Orthorexia nervosa (ON) is a recently emerging phenomenon based on the widespread acceptance of food in its natural state as a healing and miraculous substance. In this condition, it is believed that being able to identify and ingest exactly the right types of natural or ‘clean’ food, while purging the body and the diet of ‘un-clean’ or ‘dirty’ food, will result in good health and healing of all disease.
ON is so new a concept that numerous areas of research still remain to be carried out before its existence as a separate clinical entity can even be confirmed.
Diagnosis of ON
ON research was initially based on the personal experience of Steve Bratman, who fell into the trap of perfectionistic clean eating, and went almost to the brink of neurotic clean food obsession. He developed a set of assessment questions based on his knowledge of how the process worked, to show how such patients could be identified. This work has not been validated as indicative of a syndrome; therefore, the diagnostic criteria for this condition are far from certain as yet.
More recently, the ORTO-15 questionnaire and its modifications are under study, to identify how far they can be used for psychometric and specific diagnosis. More work is required to establish the validity of the existing definitions and assessment features before they can be used to formulate a new diagnostic category.
Research is also focused on the relationship between ON and obsessive-compulsive personality disorders (OCPD). This is because ON shares many similarities with both OCPD and anorexia nervosa (AN), but is not identical to either. It is also necessary to establish the potential risk relationship between OCPD, ON, and AN.
As a result of invalidated and unreliable diagnostic criteria, the prevalence rate of ON is far from being established. This is true in the general population and among special populations who may present with additional risk factors. This latter group includes those such as dieticians and nutritionists, medical students, performing artistes, and fitness-oriented individuals. For this reason, accurate tests which account for both the specific factors of ON and its overlapping features with other conditions have yet to be developed and fine-tuned.
More research is also required to establish the relationship between the thinking process and the eating behavior in people with ON. It is known that individuals with obsessive-compulsive disorders (OCD) and AN often experience disassociation from external environmental cues, which could be due to loss of connections between networks concerned with external and internal attention. This could be true of ON as well, because it shares many similar responses with OCD and AN. Neuroimaging and psychometric studies are needed to explore the inner workings of this relationship, which could contribute to better understanding and treatment of these conditions as different branches of an underlying cognitive-behavioral dysfunction.
Reviewed by Afsaneh Khetrapal BSc (Hons)