“Orthorexia”: When Healthy Eating Becomes a Problem
Orthorexia is a relatively new term used to describe a type of problematic eating and food preoccupation. As orthorexia is somewhat unknown, there is some confusion about what it actually means, and whether or not it is an emerging eating disorder, distinct from anorexia nervosa and bulimia nervosa.
The term orthorexia first appeared in a 2001 book by Steven Bratman entitled Health Food Junkies: Orthorexia Nervosa – Overcoming the Obsession with Healthful Eating. The author, who is a physician specializing in holistic medicine, coined the term and defined it as an “unhealthy obsession with healthy food.” The root “ortho” comes from the Greek meaning “correct” or “right” and “rexia” implies that it is an eating disorder similar to anorexia but with an emphasis on correct or “pure” eating. The term orthorexia is not listed in the dictionary, nor is it an official diagnosis, and as a result there are no associated criteria for diagnosis. However it may useful to think about the idea of having an “unhealthy obsession with healthy food.” Can one take an interest in healthy eating too far? If so, how far is too far? Can the interest in healthy eating lead to negative physical and mental consequences? In my everyday life experiences and in my experience as a therapist working with clients who have eating disorders, I have seen examples that I would define as “taking an interest in healthy eating too far.” I have seen the obsession with healthy eating affect people’s lives, health and happiness. I have seen this become a contributing cause of death.
I believe an interest in healthy eating can be seen as part of an attitude and behaviour continuum that ranges from those who know about, and try to make wise choices in their food selection most of the time, to those who cannot eat food that is deemed “imperfect,” even if it means starving themselves.
I personally know of an example whereby an individual let their obsession with healthy eating ultimately lead to their premature death. Not long ago, I received a call from a friend whose elderly father was in the hospital with a medical illness. My friend was very concerned because while in the hospital, his father refused food and water. For years, this man had controlled his diet by choosing foods that he thought were healthy. He tried to buy everything organic, would not eat certain food for reasons that to me seemed obscure, was vegetarian, mostly vegan and drank only bottled water. He felt good about making these choices and generally talked about them with an air of pride. However, when in the hospital, he was not eating or drinking. He stated he considered the water to be unsafe because it came from the tap, and the hospital food, which was not organic, would make him sicker. Had it not been for these attitudes and fears, which led to his refusal to eat while in the hospital, his medical issue probably could have been treated successfully.
Although this story may seem extreme, it is not uncommon. For example, someone can start out with good intentions to improve their health, but this can spiral out of control. The ways in which it can spiral out of control include limiting or avoiding social eating when the food provided is not considered healthy enough, becoming preoccupied with food and health in general. This in turn can affect mental health and happiness, and even the ability to focus on other important aspects of life such as recreation, school and career. What started out as a seemingly “normal” interest in a healthy diet ironically becomes unhealthy.
Part of the problem is that all the messages we currently get from media, Internet, books etc. about healthy eating and healthy foods can be very confusing. Almost any food you choose can be seen as either healthy or unhealthy depending on the source of the information. If you were to follow all the advice, there would be literally nothing left to eat! And don’t forget, many sources of information such as the Internet and TV can be sensational, and not based on scientific evidence. One extreme reaction to this type of information is to try to restrict all foods that are considered “bad”, as evidenced in those exhibiting “orthorexic-type” behaviours. The other is to disregard all nutritional information, because it is impossible to meet these standards. These individuals end up eating a predominance of fast food and foods with little nutritional value.
What is ideal, however, is the idea that one can develop a balanced, middle ground approach to diet and nutrition. Granted, this is not sexy or exciting. However, it can be maintained in the long term, and would not negatively impact one’s emotional and physical well-being. In a balanced approach, one thinks of healthy eating “guidelines” rather than rules or absolutes. Food is neither good nor bad, and all food can be eaten in moderation. An example of a healthy eating guideline is “whole grains are better than processed grains – I aim to have whole grains about half the time.” Or that “desserts or other “fun foods” taste great and add to pleasure in life. I can allow myself to have a portion of these foods daily.” This balanced approach is one which promotes recovery from eating disorders, and which I espouse in my own life.
If you are finding yourself preoccupied with healthy eating, or other eating concerns, it can be very helpful to seek counselling. The diagnosis or label (“orthorexia”, bulimia, etc.) is not the important thing. What is important is whether food is interfering with your life; making you feel overwhelmed, taking too much time and energy, affecting relationships, self-esteem or your mood. If this is the case, a therapist, especially one familiar with eating disorders, can be of great help.
