Orthorexia nervosa

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The term Orthorexia nervosa is the suggested name for the clinical picture of an eating disorder , in which the excessive preoccupation with the quality of the food can lead to mental and / or physical impairments due to self-imposed rules.

The term is used in social discourse and in the media to express that the speaker classifies certain nutritional behavior - usually such nutritional behavior that corresponds to a social trend - as pathological ( pathologization ).

Orthorexia nervosa is not listed on the ICD-10 international classification system or the United States' DSM-5 classification system . Their status as a potential disease is discussed controversially in specialist and popular scientific literature.

Concept history

The term orthorexia (from Greek : ὀρθός orthós "correct" and ὄρεξις órexis "desire", "appetite") was first coined by the American doctor Steven Bratman in October 1997 based on the name anorexia nervosa . Bratman, who had practiced special diets both for himself and for his patients for years, discovered pathological patterns in himself and many like-minded people in dealing with the subject of food. Nutritional philosophies with a strong ideological component that promise their followers, for example, protection against diseases of all kinds are problematic .

Discussion about a possible clinical picture

Orthorexia is understood as a pronounced fixation on the choice of "healthy" and the avoidance of "unhealthy" food. Whether it is an illness or just an “expensive” lifestyle will have to be measured by how much stress this behavior leads to. This is crucial for recognition as a disease.

On the other hand, orthorectic behavior could be seen as a coping strategy for an underlying more severe eating disorder in the sense of an “exit drug”. According to this view of orthorexia nervosa would merely noting findings collected and the diagnosis assigned "severe eating disorder."

Even in the case of an independent disease, there is still no recognized system for diagnosing orthorexia. It is discussed whether the presence of compulsive personality traits might be necessary for a diagnosis of orthorexia . The smooth transition from normal to pathological has a lot in common with the concept of personality disorders .

While anorexia nervosa is a quantitative eating disorder, orthorexia is described as a qualitative eating disorder. According to Barthels, the prevalence in the general population is one to two percent.

Suggestion of diagnostic criteria

Bratman thinks it is possible that orthorexia is a disease in the area of avoidant / restrictive eating disorder . In 2016 he suggested the following diagnostic criteria:

Criterion A: Compulsive preoccupation with "healthy food", focusing on questions of the quality and composition of the food (two or more of the following points must be fulfilled):

  • Eating an unbalanced diet due to an obsession with the "purity" or "quality" of food.
  • Worrying about eating unclean or unhealthy food, dealing with the impact that food quality has on physical and emotional health.
  • Strictly avoiding foods that the patient believes to be unhealthy, such as fatty foods, foods with preservatives, food additives, foods of animal origin, or other ingredients that the patient thinks are unhealthy.
  • For people who are not professionally involved in nutrition: Time far above average (e.g. three or more hours a day) reading about, procuring or preparing specific foods based on their assumed quality and composition.
  • Feelings of guilt and worries if you have consumed “unhealthy” or “unclean” food.
  • Intolerance of other beliefs about food.
  • Excessive financial expenditure on food (in relation to income) due to its assumed quality and composition.

Criterion B: Compulsive employment leads to at least one of these problems:

  • Impairment of physical health due to an unbalanced diet (e.g. illness due to malnutrition).
  • Excessive suffering or impairment of social, academic or professional functions through obsessive thoughts and compulsions that revolve around the patient's views of healthy eating.

Criterion C: The disorder is not just an exacerbation of symptoms from another disorder, such as obsessive-compulsive disorder , schizophrenia, or another psychotic disorder .

Criterion D: The behavior is not explained by strict observance of traditional religious meal regulations, or when preoccupation with special meal regulations is triggered by medically diagnosed food allergies or other diseases that require a specific diet.

Cultural background

Less controversial than the question of whether there is a clinical picture of "orthorexia nervosa" at all is the existence of social nutritional trends, such as: B. Stone Age nutrition and veganism , their proponents u. a. Propose health arguments, while scientific studies on the claimed beneficial effects are often lacking. As Lars Weisbrod has shown, people's preference for certain foods is often not just about the desire for healthy nutrition (which one could also fulfill in private), but about self-expression and an individualization strategy . The Food Report 2016 of the Frankfurt think tank Zukunftsinstitut says: “Food, i.e. the way we eat, what we eat when, where we eat what, with whom we meet where, says more about us than the clothes we carry. This increases food from food to a stylistic device. It becomes an expression of the generation of ideas about oneself. "

Pedagogical perspective

In her influential book The Blessings of a Skinned Knee (2001), the American clinical psychologist Wendy Mogel has the habit of many parents of eagle-eyed monitoring of their children's diets and counting bites of supposedly healthy food in their mouths as a major cause named that children develop eating disorders . Wendy Mogel considers it particularly harmful when individual foods are categorized not only as healthy or unhealthy, but also as morally good or bad. If one uses the question of a healthy diet to differentiate between good and bad, it becomes - so criticizes Mogel - a substitute religion.

literature

  • Friederike Barthels, Reinhard Pietrowsky: Orthorektisches eating habits - nosology and prevalence ( Orthorectic Eating Behavior - nosology and Prevalence Council. ) In: psychotherapy, psychosomatic medicine, medical psychology: PPmP; Organ of the German College for Psychosomatic Medicine. Thieme Verlag, Stuttgart u. a. 2012; 62 (12), pp. 445-449, doi: 10.1055 / s-0032-1312630
  • Johann Kinzl, Ingrid Kiefer, Michael Kunze: Obsessed with food. Kneipp-Verlag, Leoben 2004, ISBN 3-902191-67-8 , p. 38f.
  • Alina Petre (2020): Orthorexia: When Healthy Eating Becomes a Disorder

Web links

Individual evidence

  1. ↑ Mira Fricke: Orthorexia: When a healthy diet becomes unhealthy. August 17, 2016. Retrieved December 8, 2017 .
  2. ↑ The original article on orthorexia published in the Yoga Journal in October 1997 .
  3. ↑ Katharina Hauer: Orthorexia nervosa in Austrian dieticians. Dissertation . Innsbruck 2005. (online)
  4. ↑ LM Donini, D. Marsili, MP Graziani, M. Imbriale, C. Cannella: Orthorexia nervosa: validation of a diagnosis questionnaire. In: Eat Weight Disord. 2005 Jun
  5. ↑ LM Donini, D. Marsili, MP Graziani, M. Imbriale, C. Cannella: Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. In: Eat Weight Disord. 2004 Jun
  6. ↑ Ryan M. Moroze, Thomas M. Dunn, J. Craig Holland, Joel Yager, Philippe Weintraub: Microthinking About Micronutrients: A Case of Transition From Obsessions About Healthy Eating to Near-Fatal “Orthorexia Nervosa” and Proposed Diagnostic Criteria . In: Academy of Psychosomatic Medicine (Ed.): Psychosomatics . tape 56 , no. 4 . Elsevier, 2015, p. 397–403 , doi : 10.1016 / j.psym.2014.03.003 (English, manuscript on Academia.edu ).
  7. ↑ Lars Weisbrod: Ego, chewed mindfully . In: Die Zeit , No. 6/2016
  8. ↑ Food Report 2016 . Future Institute
  9. ↑ Wendy Mogel: The Blessings of a Skinned Knee: Using Jewish Teachings to Raise Self-Reliant Children. Scribner, New York / London / Toronto / Sydney / Singapore 2001, ISBN 0-684-86297-2 , pp. 161-173. ( limited online version in Google Book Search - USA ); see. Eva-Maria Schnurr: The better eaters . In: Die Zeit , No. 5/2006.