Orthorexia Flashcards
Where does the term orthorexia originate?
- Steven Bratman in 1997
- ortho (correct) + orexi (appetite)
What are the proposed diagnostic criteria for orthorexia (Dunn & Bratman, 2016)?
A - obsessive focus on “healthy” eating (defined by dietary theory) and marked by exaggerated emotional distress to food that is “unhealthy”
B - compulsive behaviour and mental preoccupation becomes clinically impaired by: malnutrition, distress, dependence of self-worth on “healthy” eating
What is the healthyism movement?
1 - coined in the 1970’s to describe a new health consciousness
2 - shifted responsibility for health and disease from macro level (society, medicine) to micro level (the individual)
3 - associated with the following beliefs:
That health can be achieved through discipline
That a fit body = good living
Exemplified through preventive medicine, yoga, meditation, fitness regimes, etc.
What are some of the points regarding healthy eating?
1 - some people think that illness can be prevented or treated through diet
2 - most alternative diets are developed independent of science (fads)
3 - however most of these diets can be adhered to safety and practitioners do not have orthorexia (development of a disorder is a separate stage)
Orthorexia in the DSM-5 is currently diagnosed under what two conditions?
1 - Other Specified Eating Disorder (OSFED): clinician chooses to specify the type of presentation (eg subthreshold bulimia, orthorexia)
2 - Unspecified Feeding or Eating Disorder (UFED): used in situations where the clinician does not have suffice to information to specify the type of presentation
What are the arguments for the position that orthorexia should be considered a mental disorder?
1 - orthorexia is a meaningful and impairing disorder
2 - orthorexia can be reliably and validly assessed
3 - there is evidence for convergent validity
4 - there is evidence for clinical utility
5 - health professionals support orthorexia as a diagnosis
What are the main points supporting the argument that orthorexia is a meaningful and impairing disorder?
1 - there are health risks associated with this pathology such as: social isolation, disease transmission to other family members (esp. children), poor quality of life, nutritional issues
What are the points supporting the argument that orthorexia can be reliably and validly assessed?
1 - Teruel Orthorexia Scale: distinguishes between healthy and unhealthy orthorexia (Barrada & Roncero, 2018)
Healthy orthorexia subscale (9 items): represents an interest in, and tendency to eat, healthy foods (protective?)
Unhealthy orthorexia subscale (8 items): assesses for a negative social/emotional impact of adhering to rigid eating (distress, low self-esteem)
What are the points supporting the argument for convergent validity (the degree to which two measures of constructs that should, theoretically be related, are correlated)?
1 - higher scores on orthorexia measures are associated with emphasis on organic, avoidance of preserved foods, fear of eating in front of others, body-weight concerns, increased exercise frequency, fixed schedule and 3+ hours of meal prep/food research per day (Haman et al 2016)
What are the points supporting the argument for clinical utility?
1 - satisfies the DSM’s requirement that psychopathology is accompanied by distress/impairment
2 - in a community sample, individuals with ON reported lower well-being, life satisfaction, and higher stress (Strahler et al 2018)
3 - it is meaningful in clinical settings (Segura-Garcia et al 2015): 48 patients diagnosed with AN or BN, 28% had ON at Time 1, 58% had ON at discharge 3 years later (AN, BN -> ON?)
4 - diagnosis may inform treatment (Brytek-Matera et al 2015): ON less severe eating pathology than AN and BN, but overlap should be considered in treatment planning (distorted cognitions related to ON should be considered in treatment in regard to AN, BN)
What are the main points supporting the argument that health professionals support orthorexia as a diagnosis?
1 - Ryman et al. 2019: self-report survey of psychologists, psychiatrists, dieticians, and physiotherapists in Netherlands (n = 160), 78% said ON should be its own diagnosis, 74% agreed it fits in Eating and Feeding Disorders category
What are the main arguments that orthorexia should not be considered a mental disorder?
1 - orthorexia cannot be reliably/validly assessed
2 - insufficient evidence of clinical utility
3 - orthorexia is actually a type of OCD
4 - orthorexia is actually a behavioural addiction
5 - orthorexia is actually a variant of AN
6 - orthorexia is a reaction to “health” culture
What points support the argument that orthorexia cannot be reliably/validly assessed?
1 - prevalence estimates vary widely (between <1% and 34.9%) compared to prevalence for AN (1.2%) and BN(2.4%) (multiple studies)
2 - contradictions regarding gender-based prevalence
3 - contradiction regarding orthorexia prevalence based on age, education, BMI, smoking and alcohol (Koven & Abry 2015)
4 - ORTO-15 most commonly used measure, too sensitive, leading to false positives (69.5% of non-clinical, convenience sample met criteria and 49.5% of dietician nutritionists)
What are the main points for the argument that there is insufficient evidence of clinical utility for the diagnosis of ON?
1 - current knowledge is from case studies
2 - few empirical studies to examine ON-related impairment
3 - lack of longitudinal studies to examine complications of ON
4 - after accounting for eating pathology, ON does not add predictive value
What are the main points for the argument that orthorexia is a type of OCD?
1 - correlations between symptoms of OCD and orthorexia (Brytek-Matera et al 2017): 31 vegans/vegetarians and 31 meat-eaters had same levels of orthorexia symptoms, and OCD symptoms associated with ON symptoms
