Mention the term ‘eating disorder’ and most people think of anorexia or bulimia. There are lesser-known eating disorders, however, including orthorexia.Although not currently recognised by the medical community as a diagnosis in its own right, orthorexia is defined by the Oxford English Dictionary as “an obsession with eating foods that one considers healthy”.The term ‘orthorexia nervosa’ was first used by Dr Steven Bratman MD in 1996. Bratman describes orthorexia as “an unhealthy obsession with healthy food.” He says that the main feature that distinguishes orthorexia from anorexia is that anorexics focus on weight, whereas orthorexics obsess about purity.
In this blog, Amanda* describes her experience of the condition. She self-identifies as an orthorexic, something she only discovered several years into her recovery from drug and alcohol addiction.
“I had never even heard of the term orthorexia until my mid-thirties. It was several years into my recovery from drug and alcohol addiction. I remember reading an article about it and identifying with every word of it. I had never really thought of myself as having a problem with eating.
“Looking back, I now know orthorexia started in my early 20s, whilst I was drinking and taking drugs addictively. I’d go through phases of bingeing heavily on drugs and alcohol. During those times, I was completely unable to nourish myself properly. I’d eat a lot of junk food and I often skipped meals. I also smoked a lot of cigarettes.
“Then I’d reach a point where I felt so unwell that I’d swear off drink and drugs altogether. Every time, I promised myself that I’d turn over a new leaf and live a completely healthy life. I’d write these impossibly strict rules for myself – mainly around what I needed to eat and drink to do things right. I read up on healthy eating obsessively. I turned any sensible guidance into impossible goals. For example, there were guidelines at the time on eating 5 portions of fruit and vegetables per day. I decided to make my goal 10 portions a day. If I didn’t achieve that, I felt like a failure.
“Whenever I saw something in the news about food in relation to health, I would often make a new rule for myself. The latest food fads and trends were an obsession.
Whatever the latest superfood, I added it to my menu – whatever the cost and even when there wasn’t any real evidence of its benefits. Looking back, it was exhausting trying to keep up with the requirements – but I didn’t see anything wrong with it at the time. I thought I was doing the right thing. I thought this was how I’d beat my addiction to alcohol and drugs.
“More times than I can remember, this punishing routine around food led me to relapse – not only on drink and drugs but also bingeing on unhealthy food. I’d order two pizzas rather than one, after drinking heavily. It was like alcohol gave me the freedom not to care anymore about having to eat correctly. I’d order a burger and chips from late-night vans, not worrying about what I was eating (until the next day when I could still smell the grease in my hair and felt disgusting). At other times, I’d take drugs and skip meals.
“Finally, I got professional help for my alcohol and drug addiction. Initially, I turned to sugar for comfort. I didn’t mind too much at the time, as I could see the great improvements I was making with substance addiction. For a time, that was enough to give me that sense of doing things right.
“After about 18 months in drug and alcohol recovery, however, I noticed the cycles of behaviour around ‘healthy eating’. Without substances, it was now clear to me that the thoughts and behaviours around food were causing me significant problems.
“I was obsessing about reading information or watching programmes about healthy eating. It felt like a job. I had to seek out the latest knowledge on food, every day. It wasn’t something I did for enjoyment or interest. It felt like I had to do it or else I was slacking or failing. If there was new information I found about healthy foods, I would incorporate it into my diet straight away. It didn’t matter whether the people giving the information were qualified nutritionists or not if it felt compelling to me and promised remarkable health benefits, I wanted it.
“More and more, I started to believe that the way that friends and family were eating was wrong. Meals out at restaurants became very hard, not only because I was secretly judging what they were eating, but also because there were so few options on the menu that I would allow myself to order. They were often drinking alcohol too and I was still early in recovery, so that made me focus more obsessively on eating ‘better’ than they did.
“Travelling became really difficult. I would usually make sure I took my own food with me, say if I went on a long car journey. But there were times I was caught off guard. Service stations were a nightmare. There was virtually nothing in there that I considered being healthy. I would always go without eating in those situations, rather than eating something I thought was wrong.
“Shopping for food was painful too, especially in stores I didn’t usually go to. Just as I had banned foods, there were banned stores too – the brands that didn’t meet my food ideas. Even in shops, I approved of, buying groceries could take a very long time. It wasn’t just about reading a few labels here and there. It was a feeling of total paralysis when I was trying to choose what food to eat. My mind would go completely blank when I was walking up and down the aisles. I often couldn’t think of food combinations that were acceptable to me. My rules changed so often – what
was acceptable and what wasn’t – it was so hard to keep track.
“When I did stray from my healthy eating rules, the guilt and shame I would feel were horrible. The sense of failure would make me feel worthless. I would always vow to try again, try harder – but each time, I felt less belief in myself.
“Conversely, when I did stick to my rules or exceeded one of my daily goals, I would feel an inordinate sense of relief and achievement. Obviously, it was something I couldn’t admit because none of my friends or family would have understood why I felt so delighted at sticking to food rules. It was always such secretive behaviour, whether I succeeded or failed.
“In the end, I would eat like a fussy toddler most days – three or four single ingredients on a plate in precise portions, all of which were foods I thought were healthy. I didn’t enjoy food anymore. Getting it ‘right’ no longer gave me any sense of satisfaction.”
“It’s taken me a few years in my addiction recovery to understand that anxiety has driven all of my disorders, including orthorexia. My obsession with eating the right foods was all about feeling more in control, as was taking drugs like cocaine. I always wanted to be certain that I was getting things right. I can also see that I drank alcohol addictively in the past when I’d had enough of the pressure to do things perfectly. Alcohol made me not care about my rules (until I felt so dreadful that the rules came back to bite me).
“My recovery from orthorexia is a lifelong process. The obsession with healthy eating is everywhere in our culture – you see it on social media, TV programmes, advertising and in stores. It’s often presented as a really admirable quality and there are people who make a lot of money from ‘clean eating’ websites and books. Some days, it still feels like if I crack the code for the right foods and the wrong foods, I will be free from pain and discomfort permanently.
“The main difference today is the reduction in my overall anxiety levels. Thanks to a solid recovery from drugs and alcohol, my mental health is much better. I don’t get triggered so often to do things perfectly. It’s much easier to switch off from the incessant information about healthy food. I don’t follow clean eating bloggers anymore, nor do I obsess about Instagram pages with pictures of healthy food. I have relaxed most of my rules around eating now. I don’t feel horrendous guilt and shame about eating foods I once considered off limits.
“Since the beginning of last year, I’ve chosen not to eat refined sugar anymore. This was a positive recovery choice for me because I could finally see the link between refined sugar and my cycles of controlling the foods I ate. Refined sugar was also very linked to my emotional highs and lows, so removing it has balanced my moods.
“I also know I’m in recovery because the food is no longer the main area of life where I define my success or failure. In recovery from addiction, I’ve been lucky enough to have a family and get jobs I really enjoy. I derive much more pleasure from those things today than I ever did from eating the ‘correct’ foods.
*On her request, we have changed Amanda’s name for confidentiality reasons. To speak in confidence about orthorexia, eating disorders and co-existing addiction(s), call or message UKAT today.
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