others and ourselves helps solidify powerlessness.
My experience with orthorexia places me in “for others” camp. The simple recognition that my healthy eating habits might be impairing my was not enough to create the necessary change. Similar to an alcoholic who drinks as he walks into a 12-step meeting, I had done the plenty of research and had written numerous pieces on orthorexia without fully acknowledging the severity of my condition and accepting that I needed to change my habits. I had to experience the symptoms of a nutritionally insufficient diet – lethargy, fuzzy thinking, and binge episodes – in order to see the harm that I was inflicting upon my physical health and emotional wellbeing. Fortunately, my condition was not advanced enough to inflict any physical or emotional harm on my loved ones, which was certainly not the case with my prior addictions.
After acknowledging its presence, identifying the source of our obsessive behavior will help us break free from the grips of disease. Labeling complex dietary philosophies as a way to insulate us from the judgment of others and feelings of slovenliness that we often associate with “indulgent” behavior will facilitate the healing process. Fully understanding how we eat with respect to Bratman’s hidden motivations (see above) for orthorexia will open the door to developing a loving and healthful relationship with food and ourselves.
Personally, this was the easiest part. I want to be accepted. I want to be in control. I want to stand out. All manifestations of ego gone awry. My dietary exclusionism, if such a word exists, was a vehicle for improving self-esteem and self-worth. Traditionally, recognizing these motivations may not be so easy, but considering my history of addiction and my time in recovery, I am well equipped to recognize how my character defects manifest.
Finally, orthorexics must find a healthy balance with food and what eating means within the context of their lives. Balance is key. We must remember that food is not the source of our condition. Rather, it’s our attitude towards food that generates obsession and dis-ease. According to Bratman,
Once I was able to label my condition, recovery and balance naturally followed. This part was almost automatic for me. Considering my chosen profession, I know what it means to eat healthy. All I had to learn was how to apply that in a way that was conducive to physical, emotional and spiritual health. I was able to accomplish this by simply relaxing the expectations I place upon myself and the results have been nothing short of magical. I think, feel and function on a level exponentially greater than I had previously known. I am less moody and more accepting. I sleep longer and more deeply. I am better able to be there for my friends and family. Everything in my life has improved as a result of recognizing the latest iteration of my disease.
“It is the obsession with food, the inability to drop the issue when appropriate, the failure to maintain a sense of proportion that turns healthy eating into orthorexia.”-Dr. Steven Bratman
By no means does this mean that I am “cured” of my obsession with eating healthfully. I am confronted with the temptation to manage and manipulate my food on a daily basis. However, I have gotten in the habit of acknowledging and reflecting upon such behaviors when they occur so that I am better equipped to process and dismiss them. For me, recovery is not an event. It’s a lifelong experience and I am fully prepared to fight this fight for as long as I am able.
Diet can undoubtedly improve ones health and reduce the risk of disease, but when it becomes an escape from life it no longer encourages health and wellbeing. Diet needs to be simply that – a diet. Not a means of creating isolation, control, punishment or feelings of superiority.