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Orthorexia Nervosa, while not recognized as a mental disorder by the American Psychiatric Association and not listed in the Diagnostic and Statistical Manual (DSM-IV or the DSM-V to be published in 2013) as a recognized eating disorder, is nevertheless a very real condition that is increasingly being accepted as a diagnosis within the mental health community.

What Orthorexia Nervosa Is

The term "orthorexia nervosa" was coined by Dr. Steven Bratman, who first used it in his book Health Food Junkies, Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating, co-authored with D. Knight. It is derived from the Greek orthos, meaning "correct or right" and orexia, meaning "appetite." In essence, orthorexia nervosa describes a condition where a person is literally obsessed with consuming only the right foods. For some individuals with orthorexia nervosa, this obsession with food takes on the dimensions of religious fervor.

While the origins of orthorexia nervosa may very well be purely well-intentioned – after all, who among us doesn’t want to learn how to eat right, for example – in the person who takes healthy eating to the extreme, complications can arise. Devotion to certain types of foods, to the exclusion of other healthy choices, can lead to slavish dedication to only consuming a rapidly diminishing set of self-determined approved food choices.

Here’s how orthorexia nervosa may develop in an otherwise healthy individual. Let’s say the person decides to begin the Atkins diet, eliminating or severely restricting their carbohydrate intake. In and of itself, reducing carbohydrate consumption isn’t all that bad. It’s when taken to extremes that problems may start to surface. Cutting out all carbohydrates is definitely a recipe for disaster, as it’s not a healthy practice for anyone.

Orthorexics, as people who have orthorexia nervosa are called, often also avoid processed foods. That’s because processed foods are considered artificial, and nothing artificial belongs in their "safe foods" consideration list. They also will often avoid like the plague any food that is preserved, believing that foods with preservatives are dangerous. They will also steer clear of any food that has come into contact with pesticides or herbicides. On top of this, animal products are quite regularly added to the off-limits list.

Orthorexics refuse to touch salt, sugar, caffeine, alcohol, wheat, gluten, yeast, soya, corn and dairy products. And that is just the start of their dietary restrictions.

What does this leave? Generally speaking, the only safe foods for orthorexics include fresh fruits and vegetables. That creates a big problem, since the human body cannot live on just fruits and vegetables.

The result of such self-punitive food intake is that people suffering with orthorexia nervosa are most likely to be painfully thin to the point of being malnourished. They don’t believe that, of course, since they think they are consuming a completely healthy diet. The reality is that they’re lacking protein, iron and B vitamins, key nutrients that the human body requires to remain healthy. The bottom line when orthorexia nervosa continues untreated is that the individual may develop many of the same health problems as those with anorexia, and these health problems can prove fatal.

What Causes Orthorexia Nervosa

While it may be motivated by health, especially given the media hype and awareness over organic foods, sustainable agriculture and going green, experts say that orthorexia nervosa may have underlying motivations as well. These can include a consuming desire to be thin, improving self-esteem, searching to create a new identity by using food, searching for spirituality through food, to escape from fears, to be safe from poor health, and a compulsion for complete control.

Symptoms of Orthorexia Nervosa

Looking at the symptoms of orthorexia nervosa, they’re a lot like some of the symptoms of other eating disorders, with some exceptions. Here are some of the typical symptoms of orthorexia nervosa to be on the lookout for – either in yourself or in one of your loved ones, family members or friends.

• Exhibits a dramatic weight loss – more than 10 pounds in a month.
• Displays mood and personality changes.
• Insists on isolation or becomes increasingly isolated.
• Loses a job.
• Withdraws from or is distanced from relationships with others.
• Maintains a strict diet and is obsessive-compulsive about it.
• Rarely strays from the diet for any reason, even a special occasion.
• Spends a great deal of time obsessing over food: how it’s prepared, how it was processed, where it came from, and so on.
• Takes an inordinate amount of time planning meals and preparing food.
• Does not enjoy their food.
• Is a perfectionist and is highly self-critical.
• Suffers from poor self-esteem.
• Appears unhealthily thin – even to the point of malnourishment.
• Suffers from fainting and dizziness.
• Suffers from weakness, fatigue, anemia, low blood pressure, possibly heart conditions (which can be fatal).
• Has an irregular sleep pattern.
• Shirks responsibilities.
• Suffers loss of memory and appears distracted
• Suffers hair loss, brittle nails, dry skin, cracked lips, poor skin color and tone.

