As usual when an article on orthorexia is published, the blogosphere was up in arms with rebuttals and denials.

“Whenever orthorexia is described in the media as ‘taking healthy eating too far,’ people have a standard knee-jerk reaction: ‘How can eating healthy be bad?’ Sometimes you even hear, ‘I could use a little obsession with healthy food.’ This really highlights the misunderstanding our society has about mental illness. You never hear someone say ‘I could use a little cancer,’” Setnick commented.

This inability or unwillingness to consider mental illnesses as “real” diseases is exemplified by this cartoon in the Huffington Post published on November 13, 2014. One vignette depicts a helpful pal suggesting that a different “frame of mind” is all that is needed.

Setnick is both amused and annoyed by the haters. “It’s like we’re talking about Big Foot,” she says, “or the Loch Ness monster. If you’ve never seen it, you can’t believe it exists. But once you’ve been face to face, you know that it’s real.”

She has been speaking out about orthorexia since 2009, when she was quoted in a New York Times article published February 25, 2009 about children who are scared to eat.

An eating disorder specialist since 1998, Setnick had already had many encounters with orthorexia by then. One patient stands out in her mind, a young man in search of health and fitness, exercising daily. He exemplifies the paradox of orthorexia, she says, because he genuinely thought he was on the right track.

Setnick says: “He didn’t come to me saying, ‘Help me with my eating disorder.’ He found me because of my credentials in sports nutrition and wanted advice to improve his diet. But he would only eat energy bars and vitamin pills. He couldn’t stand the thought of eating something that didn’t have all the information on the label. No fruit, no veggies… there is no one who could believe this was healthy. Yet he was completely unwilling to consider that possibility, and he was definitely not interested in changing his ways. To this day I’m not sure what he expected me to say.”

That is why some researchers suggest that orthorexia is better classified as an anxiety disorder. According to Dr. Kevin Wandler, 2015 president elect of the International Association of Eating Disorders Professionals Foundation (iaedp), with orthorexia “you see some similarities with OCD [obsessive compulsive disorder], where someone is afraid of contamination. But in OCD there are usually many behaviors that patients avoid. In orthorexia, it’s just food, food, food.”

Wandler is also the Medical Director at The Meadows Ranch, where he says many patients meet Setnick’s proposed orthorexia criteria (see box below). “We see orthorexia here all the time. Even our food, which is made by hand every day from scratch, isn’t good enough for some.”

Orthorexia

But there is no official orthorexia diagnosis or diagnosis code. Patients receive a diagnosis of anorexia, as the disorders have so much in common. But that doesn’t describe the whole clinical picture. Patients can exhibit orthorexia in addition to anorexia and even bulimia.

Wandler explains: “Some patients become so distraught after eating something that feels ‘unsafe’ that they are compelled to get it out of their bodies. Of course, this doesn’t actually work, but the neurochemicals involved in purging can cause a feeling of relief that makes them think that it helped.”

“So why waste time on disbelievers or convincing people that orthorexia is real?” Setnick says “The answer is one word: Insurance. Without criteria, there is no diagnosis, no diagnostic code, and therefore no insurance coverage.”

“Insurance company discrimination against eating disorder treatment is a longstanding thorn in my side,” admits Setnick. “I have spent years of my life on the phone trying to get the person on the other end of the line to understand what I’m saying. They use the lack of diagnostic criteria as proof that orthorexia isn’t real. But nothing has diagnostic criteria until someone writes them.”

So last year, when Setnick published the second edition of The Eating Disorders Clinical Pocket Guide, she created her own proposed criteria for orthorexia. She ran them by Steven Bratman, the author of Health Food Junkies, the first book to describe the disorder, who described them as “very insightful and helpful.”

“It is my hope to start a conversation with the other researchers investigating orthorexia. The best way to help those who are struggling with it is to pool our resources to develop a treatment,” says Setnick

Until then, the best treatment for orthorexia is in an eating disorder treatment program such as the one at The Meadows Ranch, because the treatment modalities are ultimately the same – nutritional restoration and anxiety management, usually with medication and counseling.

Wandler concludes: “Before someone with orthorexia can even get to the point where they consider treatment, they need the recognition that what they’re experiencing is real. And hopefully that recognition will eventually reach the larger community.”

We Can Help

We have treated eating disorders for more than 20 years. We know recovery from an eating disorder is possible. It’s happening every day at The Meadows Ranch. Based on feedback from patients, families and professionals, the vast majority of our patients remain committed to a life of health, balance and purpose. For additional information about the treatment of eating disorders, please call to speak to one of our Intake Coordinators at 866-390-5100 and we will contact you with the information you need.