Sunday, May 15, 2016

Orthorexia, OCD and Feelings of Lack of Control

In an earlier post, I mentioned that there’s a relationship between orthorexia and obsessive compulsive disorder (OCD).  The diagnostic criteria reads a lot like a description of OCD, but is specifically about food, health, body image, etc.  Unfortunately, there doesn’t seem to be much on this link besides that review paper and the diagnostic criteria as the research on orthorexia is in its infancy and mostly being prevalence studies

So the cases of orthorexia haven’t really been discussed much.  It’s easy to build a narrative that restrictive diets lead to orthorexia.  In some cases I agree, but this doesn’t account for why people go on restrictive diets in the first place

Again, the research is limited and there are issues with the ORTO-15, so I don’t want to use associations in the prevalence studies here, but there are a few case studies in the literature and the media.  These cases are likely to be more extreme than the ‘average’ case of orthorexia and so may not be representative, but most developed orthorexia in response to health issues (acne) [1] (tic infection) [2] (constipation) [3] (digestive issues) [4], and there’s a case study of a woman who developed orthorexia as an early symptom of schizophrenia [5]

This obviously isn’t a justification for orthorexia, and I’m not saying their orthorexia is a preferable alternative to their initial health issue.  These people weren’t in good health to begin with, but their extreme orthorexia made them much worse.  Though this can be an explanation as to what triggered their orthorexia*

So how may health issues be a trigger?  OCD can be caused by the sufferer feeling a lack of control in a specific thing, which manifests as an obsession.  The compulsions are then an attempt to re-establish control.  Similarly, someone with orthorexia may feel a lack of control regarding their health.  They then develop food obsessions based on what they’ve read/heard or patterns in their own health, and the restrictive eating is an attempt to re-establish control.  The compulsions in OCD and the restrictive eating in orthorexia are coping strategies, but just not very productive ones.  Because as we’ve seen in the 4 case reports, the restrictive eating can cause psychological distress, doesn’t necessarily address the initial health issue and can create new health issues

I think to some extent it is human nature to develop irrational beliefs and compulsive behaviours to try and feel in control of things that we are at the mercy of and don’t understand.  Humans have been doing this for a long time, and I noticed this developing with a previous issue I had, so no judgement or shaming from me

Whatever the prevalence of orthorexia is, I suspect that far more people feel a lack of control over their weight or health and have exaggerated fears on food and disease, but just don’t consistently act on them.  A major problem here is the high prevalence of chronic diseases in the community, the general failure of modern medicine to adequately treat these diseases, and our society’s narrative on health, aging and chronic disease – all of which leads to feelings of a lack of control.  In response to this the underlying philosophy of Ancestral Health/Paleo** can be very empowering while also actually being quite effective and ends the tracking of calories or macros.  The trick here is to make the message effective without including the fear mongering that can lead to orthorexia*** and giving people more than one strategy for influencing their diet (see next post).  This is why Paleo and its variants has helped some but harmed others (see Orthorexia in the Paleo/Primal Community)

* I suspect a health issue will be a more reliable trigger if it is difficult to treat, is visible (skin and weight) and have fairly regular symptoms that could provide feedback (skin and digestion particularly).  Not everyone who has a health issue will develop orthorexia (obviously), as it also depends on underlying personality characteristics that may include obsessiveness, black and white thinking and catastrophising

** The very low prevalence of chronic disease in hunter-gatherers and traditional cultures, the evolutionary argument against chronic disease and that ‘humans are not broken by default

*** I think the underlying philosophy should protect against this, but many diet books have the narrative of ‘avoid these foods that are killing you and eat these superfoods that will save you’ (note the black and white thinking and catastrophising)

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