Understand Healthy Eating Disorder

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There is no doubt that maintaining a healthy diet is essential for the health of the body and mind — in addition to preventing diseases, a balanced diet improves quality of life and disposition. However, when the person seeks an excessively healthy diet, this may signal an eating disorder to Orthorexia.

This frame — called orthorexia nervosa — is characterized by a pathological obsession with healthy foods, but has not yet been officially recognized as an eating disorder by the DSM 5 (the manual for diagnosing mental disorders by the American Psychiatric Association – APA).

This condition is also not defined in the APA’s Eating Disorders diagnostic manual, nor in the World Health Organization’s diagnostic manual, the ICD-10 (International Classification of Diseases).

Experts Warn About Orthorexia

But still, it is an increasingly common problem. It usually affects teenagers and young adults, between 16 and 25 years old, who still live with their parents and have been restricting their diet, social life and family life because they believe that only a certain type of food is good for their health.

These are people who make a gradual change in their eating pattern, with an interest that grows, becomes excessive and, at some point, becomes pathological. It may also be related to vigorexia:

“While in orthorexia the main target of food is physical health and the quality of the food that is eaten, in vigorexia the main target is physical care exclusively focused on body size. Of course, it’s great to do physical activity and eat well, but when it becomes an obsession, it’s a problem”, warns the psychiatrist. Edward Aratangysupervising physician at the Institute of Psychiatry at the Hospital das Clínicas at USP (IPq/USP).

ancient origin

According to Aratangy, orthorexia is a “nickname” that was given to the restrictive avoidant eating disorder, which is a type of food selectivity that has been described for decades, especially in children diagnosed with autism spectrum disorder.

“The main description of avoidant restrictive disorder was not tolerating certain types of food because of physical characteristics, such as texture, color, taste. This could occur transiently in children or become a constant repulsion”, explained the psychiatrist.

Over the years, the avoidant disorder that was previously characterized by food selectivity in children began to gain other contours, often as a result of standards imposed by society and social media: in addition to childhood disgust, food restriction began to be used by teenagers, young people and adults who associate food with some belief, as if certain food is bad or just a certain type of meal is good.

“The word ortho, in Greek, means correct. Rexis means appetite. So, orthorexia means correct appetite. The reports that orthorexia was possibly pathological come from the 1990s,” explained Aratangy,

The expert also points out that some religions have dietary restrictions and that in these cases the restriction is not considered pathological because it is inserted in a cultural context, socially accepted, without causing physical or psychological damage to people.

Healthy eating x Social well-being

From the 1990s onwards, says Aratangy, the first records of people with malnutrition and who did not want to ingest the necessary nutrients began to appear because of the practice of avoiding food.

This went hand in hand with a social phenomenon encouraging the consumption of healthier foods, with greater production of organic food, without pesticides and, later, the veganism movement.

“Note that neither of these two movements is pathological. But when several beliefs add up, people start to abolish and restrict more and more foods from the diet and this reaches a point that it can become obsessive. And this is happening in waves, at different times. There has already been an obsession with gluten, with lactose, with detox, among others”, said the psychiatrist.

For example, people who do not use cutlery that has already been used on food that they deem unsuitable as if it were contaminated; people who stop having a social life because they only eat things that are almost impossible to find in a restaurant or at an event; people who take their own food anywhere, who only eat foods considered ‘pure’.

It is noteworthy that any mental pathology is an exacerbation of normal worries. Worrying about the quality of the food you consume, about physical activity, is absolutely normal. But if you exacerbate it, it will become a problem and, in the future, a pathological disorder.

At the IPq Eating Disorder Outpatient Clinic, for example, it is increasingly common to identify this type of disorder among adolescents and young adults:

“Many cases are related to fad diets and questions coming from social networks. A celebrity proposes drinking alkaline water, everyone starts drinking alkaline water even though it doesn’t make any physiological sense. A celebrity proposes to stop all dairy products, and then everyone starts to stop dairy products. This becomes a health problem, it can become vitamin, protein and mineral malnutrition”, said the specialist.

How is orthorexia diagnosed?

Normally, it is not the person with orthorexia who seeks help, but the family. This is because most of the time the person with orthorexia agrees with that behavior, which he considers absolutely normal and healthy.

“People start to isolate themselves, they don’t go out anymore, they spend most of their time worrying about restricting certain foods. The person loses the ability to live together and this is pathological”, explains the psychiatrist.

To arrive at the correct diagnosis, the first thing is to exclude other psychiatric disorders that could lead to that behavior, including schizophrenia (the patient may have delusions of poisoning and think that that food will poison him).

Obsessive-compulsive disorder (when inadequate food is part of obsessive beliefs) and anxiety and depression (such as choking phobia, which is a disorder more common in elderly people who are afraid to swallow and, therefore, give up a series of of food).

So, the second thing to do is to expand the food repertoire and improve the person’s nutritional quality; the third line of treatment is to prevent the changes that this behavior has brought about, with antidepressant medical treatment to reduce the anguish that the dietary transition will bring.

The challenge to diagnose orthorexia is still immense, after all it is a fine line to separate what is healthy eating from what is pathological behavior around what the person believes is healthy eating, usually based on reports on social media.

There are still few studies on the subject and therapeutic methods available — in addition to few centers specializing in this type of treatment. Therefore, the approach should always be multidisciplinary, with the support of a psychiatrist, nutritionist and psychologist.

Technical review: Alexandre R. Marra, researcher at the Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEP) and permanent professor at the Graduate Program in Health Sciences at the Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE).

Source: vidasaudavel.einstein.br

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