Most of us have heard of eating disorders such as binging/purging disorder (commonly known as bulimia) and anorexia, both of which involve unhealthy behaviors towards food. The first involves binge-eating massive amounts of food and then getting rid of it, usually by forcing oneself to vomit. The second involves situations in which the victim perceives that she (very often young females) is too fat — in spite of all objective indications to the contrary — and she literally starves herself to lose the phantom fat. But now we have a new food neurosis— "orthorexia," which is characterized by an obsession with food cleanliness — to the point of not trusting that anyone but the victim can properly prepare food that is "clean" enough. Thus far, orthorexia hasn't been included in the latest (fifth edition ) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but research in this area is ongoing, and it may be included in the next edition.
Interest in the condition is growing, to the extent that a workshop about the condition was held at the latest meeting of the American Psychiatric Association, as described here. Workshop participants presented reports of individuals who seemed to demonstrate some degree of orthorexia but were unclear about the motivations behind the condition. For example, in one case a woman who presented with dehydration, low blood potassium levels (a dangerous condition) and low body weight was diagnosed with several psychotic symptoms, including paranoia. She responded to treatment with the antipsychotic medication Haldol and eventually was discharged consuming normal meals.
In another case, a woman suffered extreme weight loss, and was afraid of eating because "you don't know what it will do to you". Gradually she was re-educated and learned to consume a variety of foods that she no longer thought would hurt her.
One participant in the workshop, Dr. Yon Park, noted that the widespread obsession with dieting is to some extent being replaced by an "eating clean" movement, and a desire to live "holistically": "Simply put, orthorexia is a fixation on food quality as opposed to food quantity. The social and cultural context could promote certain types of food intake management that ultimately becomes pathological in a person genetically predisposed to [eating] disorders."
Another participant, Dr. Evelyn Attia, questioned whether orthorexia is really a new, separate condition, or whether it is a new form of anorexia, apparently since both can result in substantial body weight loss and significant health threats.
Obviously, more research and discussion will be needed before experts agree on exactly how to categorize this eating disorder, and whether or not it requires a separate category in the next edition of the DSM.
