What is orthorexia? An eating disorder that few understand but many unintentionally applaud.

(CNN) — Jason Wood was sitting in a restaurant on vacation with his husband, angry and frustrated because he couldn’t replace the pita bread with fresh vegetables in a bowl of hummus.

The pain was not exaggerated, Wood said. It had been 20 years of an eating disorder, she said, and the anxiety and stress that came with it had all come to a head at one point.

Wood has orthorexia, an eating disorder that is not listed in the Diagnostic and Statistical Manual of Mental Disorders, also called DSM, which is the official guide for the clinical assessment of mental health conditions. But doctors are seeing an increase in cases of orthorexia among patients, said therapist Jennifer Rollin, founder of the Center for Eating Disorders in Rockville, Maryland.

“I hope that it will be added to the DSM, but unfortunately it seems like the process of getting something in there has been very slow,” Rollin said.

Orthorexia is an obsession with “clean” eating, defined by a set of rules that vary depending on the individual and the context in which they live, said Dr. Jennifer Gaudiani, a physician who specializes in eating disorders and founder and medical director of the Gaudiani Clinic. In Los Angeles. Denver. A November 2023 study found that about three in 10 participants showed signs of orthorexia.

“This disorder often goes unnoticed or underrecognized because it is so focused on healthy eating,” said Wood, director of public engagement for the National Association of Anorexia Nervosa and Related Disorders (ANAD).

A lack of understanding of the condition prevented Wood’s friends and family from expressing their concerns (sometimes applauding her efforts to adhere to strict dietary guidelines), even as she became distant from her friends and lost so much weight that she could not maintain her weight. …body temperature, he said.

Here’s what you need to know about orthorexia.

Diet culture in disguise

Focusing on healthy eating seems like a good thing, right? Not always.

Eating disorders often have a similar basis: genetic susceptibility combined with environmental factors, Rollin said. And often the disorder is based on a set of rigid rules, be it calories, meal times or ingredients in food, he added.

When people vulnerable to eating disorders only eat in ways they consider healthy, the behavior can move from preference to obsession, Rollin explained.

According to Wood, over the years his list of unhealthy foods grew and those considered healthy continued to shrink until he stopped going to parties because he couldn’t find anything he could eat and it was causing him extreme anxiety. .

For some people with orthorexia, but not all, their body image may begin to be affected by how strictly they follow their eating habits, Rollin said.

And with similar underlying causes, orthorexia can transform into other disorders, such as bulimia or anorexia nervosa, he added.

The motivations that people with orthorexia may have, and the plaudits they receive from society, may be called health promotion or disease prevention, but they often replace a “clean, old-fashioned food culture” that prioritizes ideal nutrition. body size and shape, Gaudiani said.

“Some elements may be very similar to dietary culture in disguise,” Rollin said.

And even if there’s no weight shame behind it, orthorexia and the steps a person takes to adhere to certain dietary rules can be costly and distressing, Gaudiani said.

“It can also limit us in terms of our core goals and values,” he added.

What is healthy?

Another sign that nutritional guidelines are about more than just health is the difficulty of even defining what is healthy.

According to Gaudiani, in the 1990s, healthy and clean eating will consist of low-fat diets. People are now more likely to consider foods high in protein and fat but low in carbohydrates and sugar to be healthy, he said.

Others will prioritize the provenance of food, such as whether it is organic, non-GMO and local, Gaudiani said.

Of course, there’s nothing wrong with wanting a salad, Rollin says, but the problem comes when you think you can only eat salad.

Each person is unique, so choosing the healthiest food at any given time will depend on each person’s needs and the context in which they find themselves, he added. If you don’t need to eat a certain way because of a medical condition, Rollin says listening to your body is often the best course of action.

“And when thinking about health, it’s important to think beyond nutrition,” Wood said.

A healthy life includes social relationships, time devoted to your hobbies, enjoyable physical activity, and enough mental space to find peace—all of which are hard to achieve when you spend hours a day wondering what you “should” be eating.

“If you just want to live a fairly balanced, social and connected life, the rules of orthorexia can really isolate you from your peers because you end up turning down opportunities to eat with other people because they don’t follow the rules.” same rules as you.” – said Gaudiani. “So if you say no, your social world may collapse and become very small.”

Get well and move on with your life

If you or a loved one needs help with orthorexia, the good news is that treatment follows the same path as treatment plans for eating disorders such as anorexia or bulimia nervosa. The bad news is that lack of public awareness can be a hindrance.

“When seeking therapy, make sure it is not just an eating disorder specialist, but someone who has experience treating orthorexia,” Rollin said. Not all specialists have such experience.

People with orthorexia may encounter a team that includes therapists and nutritionists, similar to patients undergoing treatment for other eating disorders, Rollin said. But those living with orthorexia will also likely face an additional layer of unraveling their definition of health and challenging reframing of their beliefs around it, she added.

The process may also involve working with the people around you, Rollin said. More people are realizing that regularly talking about food in terms of weight isn’t a good idea, but fewer people are finding it problematic to talk about “healthy” or “unhealthy” foods, he said.

“You may need to educate friends and family quite often, helping them understand and have compassion for why comments about a new juice detox they’re doing are of interest to them,” she said.

And those in recovery should also practice compassion for themselves, Gaudiani said.

“Nobody does it just for fun or to accidentally get into trouble (…) They start doing it because they feel that it benefits their health, or they feel that there is social pressure, or they feel that something What they do is safe. ,” He said.

The recovery process can be difficult, but it is rewarding, Wood said. It’s been almost four years since he said he hit rock bottom at that Christmas dinner.

“I feel like I’m starting to live my life again,” Wood said. “I’m going to take all the time I used to spend thinking about food and apply it to other aspects of my life. “It was really cool.”