Orthorexia, this dietary practice that flirts with TCAs

“Orthorexia is when you are really pathologically obsessed with eating healthy food. It doesn’t happen overnight. We’re really into a so-called setup obsession. »

It is with these words that Nelly GoutaudierProfessor of Clinical Psychology and Psychopathology at the University of Poitiers, and researcher at the Research Center on Cognition and Learning of the CNRS, defines a “food practice” increasingly present in our society. Do you decipher every food label? Do you check the quality of everything you eat? These are the first signs of orthorexic behavior.

As I explained to you in my article on food anxiety, currently, only three pathologies are officially recognized: anorexia nervosa, bulimia and binge eating disorder. However, it still persists some gray areas in our relationship with food. Food anxiety is one, orthorexia too.

For Madmoizelle, I decided to meet Nelly Goutaudier, author of the first French report on the phenomenon, Orthorexia: A new form of Eating Disorder?, published in 2019.

Interview: let’s analyze the concept of orthorexia

Madmoizelle: Healthy eating is rather advisable and good for health… So aren’t we all affected sooner or later by this food practice called “orthorexia”?

Nelly Goutaudier: It is not yet known whether it is an eating disorder. We are in something that would look a little like anorexia while being different. In anorexia, we really have a fixation on the amount of food the patient(s) ingests. You have to eat little to accurately control your weight, because there are all these body image issues. We don’t have that component there in orthorexia. It is very rare to see an orthorexia patient eating healthy to lose weight.

In general, in orthorexia, this is precisely the idea of ​​focusing on the quality of the food. What is interesting behind this is that we have two different types of motivations and, in general, this is what can indicate whether we are in healthy or pathological orthorexia. In the first case we have more of a profile of women and men who will eat healthy out of conviction. For example, we find a lot of orthorexia in vegans or vegans. They consume healthy out of conviction in terms of animal protection, or to control their health, to prevent cardiovascular disease. But in the second case, pathological orthorexia concerns people who consume healthy foods for aesthetic reasons. Trying to control your weight, have better looking skin… These problems will look a little more like anorexic behavior.

But when does one pass from a healthy orthorexia to a pathological one?

NG: It’s much easier to diagnose anorexia because we have a minimal number of symptoms that we need to develop in order to be able to talk about a disorder. The threshold that passes from a healthy orthorexia to a pathological one is not yet well defined. We start from the principle that it must require care and monitoring when there is an alteration, or even suffering for the person.

When you suffer from pathological orthorexia, you end up isolating yourself a little from your social network, because you have this feeling of superiority in eating. As soon as we see that it starts to have an impact on the social sphere, that the person can no longer go to a restaurant for example, this marks the point of vigilance. Of course, when you start to have health consequences too. Orthorexia is a continuum that runs from normal to pathological and which, when pushed to its limits, can trigger dietary deficiencies, sometimes a lower BMI. It can also give rise to gastrointestinal problems… So there is also the sphere of health.

According to your study, orthorexia has been talked about since Dr. Steven Bratman’s first scientific research on the subject dates back to 1997. However, we still don’t know how many people have pathological orthorexia. What are the prevalence of this “disorder”?

NG: If we read all the scientific literature, we find very different prevalences on orthorexia, ranging from 6 to 88.7%. Perhaps in some studies, healthy orthorexia is mixed with pathological. But we have observed it the people most affected by this disorder are either those who follow a restrictive diet – vegans, vegetarians – or those who study or carry out a profession related to food and the body.

We see prevalences that go over 30% among students in the health sector, among nutritionists… But also a lot among top-level athletes or those who practice physical activity 3 or 4 times a week.. Finally, people for whom the body is at the center of sports practice, or work, such as among dancers for example.

Madmoizelle: Do we know what causes orthorexia? Is it a “food practice”, if we dare to say, specific to our time and rich societies?

NG: This is a great question. We do not yet know the reasons why we will or will not develop pathological orthorexia. We are truly in a disease of our time, as we are continually hammered by public health media campaigns. So it pushes people to adopt this practice which is encouraged and which is socially acceptable.

Furthermore, in some studies we see that some patients who go to health centers to treat their anorexia and who recover to have a more diverse diet in more acceptable quantities become orthorexic. The pathological character of quantity shifts into that of quality. It is also encouraged by the abundance of ‘more responsible’ food diversification we are confronted with on a daily basis. There’s organic rays, nutrient scores… We still struggle to get some people to understand that healthy eating is good for you, but it’s all a matter of degree. By pushing too hard, we can enter pathology.

Madmoizelle: If you think you suffer from pathological orthorexia, what are the treatments to follow? And can we cure it?

NG: In general, whatever the disorder, be it a biological disease or a psychiatric disorder, it is the High Authority for Health that issues recommendations on what to do or not to do. Since orthorexia is not yet recognized as an eating disorder, there is no official recommendation.

But it is assumed that some elements of eating disorder management may apply to orthorexia. Yes, the first thing to do is really work on what is called psychoeducation. That is to say, to stimulate awareness in patients: yes, eating healthy, even if we are told we can do it, becomes pathological at some point. Then, if the symptoms are really disabling for the person, you have to rework the beliefs behind them: if you don’t always eat healthy, it’s not that bad… Finally, you have to try to reintroduce a little more flexibility in how you eat .

These are the first leads we have in terms of treatment, and this also implies going to train health professionals. Again, this is often not recognized by psychologists, psychiatrists or general practitioners. What doctor would say to his patient: “Be careful there, you are eating too healthy! »

As far as the healing of orthorexia is concerned, we do not yet have sufficient perspective. If we look at previous studies that have dealt with this question, unfortunately, they are often done on what are called “all comers”, in other words ordinary people. We do not yet have sufficient perspective on the management of people hospitalized for their orthorexia.

Some resources if you have an eating disorder

Featured Image: © Pexels – Madmoizelle

Do you like our articles? You will love our newsletters! Sign up for free on this page.