I was never thin enough to be anorexic. Exercised obsessively, but never became underweight. Had thought about purging, but never done it. Occasionally went on binges, but not often enough to be considered a binge eater. And hadn’t seen a therapist, who would’ve diagnosed me with EDNOS: “eating disorder not otherwise specified,” the catchall term given to those of us with disordered eating that doesn’t quite fit the laundry list of DSM-V criteria.
It wasn’t until I read about Jordan Younger, formerly The Blonde Vegan (and now The Balanced Blonde), that I first discovered the term “orthorexia.” As I was reading her story, I kept thinking “this is me.” Jordan became so obsessed with “eating clean” and going on “cleanses” that she lost her period, suffered sallow skin and experienced thinning hair — classic symptoms of anorexia nervosa.
Though someone who looked at her might not have told her she had anorexia based on her weight, Jordan knew her eating patterns were disordered, and even discovered a name for them: orthorexia. Yet orthorexia nervosa is not yet formally recognized as an eating disorder diagnosis in the DSM-V, and won’t earn you a bed in the nearest treatment center.
As John Oliver would say, “And now, this.” The Internet is swimming with questions like, “Is orthorexia a real eating disorder?” Well, let me let you in on a little secret I learned in psychology class: the DSM-V manual, while helpful (especially for insurance purposes), is not the be-all, end-all of mental health diagnoses. The DSM-V is flawed, and one such flaw — IMHO — is excluding orthorexia nervosa from the list of official eating disorder diagnoses.
What is Orthorexia?
First thing’s first: what is orthorexia? The term, according to NEDA, was coined in 1998, and refers to an unhealthy obsession with “healthy” or “clean” eating. This can take the form of obsessive exercising, eliminating processed foods, avoiding certain ingredients (or entire food groups) and a progressively stricter and stricter diet with an emphasis on promoting health and getting an athletic figure.
Orthorexia has garnered much media attention in the past few years, thanks to famous cases like Jordan Younger and YouTube fitness star Cassey Ho. Sadly, this attention has also attracted haters, who deny that orthorexia is a “real” eating disorder — or worse, dismiss those with orthorexia as attention-seekers and drama queens. But as someone who had the eating disorder myself, I can attest that orthorexia nervosa is very, very real.
The Consequences of Orthorexia
Thanks to my eating disorder story, I know that orthorexia is real. Some might wonder why I care so much if others acknowledge it — after all, if I know orthorexia is real, why does it matter what anybody else thinks? Yet the fact of the matter is that orthorexia, like any eating disorder, is downright dangerous, and may have detrimental health consequences if it goes unaddressed.
At the height of my orthorexia, it became clear that excessive exercise and a restrictive diet were taking their toll on my body. My hormones fell out of whack, leading to plunging estrogen levels and irregular periods. For the first time in my life, I began to miss my monthly flow. I also experienced constant fatigue and chronic pain all over — pain that continues to flare in my knees, shoulders, neck and back even today. The minute I allowed my body to rest, I began experiencing horrible anxiety attacks that took my breath away, accompanied by stabbing back and chest pains.
Most importantly, however, I was avoiding people and things I previously loved, including foods and social occasions. I even began to snap at the people who cared about me, especially if they questioned my obsessive diet or exercise routine. The way my disordered brain saw it, you were either on my team, or you weren’t — and if you didn’t unconditionally support my weight loss journey, then you weren’t with me; you were against me.
Why It Matters
Thankfully, I found recovery from orthorexia — yet I still care that orthorexia is not classified as a “real” eating disorder in the DSM-V. Orthorexia has caused myself and so many others so much pain, and this pain has yet to become formally acknowledged by the medical community.
Not only do I want the validation of having my eating disorder become a clinical diagnosis, but I also believe it’s dangerous not to diagnose orthorexia nervosa as a DSM-V disorder. Fatphobia already runs rampant in the medical community, especially in eating disorder treatment — and those of us with orthorexia often don’t fit the stick-thin, underweight description of a stereotypical eating disorder patient.
As a result, someone’s dangerously disordered eating patterns may fly under the radar (or, in overweight patients, even be encouraged by doctors), worsening their disorder and preventing them from receiving the help they need to get better.
“Other specified feeding or eating disorder” is not enough for patients who suffer from orthorexia nervosa. Because of weight discrimination and the lack of clinical support for the orthorexia diagnosis, patients like me face major obstacles to eating disorder treatment in the United States.
We may not be able to change the DSM-V, but there are things you can do to support the changing landscape of eating disorder advocacy and recovery. Namely….
- Pledge to support Health at Every Size (HAES), which states that weight does NOT measure health. In other words, overweight individuals are not automatically deemed unhealthy — and individuals must not be underweight to suffer from the psychological consequences of disordered eating patterns. Click here to sign the pledge.
- Skip the scale. Eating disorder advocacy begins at home, so if you haven’t already…. THROW AWAY YOUR SCALE! Go ahead. I’ll wait. *waits* Now that you’ve done that, you should also know that you have the right to refuse to be weighed (or ask to be “blind-weighed,” so you don’t see the number on the scale) at the doctor’s office. Note that there may be times when your weight matters — when determining anesthesia dosage before a procedure, for example — so ask to be blind-weighed when these occasions arise. Print these free HAES cards to start the conversation with your doctor, without feeling awkward or ashamed.
- Become a Legislative Advocate for NEDA. Sign up for NEDA’s free legislative alerts to help advocate for legislation to support eating disorder recovery. Who knows? Someday, a law could mandate education about orthorexia in addition to other eating disorders, or that eating disorder patients be protected from size discrimination — and by signing up for NEDA’s alerts, you could be a part of it! Click here to become a NEDA Legislative Advocate.