Å være overdrevent opptatt av sunn mat
har blitt kalt ”ortoreksia nervosa”. Den
foreslåtte og potensielt livstruende
spiseforstyrrelsen omtales stadig i
dagspressen, men det finnes lite
forskningsdata om tilstanden.
Ortoreksi ble første gang beskrevet i
1997 av dr. Steven Bratman. Han
definerte da ortoreksi som å være sykelig
opptatt av sunn mat, noe som blant
annet kan føre til strenge dietter,
underernæring og sosial isolasjon.
Det foreligger ingen offisielle
retningslinjer for å diagnostisere
tilstanden. Ortoreksi er per i dag heller
ikke er en anerkjent diagnose.
Selv om ortoreksi ikke er en offisiell diagnose er min erfaring at pasienter som er sykelig opptatt av sunn man kan få hjelp av psykologisk behandling. Terapeutiske teknikker som fungerer for å behandle OCD, (F42, Obsessiv-kompulsiv lidelse (tvangslidelse)), fungerer også for mange av disse pasienten. Dette samsvarer med forskningsmessige funn, (se artikke). Dessuten hjelper det nesten alltid å arbeide med selvfølelsen til slike pasienter. Hvis pasienten erkjenner at det er tankemønstre fremfor matinntak som påvirker humøret vil spisemønstre og livsstil ofte normaliseres.
DSM-IV, (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), påpeker at en psykiatrisk lidelse må ha forårsaket og fortsette å forårsake signifikant ubehag eller negative konsekvenser i ulike deler av en persons liv. Nåværende forskning på ON har ikke tatt høyde for dette kravet. ON kan derfor ikke ansees som en psykiatrisk lidelse på nåværende tidspunkt.
I en kommentar fra The British Journal of
Psychiatry diskuteres de ulike aspektene
knyttet til den mulige
spiseforstyrrelsen:
Orthorexia Nervosa: who cares? 7 September 2007
Arthur Kummer, et al.
The psychiatric diagnostic categories are historically and culturally determined. Eating disorders, despite the description of similar symptoms since the first millennium in the Western world, were recognized as psychiatric disorders only in the 20th century. A series of studies identified eating disorders to be prevalent, frequently severe and even life-threatening.
Recently, some scientific articles and, mainly, the mass-media have emphasized the emergence of a new eating disorder known as orthorexia nervosa (ON). ON was first described by Dr. Steven Bratman in the non- scientific Yoga Journal [1]. According to his definition, ON is an obsession for healthy food which may lead to strict diets, sometimes with a shortage of essential nutrients, and a modification of social relationships due to this behavior [1-3].
Despite the fact Dr. Bratman has never written about orthorexia in scientific journals, he describes in his book an alarming situation regarding ON incidence in USA [2]. Although the first description of ON dates back to 1997 [1], it seems that ON has been neglect by the scientific community. We searched the term “orthorexia” in Pubmed by the end of July, 2007. We retrieved only 10 articles, most of them discussing ON concept. When we searched “orthorexia” in Google at the same period, we retrieved impressive 70,300 sites related to ON.
Motivated by the lack of scientific data regarding ON, Donini et al. investigated ON prevalence in a population-based study [3, 4]. These authors considered the presence of both “health fanatic” eating habits and obsessive-compulsive traits (according to Minnesota Multiphasic Personality Inventory) as “gold pattern” to the diagnosis of ON. A prevalence of 6.9% was found [3]. Interestingly, the prevalence of ON was higher in men and in those with a lower educational level, just the contrary of what is seen in anorexia and bulimia [5]. Bagci-Bosi et al. used the same criteria and questionnaire of the previous study to assess ON prevalence in resident medical doctors. They found a prevalence of 45.5% of ON [6]. They hypothesized that the high prevalence of ON in this population may be due to the fact that medical doctors tend to be more concerned about a “healthy nutrition”.
However, in our view, it seems that a major issue, which defines psychological phenomena as a psychiatric disorder, has been forgotten. As DSM-IV states, psychiatric disorder must have caused and continue to cause significant distress or negative consequences in different aspects of the person's life. This premise seems to have been forgotten by current researches about ON. Curiously, people with ON have been described to even have a feeling of superiority over the lifestyle of others [1-4]. For instance, how many medical doctors diagnosed as orthorexic by Bagci-Bosi et al. on their study had attended specialized help due to this eating disorder?
Although we agree that the matter of eating disorders urges for further researches, a conceptual discussion must be made in order to clarify the relevance of ON and even if it is actually a psychiatric disorder. Otherwise, orthorexia will continue to be neglected by the scientific community.
References
[1] Bratman S. Original essay on orthorexia. Available at: http://www.orthorexia.com/index.php?page=essay. Accessed: July, 2007.
[2] Bratman S, Knight D. Health food junkies. New York, Broadway Books, 2000.
[3] Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord 2004; 9: 151-7.
[4] Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C. Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 2005; 10: e28-32.
[5] Characteristics of eating disorders in a university hospital- based Spanish population. Rodríguez Martín A, Novalbos Ruiz JP, Martinez Nieto JM, Escobar Jiménez L, Castro de Haro AL. Eur J Clin Nutr 2005; 59: 459-62.
[6] Bagci Bosi AT, Camur D, Guler C. Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey). Appetite 2007; [Epub ahead of print]
