When Eating Healthy Turns Obsessive

How to get help
Therapists, nutritionists, and eating-disorder experts have slowly begun to take orthorexia more seriously. Anorexia and bulimia were similarly slow to be recognized: Anorexia was long considered a symptom of hysteria, while bulimia was regarded as a type of anorexia and was not considered a disease in its own right until 1980.

There are no plans to add orthorexia to the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM), a new edition of which is scheduled to be released in 2013, in part because of the dearth of research. "The problem is, we don't know enough about it," says B. Timothy Walsh, MD, a psychiatrist at Columbia University, in New York City, who chairs the Eating Disorders Workgroup for the new edition. The workgroup does, however, recommend adding to the DSM something called Avoidant/Restrictive Food Intake Disorder, which pertains mainly to children and preteens who are excessively picky eaters, to the point that they become undernourished.

Dear, who has been working with patients with eating disorders for 11 years, says adding orthorexia to the DSM could benefit people with the disorder by making clinicians more likely to recognize it. She says inclusion in the DSM could also be "counterproductive," however, if the diagnostic criteria are too narrow and leave some cases undetected and untreated.

If you suspect that you or someone you know may be orthorexic, Kaufman suggests approaching with care. "When you have a full-blown eating disorder there is a strong degree of denial [about] the extent of the condition," he says.

Recognizing orthorexia can be difficult if a person does not yet show outward signs of malnutrition, Kaufman says, but if the disorder has become medically compromising then they may need treatment to help them change their eating patterns and their thoughts that go along with eating. (Directories of eating-disorder experts can be found on the website of the International Association of Eating Disorder Professionals.)

The ultimate recovery from an eating disorder is to get beyond labeling foods good or bad, Dear says. "You have to reach a self-loving place, not a virtuous place. It would be helpful [for] clinicians to have their radar out for orthorexia because it is easily misread as just healthy eating when it can be a major problem."

Moodley no longer considers herself orthorexic. Her work with clients made her realize that the correct diet is different for each individual and helped her overcome her orthorexia. But when she discusses her diet today, a sense of pride still lingers in her voice. To some, her diet was the epitome of healthy perfection. She said she still maintains a healthy diet, but now it is a preference as opposed to an obsession. She prefers fresh vegetables, but isn't opposed to eating them frozen and she doesn't think of all sweets as junk anymore. She says her fears of "bad" food are gone.

But it still takes Moodley several moments of silent reflection before she can recall the latest treat she ate. Finally, after some deep thought on the matter, she remembers: "Two days ago. I had a cookie. An organic cookie."