Orthorexia: definition, test, how do you know if you are?

[Mise à jour le 15 novembre 2022 à 09h49] Orthorexia is obsession with healthy eating. It’s different from bigorexia which corresponds to dependence on physical activity and sports. How to recognize orthorexic behavior? What are the causes ? The consequences ? Who is most affected? The women ? How cure ? Insight from Karen Demange, clinical psychologist.

Definition: what is orthorexia?

Anorexia and bulimia are well known, much less orthorexia. “It is a set of practices, behaviors and ways of thinking that are halfway between phobia (fear of food), obsession and eating disorder related to body and weight“, immediately defines Karen Demange, a clinical psychologist specializing in eating disorders. “Orthorexia is therefore a “crossroads trouble” which entered common parlance only 2-3 years ago. Particularly for 1 year, I notice a resurgence of people who consult for this reason“. And it’s like a relief to put a word to this disorder.”This allows you to recognize that it is not an individual disorder and to see that other people are suffering from it.”

Is orthorexia a recognized disorder?

For the moment, orthorexia (which comes from the Greek “orthos” and “orexis” meaning “correct” and “appetite” respectively) has not been officially recognized by the international classifications of mental illnesses. Among the eating disorders, only anorexia, bulimia and hyperphagia are listed by the DSM5, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. “To be listed as a pathology in the DSM, one must have in-depth scientific knowledge of a syndrome and that this syndrome is widely accepted clinically, two criteria that orthorexia does not currently meet.“, said Tim Walsh, professor of psychiatry at Columbia University on the occasion of the development of the latest edition of the DSM.

What causes orthorexia?

The obsessive desire to eat only healthy foods does not come out of nowhere. There are always a trigger. This hyper-control of food can come from a discussion or advice (not always founded) around food, from a desire to lose a few pounds or to regain control… “In addition, the emergence of new food modes (vegetarianism, “gluten-free”, raw food, periodic fasting, etc.), the promotion of the perfect body in the media. Diets advocating a return to naturalness and authenticity, as well as Instagram and other social networks where image is king, are also not completely unrelated to this excessive desire to eat healthy. And consciously or unconsciously, all this guides our food choices“, explains the psychologist. Fortunately, not everyone becomes orthorexic : people characterized by a certain fragility, a lack of self-esteem, a desire to be in control all the time and a propensity for excessive behavior are more likely to fall into this type of obsessive disorder.

What are the symptoms of orthorexia?

L’obsession with quality control and the origin of all the food she eats, the fact of spend hours peeling the labels food, the fact of eating only healthy products, and no longer pay attention to taste pleasure foods are part of the typical behaviors of a person suffering from orthorexia. “Food choices are dictated by the healthy side and no longer in relation to the satisfaction they represent. For this person, products are now classified into two categories: healthy or harmful. And this scale of values ​​is absolutely not not objective or based on reliable scientific data. This categorization is only done in relation to what she hears in the media or what she sees on social networks“, regrets the nutrition specialist. But beware, some choices may seem relevant in theory, but when they are extremist, become aberrant and bad for health. For example, the orthorexic person tends to consume only “good fats ” and sometimes to consume too much of it (such as consuming avocado or coconut oil – two trendy foods considered healthy – every day).

Moreover, the orthorexic person will discard a whole lot of food that she considers impure and unhealthy, but which are not bad for your health: it can be white pasta in favor of wholemeal pasta, white bread in favor of cereal breads or even potatoes in favor of sweet potatoes. She will only eat foods that she considers healthy and good for the body. “For example, she’ll eat goji berries, kale, oatmeal and spinach-based green smoothies, because they’re supposedly super healthy foods, even though she doesn’t like not their taste. The most important thing is not that the food is pleasant to eat, but that it is healthy and good for your body.“, summarizes our interlocutor, before adding that “Ipreparation of meals thus become major sources of anxiety“. Over time, an orthorexic person finds it more and more difficult to eat outside their home, whether in a restaurant or with friends, because they will not be able to control each of the ingredients that make up their plate. In fact, she will be gradually isolated socially.

What test to know if you are orthorexic?

Dr. Steven Bratman was the first physician to discuss the concept of orthorexia in an article titled “The Health Food Eating Disorder” (1997). He accompanies his paper with a 10 question quizto help people determine if they may have orthorexia:

• Do you spend more than 3 hours a day thinking about your diet?
• Do you plan your meals several days in advance?
• Is the nutritional value of your meal more important than the pleasure of eating it?
• Has the quality of your life deteriorated, while the quality of your food has improved?
• Have you recently become more demanding of yourself?
• Is your self-esteem reinforced by your desire to eat healthy?
• Have you given up foods you used to love in favor of “healthy” foods?
• Does your diet get in the way of your outings, alienating you from family and friends?
• Do you feel a sense of guilt as soon as you deviate from your diet?
• Do you feel at peace with yourself and do you think you are in control when eating “healthy”?

If the answer is “yes” to at least 5 of these questions, it is best to talk to a doctor who can then determine if you have behaviors that are similar to orthorexia.

When to worry?

We become orthorexic when we are no longer in control of our food choices.

“Initially, the patient wants to feel better about her body. And finally, she is less well in her head. What started out as a measured, healthy, positive and reasonable initiative to take care of herself or lose a few pounds turns into socio-relational confinement, food rituals, addictions to certain foods and irrational and very time-consuming behaviors. Because yes, deciphering each label of the products we consume, carefully preparing meals, going to several organic stores… take a lot of time.“, warns the specialist. And from the moment when controlling what we eat turns into an obsession and generates excessive behavior that has a real impact on the person’s quality of life, it becomes problematic and disturbing. “We are orthorexic when we are no longer in control of our food choices.“, summarizes the psychologist.

But this permanent hyper-control is above all a source of suffering, frustration and guilt. when the person inadvertently eats a food that is not listed as healthy and “violates” one of their many rules healthy. “Worse still, some people, for fear of making the wrong nutritional choices, prefer to stop eating and can thus fall into anorexia-type behaviors. Others, in perpetual search for health and a perfect body, will practice excessive sport, and may fall into bigorexia, a disorder characterized by dependence on physical activity.“, explains Karen Demange.

What are the health consequences of orthorexia?

Wanting to eat healthier and being interested in what you have on your plate is good. But by dint of controlling everything they eat and depriving themselves of certain categories of food such as starchy foods, meat or fats, for example, the orthorexic person can become completely vitamin imbalance.

“Excess leads to deficiencies”

“The excess of these restrictive behaviors leads to nutritional deficiencies and sometimes to weight loss, which is problematic for health and can lead to weakening.“, confirms Karen Demange. These deficiencies can weaken the bones (risk of early osteoporosis), hormonal functioning, but also the supply of the brain, which then has no more energy (glucose for example) to function. In addition to the impact on physical health, the consequences on the mind are numerous and are similar to all addictive behaviors : socio-relational isolation, psychological malaise linked to feelings of frustration and guilt, negative view of oneself, anxiety that can lead to depression…

“Orthorexia is not irreversible and it is entirely possible to relearn how to eat properly. The ideal is to make help from a therapist who will take stock of the patient’s expectations“, advises our interlocutor. The so-called behavioral and cognitive therapy makes it possible to question her system of thought which has been upset until now. Some patients will want to reintroduce certain products into their diet, while others are obsessed with the fear of grow.”I don’t consider the person to be cured when they are able to eat fries again. More than reintroducing certain foods, healing is the fact of becoming free of one’s choices again and of rediscovering the pleasure of eating“, concludes the specialist.

Thanks to Karen Demange, clinical psychologist specializing in eating disorders.