How Sugar Affects the Brain: Video Highlights Similar Effects Between Drugs & Sugar
Food is one of our primary sources of pleasure, and critical to our survival. In a healthy reward pathway of the brain, food is a natural stimulus that produces feelings of pleasure from the release of dopamine. This gratifying feeling makes this activity worthy of repeating, as we want to experience it again. However, not all foods have the same effect on the brains’ reward system. So why do certain foods activate the brains’ reward system more than others? Sugar, salt and fat are three substances that ‘hijack’ the brains’ reward system, by releasing a burst of dopamine, similar to the effects of drugs and alcohol. As more research emerges, we gain knowledge about how a diet of large portions of refined and processed foods affect the way our brain responds to food. Some individuals develop a dependence on these foods to feel happy and satisfied, and eventually develop a tolerance by needing more of these ‘addictive’ foods to experience feelings of pleasure. Dependence and tolerance are fused with the fundamentals of addiction, reinforcing the link between food and addiction. This video from the TED Talks series highlights how foods high in sugar can have a similar effect on the brain as drugs, alcohol and other addictive behaviours.
Binge Eating Disorder is Now Recognized as an Eating Disorder in the DSM V
As clinicians and researchers learn more, categorization of various mental health issues and disorders changes to reflect more precise diagnostic criteria, thus helping those who are seeking treatment and understanding. For example, the tool that mental healthcare professionals use to help guide their diagnoses and treatment plans – the Diagnostic and Statistical Manual of Mental Disorders (DSM) is revised from time-to-time to ensure that updates are made as more information about various disorders becomes clearer. In its latest edition, the DSM-5 has included an important revision in the chapter involving Feeding and Eating Disorders.
Definition of Binge Eating Disorder According to the DSM-5
In the latest edition of the DSM, Binge Eating Disorder has now been recognized as separate and distinct from the “catch-all” category of eating disorders labeled “Eating Disorder Not Otherwise Specified (NOS).” In the past, this category was used for individuals who had disordered eating and behavioural patterns that did not fit into the DSM-IV criteria of anorexia nervosa and bulimia nervosa. However, it is now recognized that a large number of individuals diagnosed with Eating Disorder NOS category may actually have Binge Eating Disorder. This is an important distinction because diagnostic criteria for this disorder can be more clearly articulated. According to the DSM-5, Binge Eating Disorder causes distress and significant physical and psychological problems. It is defined as:
- Recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances
- Eating episodes marked with feelings of lack of control
- Eating too quickly, even when not hungry
- Feelings of guilt, embarrassment, or disgust
- Eating alone to hide the behaviour
The Implications of this New Diagnosis
This new distinction of Binge Eating Disorder in the DSM has important implications for individuals seeking help. The DSM criteria associated with the disorder will hopefully be associated with a more meaningful and accurate diagnosis. In addition, healthcare professionals can improve communication among service providers and improve treatment planning given their shared understanding of what the disorder represents, as compared to the previous diagnosis of an eating disorder, “not otherwise specified.”
In addition, the formal categorization of binge eating disorder may also reassure individuals who are attempting to seek help for this cluster of behaviours that causes them a significant amount of pain and distress. Family members or others may have told individuals with binge eating disorder that they simply are “overeating,” making the individual with the problem feel like the problem should be within his/ her control to fix. The diagnosis of binge eating disorder, when indicated, may help the individual to realize that seeking help for the problem is necessary and appropriate. It may also provide the individual with insight into the fact that binge eating disorder is more than simply “overeating” – that it is far more severe and requires treatment by professionals who can help. When an accurate diagnosis is made, an appropriate treatment plan can then be developed. With the appropriate treatment plan and guidance and support from professionals, an individual can begin to recover from their binge eating disorder.
Think you might have an eating disorder? Do you have a family member or friend who may require help with a binge eating disorder? Bellwood Health Services can provide you with you information, resources and support needed to recover from an eating disorder.
Contact Bellwood to learn how we can help.
What Are the Signs of a Binge Eating Disorder or Compulsive Overeating?
What is the difference between overeating and binge eating?
How is this different from normal eating? Are these serious issues? Is change possible? Some post-holiday thoughts.
