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The University of Southampton

Orthorexia Nervosa - when does healthy eating become unhealthy?

Published: 9 October 2020
Woman swimming underwater

To mark World Mental Health Day 2020, Emily England, second year MSc Adult and Mental Health nursing student at the University of Southampton, provides her personal and professional insight into Orthorexia Nervosa – an often misunderstood condition yet to be a clinical diagnosable eating disorder.

Dear Orthorexia,

You suffocate me.

You began simply with harmless healthy lifestyle tweaks; adding more fruit and veg, cutting down on refined sugar and subscribing to the gym. Little did I know that you would grow and take the reins of control over my whole life. It felt good at first when slipping into a smaller pair of jeans, but your problems began when you chained my arms and restricted me. Say goodbye to carbs, sugars and meat. No salt. No carbonated drinks. No caffeine. No dairy. Tunnelling down my meals to simply fruit, kale and eggs and forcing me to run every day at exactly 6:33am all week, every week.

My body continued to scream in change as I dropped by 5kg to 10kg to 20kg. “You look amazing!” the words of friends buzzed in my ears and a faint smile washed across my face. “Feels good, right?” you would whisper with words of encouragement, and for a moment I truly believed you were good for me.

But deep down you’re my biggest fight when I wake up in the morning as you schedule every run, every workout and every meal to an exact time. And if I’m late? I’m drowned in a blanket of guilt, self-hate and receive a punch in the chest from anxiety. As night falls, you rattle through my head demanding me for your biggest goal; personal perfection.

My nightmares are flourished with lucid indulgence of cake, chocolate and wine- but I’m awoken in sweat and panic by the thought of disobeying your commands. I must keep losing weight and staying fit. You lie in the bags underneath my eyes and twist every muscle, so it aches with exhaustion. My friends haven’t heard off me for weeks because I still worry about ignoring that invite to go out for pizza because you have forced me bathe in a fear of food.

I can’t keep lying to my family about skipping dinner or ‘feeling unwell’ every time a takeaway is mentioned. I don’t have a gluten intolerance, but it’s an easier excuse compared to ‘I’m scared’. You chip away at my brain all day, everyday 24/7. There is no such thing as rest.

The bar of excellence you have raised for me is far too high, yet you still threaten me, so I continue to climb.

Will this debilitating cycle ever end?

Yours faithfully,

An unidentified eating disorder

Emily England
Emily England - MSc Adult and Mental Health Nursing student

Although far from a clinical diagnosis, many individuals may find themselves trapped in the cusps of Orthorexia but remain under the umbrella prognosis of EDNOS (Eating Disorder Not Otherwise Specified).

Orthorexia is an eating disorder by where the individual strives to be ‘healthy’ through an obsessive and perfectionist manor. This can include categorising food as “bad” and “good” leading to certain vital nutritional groups such as carbohydrates to be removed from their diet completely. The condition usually also encompasses extreme body dysmorphia, OCD, anxiety and anorexia nervosa. It can involve the individual having very strict food rituals, certain food preparation techniques, obsession around skin completion or ‘glow’, severe guilt if certain dietary standards aren’t met and the avoidance of food others have cooked or prepared due to fear.

When having Orthorexia, it is more than likely you will experience depressive episodes, mood swings, insomnia, low self-esteem or feel like you have a lack of control over your life. Individuals often lie or make excuses to evade meeting with friends or attend social events. Orthorexia is prevalent in both males and females equally and usually correlates with excessive exercise. This can be identified as obsessive exercise organised within no moderation, no flexibility and induces extreme anxiety if incomplete or missed. There is no room for physical illness and individuals will continue to exercise regardless of their health; with the routine becoming a set self-order.

This description only explores the tip of the iceberg for Orthorexia. The eating disorder is debilitating both physically and mentally and it is very difficult to watch someone go through or experience yourself. If you have encountered any of these tendencies or are worried for someone else, I recommend reaching out to the Beat eating disorder charity. Another useful resource is the book “Orthorexia: When healthy eating goes bad” written by a Performance and Clinical Dietician with eating disorder experience, Renee McGregor RD. Talk to someone; your friends, your family, your nurse or GP and start your road to recovery.

You aren’t alone in this battle.

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