I am in the unique position where, not only am I vegan and a plant-based chef, but I’m also a mental health counselor. I’ve had the privilege of helping people overcome a wide range of mental health issues. So, it’s not surprising that I would be interested in a proposed eating disorder called, Orthorexia Nervosa, which is a steadily growing trend among the eating disorder community. Especially since, as of late, orthorexia nervosa has been connected with a vegan/plant-based diet. Before I get into that, what is Orthorexia Nervosa? This is not an official diagnoses in the most recent edition of the Diagnostic and Statistical Manual of mental health disorders fifth edition (DSM5). However, Doctor Steven Bratman’s site http://www.orthorexia.com/ provides a possible diagnostic criteria for this disorder, which was published in the journal Eating Behaviors.
The proposed criteria is as follows:
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:
- Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices* believed by the individual to promote optimum health.**
- 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.
- 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.
*Dietary practices may include use of concentrated “food supplements.”
**Exercise performance and/or fit body image may be regarded as an aspect or indicator of health.
Criterion B. The compulsive behavior and mental preoccupation becomes clinically impairing by any of the following:
- Malnutrition, severe weight loss or other medical complications from restricted diet
- Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet.
- Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined “healthy” eating behavior
Dunn, T.M & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors, 21, 11 -17.
Now at first glance, you might be asking “so, wanting to eat healthy is a disease?” or “going vegan means I have an eating disorder?”. The answer to these questions is a big “NO!”. The most important feature to this disorder, as with any eating disorder, is the extreme preoccupation and emotional distress that accompanies the behavior. I’ll use my own experience to explain and differentiate between this disorder, and simply choosing to happily follow a diet, or lifestyle, like veganism or plant based.
Chicken Bait and Switch
I once went out with a group of friends to a restaurant that provided Gardein chicken on their menu, soon after deciding to go plant based. One of my friends ordered a Gardein dish, even though she wasn’t necessarily vegan herself. Towards the end of the meal, I asked my friend if I could try her dish. Unfortunately, I didn’t know that the kitchen had messed up her order and had given her actual chicken meat. She didn’t notice the difference, but as soon as I bit down, I did. Now, it’s important to note that at this point in my life I had chosen to go plant based and had cut out all animal meats and byproducts primarily for health reasons. However, when I accidentally ate that piece of chicken, I did not feel any emotional distress and simply found the whole incident humorous. I had no feelings of shame or fear of disease related to the incident. If I had been someone with orthorexia nervosa, I may have felt an extreme emotional reaction. I may have done several cleanses afterward or been afraid of developing a disease due to the piece of chicken I had ingested. In other words, my reaction would have been irrational and disproportionate to the behavior I engaged in. This is what really dictates whether something is considered a disorder in general. It has very much to do with how disruptive a behavior can be to your every day life, how irrational and rigid the thoughts are that lead to the behavior, and how distressing it can be emotionally.
So, just because you engage in a diet with certain guidelines for health reasons, does not necessarily mean you have this disorder. You can be paleo, low carb, high carb, vegetarian, vegan, plant based, atkins, etc… and not have orthorexia. However, vulnerable people who are predisposed to having this eating disorder can gravitate towards these diets due to their restrictive and health promoting nature. When they do, eating “healthy” becomes an all consuming preoccupation for them. Fear can be prominent in motivating them to be extremely restrictive with their diet and, ironically, they can even put their health at risk via extreme weight loss, anemia, and other health problems. I personally became plant based for health reasons and remained vegan for ethical ones. But, I do it joyfully. I want to be healthy, but I don’t make the idea of health an all consuming focus in my life, nor do I constantly engage in a battle between myself and my food.
If your relationship with food has spiraled into the realm of panic attacks, depression, anxiety, shame, and fear…
If you’ve allowed your relationship with food to negatively impact your interpersonal relationships and activities of daily living…
Then perhaps you should seek help from a mental health professional that can help you bring balance back into your life and allow you to improve your relationship with food once more. Because, eating healthy and making your health a priority is not a bad thing. But, turning your pursuit of heath into a constant state of distress is.