If you are asking yourself:
- Do I have a ‘real’ problem or do I just lack the willpower to stop?
- Should I just ‘try harder’ to stop?
- Will a different diet do the trick?
- Does my eating problem qualify as an eating disorder?
- What’s the difference between binge eating and overeating?
This blog post may help you sort out some of those questions and help you understand better what type of treatment you need.
It is very common and normal, in fact, to sometimes overeat. Everyone with easy access to food does this at times. We overeat at holiday time, parties, good restaurants, and even occasionally for emotional reasons. It is also common and normal to gain a small amount of weight over time. This may be due to overeating and/or slower metabolism associated with aging and decreased energy expenditure. Simple overeating and weight gain can be dealt with in a healthy way by making modest adjustments to your eating habits and/or increasing your activity level. In addition, self- acceptance of having a less than perfect body weight or less than perfect eating habits can prevent these issues from escalating and interfering with your overall happiness, well-being or self-esteem. The personal philosophy that “no body is perfect” and food and weight while important, are only a part of what makes a healthy, happy, and meaningful life, help to put perspective on weight and eating issues.
For some people, however, these issues can become overwhelming. Eating can feel out of control. Attempts to lose weight may feel desperate.
The following are some signs that you may have an overeating problem:
- While wishing to lose weight, you may actually end up overeating or binge eating.
- You may find that instead of losing, you are gaining weight and this can add to feelings of discouragement and depression.
In this context overeating is not normal. Problematic overeating is overeating that occurs regularly, from once a week to many times each day. Problematic overeating involves eating food and feeling guilty. It is often associated with feelings of being out of control.
Binge eating disorder is a specific type of overeating. The following are signs that you may have a binge eating problem:
- You eat an amount that is clearly very large, within a relatively short amount of time, rather than spread through-out the day or at just one meal.
- Large amounts of food intake are frequently done in secret due to shame.
- There is generally a sense of loss of control during a binge eating episode and the feeling that the eating episode could not be prevented.
Sometimes people experience both overeating and binge eating, while others do one or the other. If you try but cannot seem to stop these behaviors and feel that weight and body image issues are negatively affecting your self-esteem or other important aspects of your life, such as relationships or social life, it is clear that your problems are worth addressing.
You don’t need a formal diagnosis of eating disorder to warrant help. In this situation, just “trying harder” is seldom the answer. A new diet is seldom a long- term answer. On the other hand, understanding yourself emotionally, feeling supported, and learning specific tools to address behaviours can be extremely helpful.
Treatment, whether in individual or group therapy, or in residential treatment, can help you re-learn or sometimes learn for the first time, how to become a normal eater and address the underlying issues that are at the core of the eating problem. An assessment at Bellwood could help identify which type of help would be most effective.
Written By: Lauren Goldhamer, M.Ed, has been on staff at Bellwood as an Eating Disorder Therapist since 2001 and has been working with clients with eating disorders and related issues since 1995. She has a M.Ed. in Counselling Psychology, and training in both Cognitive-Behavioural Therapy and Emotion-Focused Family Therapy for eating disorders. Her involvement with Bellwood’s Eating Disorders Treatment Program includes clinical assessments, group and individual therapy, outpatient therapy and meal supervision.
Her previous work with eating disorders includes: facilitating groups at Sheena’s Place; Eating Disorders of York Region, and a collaboration with the University of Toronto’s Health Services where she initiated their first body image groups supporting students at risk of developing an eating disorders. In addition to her work at Bellwood, Lauren maintains a private practice.
Bellwood Alumni Wins iaedp Body Image Art Competition
By: Jen Foote, Bellwood Alumnus
One year ago, I was in a residential treatment program at Bellwood in Toronto. I have struggled with an eating disorder for my entire adult life and have been pretty much scraping the bottom the past few years. I came to realize that this was not something I was going to grow out of or overcome through willpower and determination.
I needed something else and with my local treatment team, it was decided that I would spend a few
months at Bellwood. At Bellwood, I was introduced to art therapy. I am sure the therapist’s ears are still ringing as I talked non-stop during our sessions, while my hands were busy creating.
