To start the story from the beginning go here.
One day I was scrolling through stories on my news feed when I came upon a story about a guy who had adopted a vegan diet. He chronicled how his vegan diet led him down a path of thinking that any food that was not vegan was bad. And as he developed this thought process he became fixated on it. He even began shaming his friends that chose to eat animal products. He started losing a significant amount of weight to where he was considered malnourished. His doctor referred him to a psychologist where he was told he had an eating disorder called orthorexia nervosa.
Orthorexia nervosa is a fairly new term, first coined in 1998 and is not yet an official DSM-5 diagnosis. According to nationaleatingdisorders.com it means “an obsession with proper or ‘healthful’ eating.” As I was reading this man’s story and learning about the signs and symptoms of orthorexia, I could identify with every single one of them:
WARNING SIGNS & SYMPTOMS OF ORTHOREXIA
- Compulsive checking of ingredient lists and nutritional labels
- An increase in concern about the health of ingredients
- Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
- An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
- Unusual interest in the health of what others are eating
- Spending hours per day thinking about what food might be served at upcoming events
- Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
- Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
- Body image concerns may or may not be present (https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia)
Orthorexia nervosa is different from anorexia nervosa, although there can be overlap. According to Dr. Jonathan R. Scarff,
“to meet DSM-5 diagnostic criteria for AN [anorexia nervosa], patients must weigh below minimally normal weight for their height and age, have an intense fear of gaining weight or becoming fat, and have a disturbed experience of their weight or body shape or cannot recognize the severity of the low weight. In contrast, an individual with ON [orthorexia nervosa] may possess normal or low-normal weight. Patients with AN focus on food quantity, while patients with ON tend to focus on food quality. As summarized by Bratman, ‘People are ashamed of their anorexia, but they actively evangelize their orthorexia. People with anorexia skip meals; people with orthorexia do not (unless they are fasting). Those with anorexia focus only on avoiding foods, while those with orthorexia both avoid foods they think are bad and embrace foods they think are super-healthy.’” He also discusses comparisons to obsessive compulsive disorder or OCD. “Similarities between ON and OCD include anxiety, a need to exert control, and perfectionism. However, patients with OCD tend to report distress from compulsive behavior and a desire to change, thus exhibiting insight into their illness. Similarities between obsessive-compulsive personality disorder (OCPD) and ON include perfectionism, rigid thinking, excessive devotion, hypermorality, and a preoccupation with details and perceived rules.”
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370446/#b9-fp-34-06-36)
I definitely did not have anorexia, but I exhibited all the signs of orthorexia. Maybe I had some OCD tendencies, at least as far as control over my food was concerned. From the research I had seen it didn’t appear that I was in any danger. I was on the low side of normal for body weight and BMI. I had my blood tested regularly and I didn’t show any deficits in electrolytes or other signs of malnutrition. It seems to be purely psychological in my case.
I was a little disturbed to think that I could have an eating disorder. I knew all about anorexia and bulimia and even knew some people who struggled with them. It was usually related to issues with control issues and body image. I didn’t feel as though I was significantly bothered by my body image. Sure there are things that I would like to change to have the “ideal” body, but it wasn’t something that I obsessed over. I was content with how I looked. In fact, I love eating food way too much to go without and I really don’t like throwing up, so I would not be able to reconcile either method to achieve what I believe was an unrealistic body type. I was having a hard time wrapping my mind around the idea that I had a mental/eating disorder. But the food choices I was making were good for me, right? The food that I was selectively eating was healing my body and providing it with the nutrients it needed to correct itself and overcome the cancer cells. I was intentionally avoiding the foods that would negatively affect my body and cause the cancer cells to grow. It was a weird sort of epiphany: I had developed an eating disorder that helped me heal from cancer.
After this realization I was more aware of my thought processes regarding food. It was hard not to think of food as “good” or “bad.” It had become such a part of my mental programming in food selection and preparation that I couldn’t see food outside of this context. I had to start reevaluating my approach to food. By this point I had survived over three years without a recurrence of my cancer. That is a huge achievement with stage IV leiomyosarcoma. Those pieces of cake I had eaten and other times I had “slipped” in my diet hadn’t caused any tumors to grow.
Now that I recognized I had a problem, I could move on towards healing from that also. But trying to change a thinking process is trickier than healing from cancer. I had to develop these thinking habits and rigid mindset to maintain a lifestyle that was conducive to healing my body. The scary thing about cancer is that it can come back anytime without warning. I had too much to live for to succumb to it again. Was I ready to let down my guard and my control over food? Food had been an ever present concern in my mind. Thoughts about food would constantly be circling around my brain: “What would my next meal be? Do I have all the necessary ingredients? Is there a way to make that dish using only ingredients that are healthy? I really miss eating certain kinds of foods, but those foods are bad. Don’t those people know that eating that will make them sick? If not now, eventually? Should my kids be eating that at this party? Are my kids getting enough nutrition? Are they able to eat foods that I enjoyed as a kid? Will that affect their happiness in life?” The thoughts went on and on.
After reading about orthorexia I could also recognize the effect it was having not only on my relationship with food, but my relationship with others. I had become a pariah among my friends, never being invited over to eat because no one knew what to feed me. My friends were hesitant to eat in front of me and were very apologetic when they did so. My mom stressed about making meals for me when we would come over to visit because she wanted to make something that I could eat. She reverted to making the same meal that she was sure was safe for me to eat. We ate beans and rice every time she knew we were coming over and always had some home made bread from my recipes on hand as well. People hesitated to talk about food around me as well. They knew my stance on sugar being the root cause of disease. I had alienated myself from quite a few people with my strong beliefs and negativity about certain foods and lifestyles. It was not a healthy mindset.
I began to notice the discomfort it caused others when I discussed food in such a self-righteous way and I decided to refrain from talking about it. Once I recognized I was struggling with orthorexia, I was even more aware of how this mindset was not normal. I justified it because it was necessary to heal from cancer. But now that I was healed, was it still necessary? I struggled with this conflict of priorities.
To continue the story go here.