Motivation and emotion/Book/2024/Orthorexia and emotion

Orthexia and emotion:
What are the emotional risk factors and consequences of orthorexia?

Overview

Case study

[Consider adding an image to help attract reader attention] A 20-year old woman, Evangeline, was presented to the hospital, under the request of her doctor, with issues regarding rapid weight loss, constant fatigue, bodily discomfort, anaemia, chills, and hair loss. At first mental health professionals suspected anorexia nervosa; however, upon further assessment Evangeline claimed that she did not fear gaining weight, or that she did not have a distorted view of her body, therefore, she was given the diagnosis of Orthorexia nervosa after she reported on her excessive healthy eating habits. Proclaiming she was too fearful of being unhealthy and would remove specific food groups, such as sugar, nuts, certain meats and dairy products, from her diet due to fear of developing a chronic illness.

Orthorexia nervosa is an emerging eating disorder that is characterised by one's obsession with healthy eating, and fixation on the purity of the food consumed (Herman & Polivy, 2002). Although orthorexia is not defined as a proper eating disorder within the DSM-IV, it is an ongoing conversation throughout the mental health community; as orthorexia has related concepts of distorted eating behaviours (Messer et al,. 2022). Studies show that orthorexia is strongly motivated by healthy eating; individuals with orthorexia exhibit extreme dietary rules often evading entire food groups and being increasingly hyper-aware of the nutritional content. However, the question remains "what are the emotional contributions of orthorexia?" and "what are the ramifications of orthorexia?".

This book chapter discusses the complexity of orthorexia and emotion. In particular, gaining insight into psychological science, and individual characteristics of eating disorders. We continue to further dive into the emotional risk factors of orthorexia, the consequences of orthorexia including mental health disorders that can further develop due to the eating disorder, and the role of media and social influences. Furthermore, we explore the emotional and physiological advantages of healthy dieting and compare a healthy dieting mindset to those suffering orthorexia.


Focus questions

What is Orthorexia nervosa?
What are the physiological and emotional consequences of orthorexia?
What are the emotional influences that cause someone to develop orthorexia?
What are the emotional risk factors?
What are the strategies for treating orthorexia?

Eating Disorders

Figure 1. Food aversion which is a common symptom of an eating disorder.

The prevalence of eating disorders are constantly growing, particularly amongst western societies (Polivy & Herman, 2002). Eating disorders are behavioural conditions that present in an individual's disturbance in eating behaviours, often caused by experiencing distressing thoughts and emotions; to which may lead to a change in eating behaviours, individuals exposed to trauma can be predisposed to developing eating disorders (Barthels et al., 2019).

Eating disorders are seen to be the most life-threatening psychiatric disorder, as this impacts the physical body and mental state of the individual and can often be difficult to treat at the same time (Qian et al., 2020), anorexia nervosa and bulimia nervosa are found to be the most common forms of distorted eating; however, over time the Diagnostic and statistical Manual of Mental Disorders, 4^th edition (DSM-IV) eating disorders that are not otherwise identified as anorexia nervosa or bulimia nervosa are classified as EDNOS – eating disorder not otherwise specified (Qian et al., 2020).

Types of eating disorders:

Common Eating Disorders	Definition of each of the following eating disorders
Anorexia Nervosa	Anorexia nervosa is often characterised when an individual has an obsessive fear of gaining weight and a distorted perception of their body, it is seen that this fear of gaining weight manifests itself through food restrictions and can coincide with increases motives of physical activity (Eating disorder Victoria, 2024). A common behaviour found from those suffering from the illness is food restriction, whereby an individual may severely restrict their food intake and may follow or create rules surrounding the types of food they consume or how they might consume it (Moore & Bokor, 2023).
Bulimia Nervosa	Bulimia nervosa is another common eating disorder found within the DSM-IV, it is characterised by a period of binge eating and followed by self-induced vomiting, periods of fasting, over-exercising or a misuse of laxatives which is used in efforts of avoiding weight gain (Jain & Yilanli, 2023).
Binge Eating	This psychiatric disorder follows episodes of binge eating. Binge eating involves a person eating an excessive amount of food, to which can occur during a small amount of time, or an extended phase (Eating disorders Victoria, 2024). During these binge eating episodes, a person may not feel hunger or continue past the point of feeling hungry. It is a common occurrence for individuals to eat in secrecy and experience feelings of guilt, shame and disgust during or after a binge.
OSFED	OSFED also referred to as Other Specified Feeding and Eating Disorder in the DSM-IV, includes eating disorders that share the concern about eating, body shape, and weight and also engage in disordered eating behaviours (Balasundaram & Santhanam, 2023). A person with this diagnosis will often present signs of an eating disorder, however, may not meet all of the diagnostic criteria of, for instance, anorexia nervosa, or binge eating disorder.
Orthorexia Nervosa	Orthorexia nervosa is still a relatively new form of eating disorder, often associated with an obsessive preoccupation with healthy food consumption and a hyper fixation on food purity (Horovitz & Argyrides, 2023). Similar to anorexia nervosa, a person suffering orthorexia exhibit extreme dietary rules, avoid certain food groups and focus purely on nutritional contents of their food. Many individuals suffering this type of eating disorder hold a different motivation in comparison to those diagnosed with anorexia or bulimia, being that the desire is more to feel health and natural, rather than to lose weight (Saraswati & Nagendraswamy, 2024).

Further information will be provided, regarding the topic of eating disorders, including the emotional influences of eating disorders, and the discussion of how Orthorexia in particular is not yet define as a disorder in the DSM-IV.