It is also important to note than orthorexia nervosa occurs more often in men than in women, which is contrary to the experience with the eating disorders of anorexia and bulimia. Those with orthorexia nervosa tend to be over the age of 30, well-educated and from the middle class.

According to the National Eating Disorders Association (NEDA), the following questions should be asked. The more "yes" answers to the questions, the more likely it is that orthorexia nervosa is a possibility.

• Do you wish that occasionally you could just eat and not worry about food quality?
• Do you ever wish that you could spend less time on food and more time on living and loving?
• Does it sound beyond your ability to eat a meal prepared with love by someone else – one single meal – and not try to control what is served?
• Are you constantly looking for ways food is unhealthy for you?
• Do love, joy, play and creativity take a backseat to having the perfect diet?
• Do you feel guilt or self-loathing when you stray from your diet?
• Do you feel in control when you eat the correct diet?
• Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the food they eat?

Treatment for Orthorexia Nervosa

Before anything else, the individual suffering from orthorexia nervosa, just as someone with anorexia nervosa or bulimia, must be treated so that their medical condition is stabilized. That is, if there are any serious medical problems, they must be attended to first.

Before any eating disorder treatment for orthorexia nervosa can begin, the individual must admit there is a problem. Then, they need to identify what caused their eating obsession and learn how to become more flexible and less dogmatic about their eating patterns.

Ideally, after any medical problems have been stabilized, the individual should undergo a treatment phase consisting of education about what is and is not proper nutrition. This will involve dispelling many erroneous pre-conceived ideas and replacing them with factual information.

Coupled with education, counseling with a professional therapist skilled in treating eating disorders is recommended. That’s because the orthorexic will be highly resistant to making these kinds of changes in their eating behavior, believing, again erroneously, that what they have been doing has been the right thing, the proper regime for their lifestyle. It is often said that a little knowledge is a dangerous thing. When taken in context with orthorexia nervosa, this little knowledge is what the individual has amassed and now believes is doctrine. He or she thinks they know what healthy eating and a proper diet is, and it is very difficult to change that opinion.

Orthorexics also lack the ability to know when they’re hungry, how much they need to eat, and when they’re full. Without treatment, they’re likely destined to keep repeating the pattern of unhealthy eating, and consequently feel shame and other emotions that are similar to those felt by individuals with any other eating disorder.

Counseling also helps the individual with orthorexia nervosa to overcome deeper emotional issues, such as problems with self-esteem, and to help them create more realistic expectations for themselves. Orthorexics are often isolated, cutting themselves off from social interaction due to their obsessive attention to their personal diet and food choices. Lacking a sound social network, helping the individual to restore social connections is another important component of counseling in the treatment program.

Treatment success is very much dependent on the individual’s willingness to want to change, and to engage in the treatment process. Once they do commit to treatment and to learning how to overcome orthorexia nervosa, they have a greater likelihood of success.

How to Help Someone with Orthorexia Nervosa

If you suspect, based on the list of common symptoms of orthorexia nervosa, that you or a loved one, family member or close friend has the condition, the best thing to do is to seek the help of a professional. If you are concerned about yourself, start by seeing your doctor and asking for a referral to a treatment facility that specializes in treating eating disorders.

If it is your friend, loved one or family member who you believe has orthorexia nervosa, be supportive and encourage the individual to talk with his or her doctor and to seek treatment. You may need to keep this kind of supportive dialogue going for some time, since the individual probably won’t readily admit, or be ready to admit, that there is anything wrong.

In the meantime, gather as much information as you can about orthorexia nervosa. You can make this information available to the individual you are concerned about, or leave it where it can be easily found. Over time, he or she may come around and be willing to admit there is a problem and ask for help in overcoming it.

As with any other eating disorder, it will take time to overcome orthorexia nervosa. It is not impossibility, but it does require patience and the understanding and support of people such as you. The best thing you can do is to always be there for the person, ready to stand by him or her and always be encouraging, without being a nag, in his or her efforts to overcome orthorexia nervosa.