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Orthorexia nervosa


It is a proposed distinct eating disorder characterized by extreme or excessive preoccupation with eating food believed to be healthy. The term was introduced in 1997 by American physician Steven Bratman, M.D., who suggests that in some susceptible people, dietary restrictions intended to promote health may paradoxically lead to unhealthy consequences, such as social isolation, anxiety, loss of ability to eat in a natural, intuitive manner, reduced interest in the full range of other healthy human activities, and, in rare cases, severe malnutrition or even death.


Diagnostic criteria

Criterion A. Obsessive focus on "healthy" eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue, but this is conceptualized as an aspect of ideal health rather than as the primary goal. As evidenced by the following:
  1. Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health. 
  2. Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame.
  3. Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe "cleanses" (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy food.

Criterion B. The compulsive behavior and mental preoccupation becomes clinically impairing by any of the following:
  1. Malnutrition, severe weight loss or other medical complications from restricted diet
  2. Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet
  3. Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined "healthy" eating behavior.

Symptoms

Symptoms of orthorexia nervosa include "obsessive focus on food choice, planning, purchase, preparation, and consumption; food regarded primarily as source of health rather than pleasure; distress or disgust when in proximity to prohibited foods; exaggerated faith that inclusion or elimination of particular kinds of food can prevent or cure disease or affect daily well-being; periodic shifts in dietary beliefs while other processes persist unchanged; moral judgment of others based on dietary choices; body image distortion around sense of physical "impurity" rather than weight; persistent belief that dietary practices are health-promoting despite evidence of malnutrition."


Treatment

Orthorexia is generally treated with psychotherapy, medication, or preferably with neurofeedback.
  • Psychotherapy: A type of psychotherapy called cognitive behavior therapy is especially useful for treating OCD. It teaches a person different ways of thinking, behaving, and reacting to situations that help him or her feel less anxious or fearful without having obsessive thoughts or acting compulsively.
  • Dialectical Behavioral Therapy (DBT) is used extensively in treatment of anxiety disorders. DBT combines behavioral, cognitive, and meditative therapies to help a woman heal.
  • Medication: Doctors also may prescribe medication to help treat orthorexia. The most commonly prescribed medications for orthorexia are anti-anxiety medications and antidepressants. Anti-anxiety medications are powerful and there are different types. Many types begin working right away, but they generally should not be taken for long periods.
  • Neurofeedback: Neurofeedback is a form of biofeedback designed to help people alter their brain waves in ways that can have a profound effect on their behavior, mood, and thinking. Neurofeedback provides information about the type and intensity of brain waves being generated. A 2003 study describes how neurofeedback was used to reduce OCD symptoms by 89% as measured by the internationally-recognised OCD test, the Padua Inventory. OCD had not returned more than 12 months after the Neurofeedback training. It is postulated that orthorexia is a type of OCD.
  • In an age dominated by pharmaceutical approaches to treating the brain, neurofeedback has emerged as a bold new nonchemical alternative-one that is surging in popularity among patients frustrated by the limitations and side effects of anti-depressants, stimulants, and other drugs.

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