What influences eating disorders? Expand.

Discuss diagnostic criteria for orthorexia.

Quiz

Healthy Dieting vs. Unhealthy Dieting

Physiological and emotional advantages of healthy dieting

Improvement of health and well-being, include evidence of neurological improvements.
Discussions of how the body improves physiologically based off a healthy diet.

Consequences of extreme dieting

Discuss how people may over engage in diets.
Physiological impacts of excessive dieting, primarily focusing on people suffering with orthorexia.
Discuss specific diets, such as veganism, the ketogenic diet and how this may impact the body.
Nutritionist's perspectives on extreme dieting.

Emotional Risk Factors of Orthorexia

Emotional regulation is a process in which individual can express and regulate their emotions (Gross, 2003). Emotional dysregulation encompasses emotion description and identification (also known as alexithymia), regulation of negative emotions, and behaviour. Empirical research has found that individuals who display eating disorder related behaviours are found to experience high levels of intense emotions, including having less adaptive strategies to regulate negative emotions and reframe from engaging in impulsive behaviours (Mitchell et al., 2024). Interpersonal experiences are often risk factors leading to emotional dysregulation and further influences the development of eating disorders, for instance, individuals’ exposure to abuse, trauma, or certain life stressors that are not easily controlled are all contributing factors (Trompeter et al., 2022).

Common aspects of the emotional dysregulation in Orthorexia nervosa

Perfectionism - individual's suffering orthorexia nervosa have an fixation on "clean eating", individual's suffering this disorder often have an intense preoccupation with the quality of food or purity of food they are consuming (Horovitz & Argrides, 2023).
Fear and anxiety towards becoming sick or developing certain illnesses may reinforce the behaviour of excessive dieting.
Identity and purpose - due to the restrictive diet, individuals may force themselves into social isolation, prioritising dietary rules than personal relationships. The impact of orthorexia and social functioning can further impair mental well-being, causing depression (Akel et al., 2021).

Factors that contribute to the emotional dysregulation of Orthorexia nervosa

Social media influences control over healthy diets, being there is a substantial amount of unrealistic standards when it comes to body types and appearances. The media has a tendency to label certain food groups as "bad" or "unhealthy", articles that contain information on types of diets may not have the appropriate certification on nutrition.
Orthorexia nervosa is linked to attachment-related anxiety and avoidance according to a recent study by Strahler et al., 2022. It was also found certain personality types were strong predictors for orthorexia nervosa.

Treatment Strategies

Types of treatments for orthorexia, which therapeutic technique are best suited for this type of eating disorder.
In using psychoeducation it informs individuals of the potential consequences when engaging in excessive dieting. Furthermore, it provides information on the nature of orthorexia nervosa and the underlying impacts it can further cause on mental well-being.
Psychoeducation can challenge an individual's thoughts and beliefs surrounding their distorted eating behaviours.

Cognitive behavioural therapy

Cognitive behavioural therapy offers intervention, that is evidenced based and targets maladaptive behaviours and thoughts related to Orthorexia nervosa (Horovitz & Argyrides, 2023).
Provides opportunities where individuals learn to identify and restructure unhealthy thoughts on food.
Further assists with managing anxiety and distress related emotions.

Acceptance-based therapy and mindfulness practices

Emerging therapeutic approach for orthorexia nervosa patients, involves remaining aware of the present moment, acceptance of one's thoughts and feelings, and sensations throughout the body.
Used to identify underlying triggers and motivations that trigger the desire to restrict food in-take.
To further expand on acceptance-based therapy, promotes mindfulness practices through encouraging individuals to accept their vulnerabilities and self-criticisms (Horovitz & Argyrides, 2023).

Conclusion

Summarise the emotional risk factors of orthorexia, further summarise the consequences of excessive dieting and the types of treatment strategies used to help individuals with orthorexia.
Emphasis on the importance of healthy eating, also highlight on how dieting may cause people to become over engaged in being healthy.
Reflect on how social media influences orthorexia and diet culture, and how specific personality types are more at risk of developing eating disorders.
Reflect on the types of treatment used for people with orthorexia and the rate of relapse.

References

Akel, M., Brytek-Matera, A., Hallit, S., & Obeid. (2021). Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults. Eating and Weight Disorders, (26), 2607-2616, https://doi.org/10.1007/s40519-021-01112-9.

Argyrides, M., & Horovitz, O. (2023). Orthorexia and Orthorexia nervosa: A comprehensive examination of prevalence, risk factors, diagnosis, and treatment. Nation Library of Medicine, 15(17), 3851, 10.3390/nu15173851.

Barthels, F., Barrada, J., & Roncero, M. (2019). Orthorexia nervosa and healthy orthorexia as new eating styles. PLOS ONE, (7)14, https://doi.org/10.1371/journal.pone.0219609.

Herman, P., & Polivy, J. (2002). Causes of eating disorders. Annual Review of Psychology, 53(1), 187-213.

Messer, M., Liu, C., McClure, C., Mond, J., Tiffin, C., & Linardon, J. (2022). Negative body image components as risk factors for orthorexia nervosa: Prospective findings. Science Direct, 178, https://doi.org/10.1016/j.appet.2022.106280

Strahler, J., Wachten, H., Neuhofer, S., & Zimmermann, P. (2022). Psychological correlates of excessive healthy and Orthorexia eating: emotion and regulation, attachment, and anxious-depressive-stress symptomatology. Frontiers in Nutrition, (9), 817047, https://doi.org/10.3389/fnut.2022.817047