Orthorexia Nervosa – Too Much of a Good Thing

(From 2008)

Every two weeks I FaceTime with my brother from my 1971-72 American exchange student year, Bob Hirshon, and this topic came up…

In Swedish, there is a word that just can’t be translated succinctly into English. “Lagom” means “just enough” or “adequate”, but it is saturated with overtones of moderation, contentedness and political, even social, correctness. “Lagom” is a way of life – moderation in everything. It is no surprise that Swedish newspapers seem to be on the lookout for stories about people who stray from that middle-of-the-road way of life. One story in Dagens Nyheter caught my eye (for interested/concerned readers, my right eye is almost back to normal) during the flight back to the States this morning. It sent me out on the Internet once I landed and got connected to the airport wireless network: “Exaggerated Healthfulness Can Lead to Serious Disease” is a feature about a 30-year old woman, who after eating a lot of junk food while living in the US started on a journey filled with strict diets and rigorous exercise. She never thought she was too fat, which is the defining feature of Anorexia Nervosa, but she somehow felt she had to eat extremely healthfully to compensate for her prior indiscretions. Her condition, Orthorexia Nervosa (obsession with healthy eating), described by Steven Bratman in 1997, although not officially recognized, is getting increasing attention. Its complications are not dissimilar from those of Anorexia Nervosa, as it can lead to malnutrition with all its consequences. I had not run into the term before – figures I would run into it in Sweden, the Mecca of Moderation. I can see that this is a culture-dependent variety of Anorexia Nervosa, which was first described in the late 1800’s as Fasting Girls. The culture was not focused on healthfulness the same way then as it is today. In Victorian times, fasting was of body image and spiritual interest, and Fasting Girls were said to have mystical powers. Our current DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) classification of Anorexia Nervosa doesn’t mention restricting foods based on their healthfulness, and Orthorexia Nervosa isn’t recognized in it at all. I looked around for blogs on the topic, and found some, including “There’s no such thing as orthorexia nervosa, it’s only a fancy term for a health food junkie“. I like that title, because I think that whenever there is a “new” disease or when an “old” disease gets more attention, patients tend to over-report the symptoms of it and doctors have a tendency to over-diagnose it. While the DSM-IV has weight criteria that help keep the diagnosis of Anorexia Nervosa more objective, most psychiatric diagnoses hinge on value-laden words like often, intense or undue, which are all subjective to some degree. I have said before that there is a tendency (at least in the US) to medicalize the human experience. The last thing we want to do is start calling “health food junkies” sick; let’s not forget that “junk food junkies” have been well proven to get very bad complications from their food choices, too! I have made the observation a few times that the spectrum of what we call the human experience can be defined by what lies at the extremes or by the nuances within the range where most people find themselves. People say “I’m depressed” even if they know they are only experiencing a temporary sadness. They say “I have OCD”, even if they don’t meet the DSM-IV criteria. Going too far with our words isn’t always the most effective way to communicate. Now that there is a new medical term with no DSM-IV definition behind it yet, we all need to be careful how we use it. Let “health food junkies” be just that as long as they don’t suffer medical or social consequences. Let’s restrict use of the new medical term for people who, as Steven Bratman originally suggested, suffer negative consequences of their behavior. It is ironic that we now have a new disease for people who do everything they can think of to be healthy. This is where the concept of “lagom” comes in: Instead of holding perfect eating and maximum exercise as an ideal, we should all do as the Swedes, and aim for pretty good eating and pretty adequate exercise. I guess it’s always hard to see for yourself when you cross the line to extremism. As the old Swedish saying goes: “Lagom är bäst!” (Enough is best!)