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Anorexia or Orthorexia?
Anorexia nervosa and orthorexia nervosa can and often confused with each other. There are some similarities to both disorders, but there are also many differences.
Knowing the signs, symptoms, and differences of each disorder can help determine if you or a loved one is struggling with either disorder.
Orthorexia Defined
Unfortunately, orthorexia is not recognized as a clinical diagnosis for mental health, and it is not included in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). It is a common co-occurring eating disorder which is characterized by a fixation or desire to eat only “healthy” foods or to avoid entire food groups.
The term itself means a fixation on righteous eating [1]. This issue often starts when a person wants to eat healthier, and the food quality and quantity drastically begin to change as it moves into orthorexia.
Frequently, orthorexia is challenging to identify in the early stages because it appears that the person is making “healthier” food choices and striving to live a more healthy life.
Orthorexia, coined by Dr. Bratman in the 1990s, was a phrase he used for his clients who were ‘overly health-obsessed’ [1].
Some engage in orthorexia behaviors for health reasons or prevention of health issues, such as cancer, diabetes, etc. Others engage in these behaviors as a need to exercise some sort of control or escape from stressors or fears.
Symptoms of orthorexia include an obsession with healthy eating, a perception of superiority to those who do not eat as “purely.” They will also exhibit extreme limitations in food choices, and they often avoiding entire food groups (fats, carbohydrates, etc.).
Focus of Orthorexia
There is a focus on pure foods when a person is struggling with orthorexia. They never eat foods that contain additives, and they go to an extreme in planning their diet to make sure they do not eat the undesired foods and food groups. It can become almost like a religion to them.
Dr. Brytec-Matera in Poland conducted a study to assess orthorexic behaviors, eating disorder pathology, and body image issues to see if orthorexia was included in other eating disorders.
She and her colleagues assessed 52 women using the Eating Attitudes Test-26 and the Polish version of the ORTO-15 [2]. Two groups were identified from this study.
The first group showed lower levels of disordered eating and more orthorexia symptoms. The second group, which had higher levels of eating disorders, had little to no orthorexic behaviors.
Orthorexia does share some similar qualities with anorexia. Symptoms such as an excessive focus on food, a rigid and strict diet, perfectionistic tendencies, and a co-occurrence of anxiety, need for control, food and behavior rituals, and depression are all related [3].
Frequently, those following an orthorexia diet will become emaciated similar to someone who is anorexic. The motivation of anorexia is different from that of orthorexia. Orthorexia’s goal is to feel pure while an anorexic’s goal is to lose weight [4].
Recently, orthorexia was defined as a “pathological obsession with proper nutrition including a strict avoidance of food believed to be unhealthy or impure, that can have serious nutritional, medical consequences”[5].
Some clinicians feel that orthorexia fits somewhere in between anorexia nervosa and avoidant restrictive food intake disorder (ARFID), but neither address the complexity of motivation and behaviors seen in orthorexia.
Anorexia in Short
Anorexia is a mental health disorder and is included in the DSM-5. It is defined as someone who restricts their food intake and eating habits to an unhealthy amount. The result can be extreme weight loss, malnutrition, and even death.
Some behaviors that overlap with orthorexia include rigid dieting and eating behaviors, perfectionism, or feelings of superiority. The goal is often weight loss due to dissatisfaction with body image, shape, size, and weight.
Anorexia typically develops in childhood and is about gaining control of one’s life. It can be to avoid past or current trauma, bullying, unhealthy family dynamics, and/or many other issues.
It is also common to see individuals include popular diet or weight loss fads into their anorexia behaviors. This has also been noted historically through research and documentation [5].
Both orthorexia and anorexia have similar characteristics but are very different in presentation. Both involve significant weight loss depending on the length and severity of each disorder.
Anorexia, however, is focused on weight loss due to distress regarding one’s own weight, shape, size, and body image. Orthorexia is about eating “pure” and avoiding “bad” foods.
Regardless of the disorder, treatment is needed. Through treatment, the person suffering can learn how to better cope with life’s struggles and stresses without using the eating disorder.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is an Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References:
[1] Orthorexia Nervosa. (n.d.). Retrieved November 18, 2017, from https://www.nationaleatingdisorders.org/orthorexia-nervosa [2] Review, E. D. (2017, October 04). Orthorexia Nervosa and Anorexia Nervosa: Similar, But Distinctly Different. Retrieved November 18, 2017, from http://eatingdisordersreview.com/orthorexia-nervosa-anorexia-nervosa-similar-distinctly-different/ [3] Gramaglia, C., Brytek-Matera, A., Rogoza, R., & Zeppegno, P. (2017, February 21). Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples. Retrieved November 18, 2017, from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1241-2 [4] Bratman, S., MD. (n.d.). Fatal Orthorexia. Retrieved November 18, 2017, from http://www.orthorexia.com/original-orthorexia-essay/fatal-orthorexia/The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on December 30, 2017.
Published on EatingDisorderHope.com
