Our culture is obsessed with food. This manifests in a variety of movements, from those fighting to stem America's obesity epidemic to a growing emphasis on "clean eating" and "juicing." But while the latter's attention to health seems universally beneficial, it comes at a huge cost for some.
"Orthorexia nervosa" is defined by the National Eating Disorder Association as an "unhealthy obsession with otherwise healthy eating" in which individuals become "fixated on food quality and purity." Orthorexia registers as an emotional quest related to quality of food — and, by extension, the quality of oneself. It requires "ironclad will," and sufferers treat every food choice as "a chance to eat right, be 'good,' rise above others in dietary prowess and self-punish if temptation wins," according to the NEDA.
And yet, this psychological disorder differs in another significant way from disorders such as anorexia: It's not included in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, which is considered the "authoritative guide to the diagnosis of mental health disorders" and standardizes the language used to help treat them.
The omission of orthorexia from the DSM-5, therefore, is not simply one of medical correctness. Inclusion ensures legitimacy and may even impact whether or not individuals receive accurate diagnoses. The DSM has become "the arbiter of who is ill and who is not" and the "primary determinant of treatment decisions," according to Allen Frances, who led the task force that produced the previous version of the DSM-4. When disorders like orthorexia are excluded from the text, sufferers may be less likely to receive a diagnoses and treatment.
Food blogger Jordan Younger, who runs the popular health blog "The Balanced Blonde" (formerly titled "The Blonde Vegan"), is raising awareness about what it's like to experience orthorexia. The blogger publicly revealed her own struggle with orthorexia in 2014. Younger has found that people continue to doubt "how debilitating and difficult" the disorder is. She noted that the disorder, while related to her feelings about body image, was ultimately an "internal struggle," reiterating that "so much of the pain of suffering from an eating disorder happens on the inside." Tellingly, Younger failed to receive an official diagnosis, only identifying her eating disorder when a friend revealed similar symptoms, she told Women's Health.
Despite efforts to get orthorexia added to the DSM, substantive research on the disorder is admittedly sparse. A 2014 study notably outlined criteria for diagnosis, but experts agree that further research is necessary. "We know precious little about [orthorexia] and need a new diagnostic label," Thomas Dunn, one of the study's authors, told Fast Company. Dr. Tim Walsh, chairman of the DSM-5 Eating Disorders Work Group, concurred, telling Fast Company that while "the thinking about orthorexia has merit," more research must be published to warrant a change in the DSM.
Given the pervasive cultural stigma that already surrounds eating disorders, it would seem that legitimizing orthorexia specifically would go a long way toward helping individuals receive the help they need. Until then, further research on the topic is necessary. As Younger told Mic, "Health is a beautiful thing when it's not taken to the extreme."