In Sickness and In Health: Orthorexia Nervosa, the Study of Obsessive Healthy Eating

by Borgida, Amanda, Psy.D., ALLIANT INTERNATIONAL UNIVERSITY, SAN FRANCISCO BAY, 2011, 113 pages; 3467161


This qualitative study explored clinicians' perceptions of Orthorexia Nervosa (ON). ON, a term coined by the physician Steven Bratman (Bratman & Knight, 2000), is the compulsion to eat healthy, pure or organic foods. Healthy eating becomes ON when self-imposed strict dietary restrictions produce malnutrition, social isolation and impairment in daily activities. Only limited research exists on prevalence, diagnosis and treatment of ON. The intent of this study was to determine the extent to which ON is perceived as distinguishable from current DSM-IV-TR disorders such as anorexia nervosa (AN), obsessive compulsive disorder (OCD) and even delusional disorder.

Ten licensed professionals (three psychologists, one general practice physician, two psychiatrists, two marriage and family therapists, and two registered dieticians) who specialize in treatment of eating disorders or OCD and who indicated that they have provided services to at least one individual with symptoms similar to ON, served as participants. The study utilized a case-history approach in which participants' experience with a client with symptoms of ON was used as a springboard to explore participants' perceptions of presentation, precipitating factors, co-morbid DSM-IV diagnoses, and treatment recommendations.

The majority of participants stated that ON can be serious and incapacitating, and that it had mental, physical, social, and financial consequences. Most participants conceptualized and treated ON as both unique and as a subtype of either AN (without body size concern) or OCD. The most common reported co-morbid features of ON were social anxiety, phobia and depression, and cognitive rigidity exacerbated by malnutrition. Common precipitating life events were history of abuse, physical illness and social rejection. Symptoms were described as a pathological extension of highly reinforced current health practices. Participants recommended the use of a treatment team including a mental health practitioner, registered dietician, psychiatrist and general medical practitioner. The findings concur with the limited existing literature on ON, and confirm that the term ON is consistent with real encountered clinical phenomena. There is a need for continued research using both quantitative and qualitative methodology to further develop diagnostic criteria and to develop appropriate intervention.

Source TypeDissertation
SubjectsClinical psychology
Publication Number3467161

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