What is an eating disorder?

An expert explains it 4:02

(CNN) --

Jason Wood was sitting at a restaurant on vacation with his husband, angry and upset because he couldn't swap the pita bread for fresh vegetables in their hummus bowl.

The pain was not exaggerated, Wood said.

It was 20 years of an eating disorder, and the anxiety and stress that comes with it culminated in one moment, she said.

Wood has orthorexia, an eating disorder that is not listed in the Diagnostic and Statistical Manual of Mental Disorders, also called the DSM, which is the formal guideline for the clinical evaluation of mental health conditions.

But doctors are seeing an increase in orthorexia among patients, said therapist Jennifer Rollin, founder of the Eating Disorders Center in Rockville, Maryland.

"My hope is that it will be added to the DSM, but unfortunately, it seems like the process of getting something in there is very slow," Rollin said.

Orthorexia is an obsession with eating “clean,” as defined by a set of rules that depend on certain individuals and the context in which they live, said Dr. Jennifer Gaudiani, an eating disorders physician and founder and medical director of the Gaudiani clinic in Denver.

A November 2023 study found that about three in 10 participants showed signs of orthorexia.


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

The lack of understanding around this condition prevented Wood's friends and family from expressing their concerns (sometimes applauding her efforts to adhere to rigid eating principles), even when she became estranged from her friends and lost so much weight that she couldn't maintain her weight. body temperature, he said.

Here's what you need to know about orthorexia.

Diet culture in disguise

Focusing on eating healthy seems like a good thing, right?

Not always.

Eating disorders often have similar underpinnings: a genetic predisposition combined with environmental factors, Rollin said.

And often the disorder centers on a set of rigid rules, whether it's calories, when to eat or the ingredients in food, he added.

When people vulnerable to eating disorders stick to eating only in a way they consider healthy, the behavior can go from a preference to an obsession, Rollin explained.

As the years went by, Wood said his list of unhealthy foods grew and those considered healthy kept shrinking until he stopped going to parties because he couldn't find anything he would allow himself to eat, and that left him with a lot of anxiety.

For some people with orthorexia, but not all, their body image may begin to depend on how strictly they follow their eating rules, Rollin said.

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

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The motivations that people with orthorexia may have, as well as the applause that society gives them, could be labeled as health promotion or disease prevention, but they are often substitutes for a “pure, old-fashioned diet culture,” which prioritizes an ideal body size and shape, Gaudiani said.

"Some elements can look a lot like diet 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 cause distress, Gaudiani said.

“It can also limit us in terms of what our greatest goals and values ​​are,” he added.

What is healthy?

Another sign that food rules are not just about health is the difficulty in even defining what is healthy.

In the 1990s, healthy, clean eating would consist of low-fat diets, Gaudiani said.

People are now more likely to consider foods high in protein and fat but low in carbohydrates and sugar to be healthy, she added.

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

Of course, it's not wrong to want to eat a salad, Rollin said, but the problem arises when you think you can only eat a salad.

Each person is unique, so the healthiest food choice at any given time will depend on the needs of each individual and the context in which they find themselves, he added.

Unless you need to eat a certain way due to a medical condition, often the best course of action is to listen to your body, Rollin said.

And when thinking about health, it's important to not just think about nutrition, Wood said.

A healthy life includes social relationships, time dedicated to your passions, enjoyable physical activity, and enough brain space to find peace—all of which are difficult to achieve when you spend hours a day reflecting on what you “should” eat.

"If you're someone who just wants to live a reasonably 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 humans because they don't follow the same rules as you."

Gaudiani said.

"So, if you say no, your social world can collapse and become quite small."

Recover and live life

If you or a loved one needs help with orthorexia, the good news is that treatment follows a similar path to plans established for eating disorders such as anorexia or bulimia nervosa.

The bad news is that a lack of awareness among the public can present obstacles.

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When looking for therapy, make sure it's not just an eating disorder specialist, but also one with experience in orthorexia, Rollin said.

Not all specialists will have that experience.

People with orthorexia may encounter a team that includes therapists and dietitians, similar to patients in treatment for other eating disorders, Rollin said.

But those living with orthorexia will likely also face the added layer of unraveling their definition of health and reframing their ideas around it in a challenging way, he added.

The process may also involve working with those around you, Rollin said.

More people are realizing that it's not a good idea to regularly talk about food in terms of weight, but fewer people find it problematic to talk about "healthy" or "unhealthy" foods, he said.

"You may need to educate friends and family quite frequently, helping them have understanding and compassion about why comments about the new juice detox they're doing are triggering for them," she said.

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

"No one does this just for fun or to accidentally end up in trouble (...) They start doing it because they feel that their health benefits or they feel that there is social pressure, or they feel that what they are doing is safe," he said.

The recovery process can be difficult, but it is rewarding, Wood said.

It's been almost four years since she said she 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 that time I used to spend thinking about food and apply it to other aspects of my life.

“That’s been really cool.”

Eating Disorder