How Healthy Eating Can Be a Mental Illness

An obsession with healthy eating nearly killed Kristie Rutzel. In college, the 5’ 4” student’s weight plummeted from 120 to 68 pounds, as she stopped eating carbs, fats and anything processed. She became a vegetarian, then a vegan, following a strict raw-foods diet. At one point, she ate little more than organic cauliflower and broccoli.

Ultimately, she was hospitalized with anemia and osteopenia, a precursor to osteoporosis, the brittle-bone disease that leads to fractures. Now 29, Rutzel has a name for her eating disorder: orthorexia, a controversial diagnosis marked by an extreme fixation on avoiding unhealthy foods.

“I began suffering with orthorexia and within a year, it spiraled into anorexia,” she told me in an email after I blogged about her case in 2011. “It was a stepping stone, and had I received help earlier on, I would not have been so sick.”

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As the list of unhealthy foods swells—from high fructose corn syrup to trans fats, diet soda and pink slime—eating-disorder experts across the US are seeing a surge of patients like Rutzel, who would rather starve than eat anything unwholesome, Time magazine recently reported.

What is orthorexia?

Orthorexia is a term coined by Steven Bratman, MD, a physician in Fort Collins, Colorado, to describe a condition he had been seeing: a fixation on healthy eating that may be a cross between an eating disorder and obsessive compulsive disorder (OCD).

Ortho is derived from a Greek words meaning “right” or “correct” and rexia means “appetite.” Bratman also identified what he called orthorexia nervosa, which may turn out to be a not-so-distant cousin of anorexia nervosa, the scariest of eating disorders because it can be fatal.

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Is this a recognized mental disorder?

So far, orthorexia hasn’t been officially recognized as a psychiatric condition. Unlike anorexia nervosa and bulimia, the binge and purge syndrome, orthorexia isn’t listed in the current or forthcoming editions of American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), the “bible” of mental disorders.

A disorder that isn’t listed in the DSM exists in psychiatric limbo: insurance is unlikely to reimburse treatment and researchers have trouble getting grant money for studies to better understand it. As a result of its exclusion, orthorexia isn’t very well known even among therapists who treat eating disorders.

A search of the medical literature turned up only 23 scientific studies on the subject (compared to 11,661 on anorexia nervosa). One study by Italian researchers published this year defines orthorexia nervosa as a “psychopathological condition characterized by the obsession for high quality foods” and concluded that it occurs frequently in athletes.

What are the symptoms?

Unlike those who suffer from anorexia nervosa or bulimia, orthorexics aren’t yearning to be slim. Body image isn’t their thing. They’re focused on healthy food, and ruthlessly remove from their diets whatever they perceive to be unhealthy.

This can begin with a perfectly understandable avoidance of foods containing artificial colorings or flavorings, meats with hormones, non-organic fruits and vegetables, and artificial sweeteners, and then veer off into the ultimate elimination diet.

In severe cases, people cut out entire classes of food, such as all carbs or all fats. Here’s where the fixation with healthy eating seems to meld with obsessive compulsive disorder and where orthorexia becomes a march toward malnutrition. In the throes of the disorder, Rutzel believed that few foods were safe to eat, and spent hours planning her next meal.

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What triggers orthorexia and who’s at risk?

Some eating-disorder specialists have suggested that orthorexia may begin with health problems, primarily digestive troubles that lead to a focus on food and, perhaps for better or worse, medical advice to avoid certain types of food. Experts also say that women may be more at risk for micromanaging their diets to the point of seriously undermining their health.

Other specialists argue that an extreme obsession with healthy eating may be a symptom of other disorders, such as OCD, anxiety disorder, or anorexia, and doesn’t need a separate diagnosis.

How dangerous is orthorexia?

Taken to an extreme, obsessing over a healthy diet can even be fatal. Dr. Bratman reports that a young woman named Kate Finn died in 2003 after her weight dropped dangerously low while she was eating a limited number of healthy foods. The official cause was heart failure brought on by starvation.

Prior to her death, Finn wrote her ordeal, attributing her orthorexia to stress plus digestive problems brought on by a vegan diet during her college years that provided her with plenty of carbs but not enough fat or protein.

For seven years, she tried a number of so-called healthy diets, which didn’t make her feel better and resulted in extreme weight loss her relatives attributed to anorexia nervosa. Yet Finn, like others with orthorexia, maintained that her goal was healthy eating--not weight loss.

What’s the treatment?

No specific treatment exists for orthorexia, but what seems to work best is cognitive behavior therapy (CBT), which has been successfully used to treat other eating disorders as well as depression, anxiety, and substance abuse. When used to treat eating disorders, the goal of CBT is to change obsessive thought patterns relating to food.

With the obesity epidemic surrounding us, we all should be focused on healthy eating, bearing in mind that too much of a good thing can backfire.

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