Although I was making stuff, I did not consider it art, nor did I consider myself any sort of artist. Sure, I
have dabbled in all sorts of crafts over the years and love making things, but never professionally, and certainly not for public consumption. I was talking to a fellow client one day and he mentioned that he does pen and ink drawings. I said to him “how cool that you have a thing.” And he asked me, “what’s your thing?” I responded, “I don’t have a thing.” That rang true to an extent in terms of my feelings regarding my self-worth, but at the same time I knew that wasn’t my story.
I started to think about all the things I could do, and decided I was a “Jill of all Trades.” I could do a lot of things, and while I was not an expert in any of them, that didn’t lessen the importance of my ability to do them. So I started a list of all the things I could do. As I created this list, which included things like racing a dirt bike and doing electrical wiring, I started to envision an art-based project that would be a physical and visible reminder to myself that I have worth, that I have value, even if I don’t have a “thing” (I have yet to create this piece).
Bellwood also showed me that recovery is a team effort. I needed a team of professionals behind me to support me as I healed from the eating disorder. Once back at home in Ottawa, I started to establish my support network including social workers, doctors, a massage therapist, a fitness trainer, a nutritionist and a dietician. I signed up for support groups and mentoring. I got involved with my recovery and while these professionals were all busy doing their thing, I slowly discovered mine.
In the fall of 2012, through the magic of Google, I stumbled across an ad for a contest put on by the International Association of Eating Disorder Professionals (IAEDP) in the US (www.iaedp.com). I immediately had a vision of what I might do. And that vision kept growing and wouldn’t leave me alone, so I contacted IAEDP to see if they would accept an international applicant. It was a yes, so I started to put my plan into action. The contest was called “Imagine Me Beyond What You Can See” (www.iaedp.com/ImagineMe.htm) and involved the use of a mannequin to express the challenge of eating disorders and/or recovery. I started making my vision a reality with a trip to Montreal to buy my mannequin. “Billie” as I came to call her, moved in with me at the beginning of December. She scared me a few times…I would forget she was there and out of the corner of my eye I would see this 6’ naked mannequin and would think “OMG, there is someone in my house!”. We eventually got used to one another and I liked having her for a roommate.
I officially finished Billie over the Christmas period and submitted my application via email with photographs at the beginning of January.
All done, right!? Not even close! It turns out this was the beginning of something that has almost taken on a life of its own. I was itching to help out Hopewell (www.hopewell.ca) again after the success of their Christmas wrapping kiosk in the Place d’Orleans Mall so I got in touch with the Program Coordinator to see what might be a good fit for me. It turns out Hopewell hosts an art show every year in support of National Eating Disorder week. I quickly signed up to be the co-curator of the 2013 “Inner Beauty” show. I was asked to bring Billie to the vernissage as her message speaks to inner beauty. But I didn’t want to stop there. I wanted something that could hang in the show all month long. Initially my plan was to mount a photograph of Billie, but then I got another idea: create a wall-mounted version. So poor Billie was my model and I cast her torso, allowing me to make a paper-mache wall-mounted version. In a little over two months, I had created two significant pieces, entered an art contest, was going to have Billie at an art show opening and have another piece hang in the show itself. WOW!
I was contacted the third week of February and advised that I had won the iaedp art contest, but could I please keep it a secret. I was only advised in advance as they unveil the winner at a banquet during their annual symposium and Billie had to get to Las Vegas. I was stunned. I created a website to start to keep track of this journey. I made up business cards so I could share my art with others. As this was a once-in-a-lifetime opportunity, I travelled down to Vegas as well. I have friends that live in the area so I took advantage of the opportunity to spend time with them and see some of the sights. These women were so supportive, encouraging, loving and accepting. I was starting to see myself as others do, not through the distorted lens that I usually use. Not only did I win first prize for the overall contest, but I won the Professional’s Choice award as well. I got a chance to address the 300+ symposium participants who are all health care professionals working in the field of eating disorders.
It was such a powerful experience for all of us. At the end of the night, Billie was auctioned off and now lives in South Miami. The winning bidder offered to let me keep her, but I knew her story did not belong to me alone and that she needed to go. I currently have two other pieces in art shows in Ottawa and will be submitting a piece for another show. I have created one piece on commission and have orders for at least two more. I have an ever increasing
list of projects that I want to tackle and have carved out a small studio space in my home. My journeys of recovery and art have just begun, but I am happy to say that I have found my “thing”.
Please stop by to visit me at iseeiplayicreate.com, I would love to hear your story.