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Effective Methods for Addressing Orthorexia in the Middle-Aged Adult
Contributor: Courtney Howard, B.A., Executive Assistant at Eating Disorder Hope and Addiction Hope
Though anorexia nervosa, bulimia nervosa, and binge eating disorder (BED) often get the most attention from the media and researchers, a recent study [1] reports that the rate of other specified feeding or eating disorder (OSFED) is almost as high among adolescents as the rates of these other eating disorders combined.
OSFED is an umbrella diagnosis that covers a wide range of feeding and eating disorders that do not fit the diagnostic criteria for one of these more mainstream disorders. Orthorexia currently falls under OSFED, though some professionals are pushing for it to be given its own diagnosis in the next version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
This unique and newly recognized disorder, like all eating disorders, can affect anyone regardless of age and does not discriminate.
What is Orthorexia?
According to Dr. Steven Bratman [2], who coined the term, orthorexia is the “obsessive focus on ‘healthy’ eating, as defined by a dietary theory or set of beliefs whose specific details may vary.” This primarily includes disordered thoughts surrounding food quality and related behaviors.
The orthorexic mentality is becoming increasingly common and is perpetuated by “detoxes,” juice cleanses, and the gluten-free trends of the past decade. While not everyone who follows these diets necessarily struggles with orthorexia, it is the popularity of these fads that allows orthorexia to fly under the radar, disguised as healthy living.
Typical orthorexic behaviors include cutting out entire food groups, having extreme anxiety related to food preparation and quality, and avoiding social situations in which complete control over food preparation and quality is not possible. In many cases, individuals pre-pack their food for an entire week at a time to ensure their strict meal plan is followed, and might bring food to social situations in which such behavior is abnormal or socially awkward.
Similar to individuals with other eating disorders, those with orthorexia typically feel extreme guilt or shame when their diets are not adhered to, and put an inordinate amount of time and money into their relationship with food. Though weight loss might be a side effect of an extremely restricted diet, orthorexia is generally not about losing weight. The focus is on food quality, not quantity, and the relief it provides comes from feeling “pure,” or “clean.”
A 2012 study [3] found that orthorexic tendencies might be common among elite athletes. Eating disorders in athletes are common due to weight pressures, stress, and other variables. Coaches should be aware of this and look for red flags of orthorexia and other eating disorders among their athletes.
Triggers in Middle Age
The myth that eating disorders only affect young women often keeps middle-aged men and women from identifying their eating disorders and seeking help.
There are three categories that an individual can fall into when presenting with eating disorder symptoms in middle age. Sometimes these are individuals who had an eating disorder in the past, recovered, and have now relapsed. Others had an eating disorder earlier in life and have struggled on-and-off since then, never having reached a state of full recovery. Though more uncommon, the third category is those who develop an eating disorder for the first time in middle age.
Middle age triggers can include career changes, divorce, death of a parent, the empty nest, or health problems. There is an infinite amount of potential triggers at any age, but these life transitions and concerns can be especially likely to trigger disordered eating in this population. When an individual is faced with these triggers and does not know how to cope (or for whatever reason is unable to), he or she might turn to food behaviors.
Since eating disorders are believed to primarily affect adolescents, they often go undiagnosed and untreated in middle-aged individuals. Awareness for eating disorders at all ages is important among medical and mental health professionals nationwide.
Effective Treatment Options
There is little research on effective treatment for orthorexia since it is still not officially recognized by the mental health community as a diagnosis, instead falling under OSFED. However, effective treatments for eating disorders generally include a combination of psychotherapy, nutritional counseling, and medication, if needed.
Particularly effective therapies for other eating disorders are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). CBT focuses on the relationship between thoughts and behaviors, while DBT emphasizes mindfulness, communication skills, and emotion regulation.
Regularly meeting with a nutritionist is also an important part of eating disorder recovery. Individuals with orthorexia have an intense fear of what they perceive as unhealthy foods. A nutritionist will help the individual address these fear foods and reintroduce food groups that the individual cut out. Sticking to a meal plan also helps with accountability when maintaining recovery.
If you are struggling with orthorexia, remember that recovery is possible. Search for an individual provider or treatment center near you.
Community Discussion – Share your thoughts here!
How can we further raise awareness for eating disorders among middle-aged adults?
About the Author: Courtney Howard is the Executive Assistant for Eating Disorder Hope and Addiction Hope. She graduated summa cum laude with a B.A. from San Diego State University, holds a paralegal certificate in Family Law, and is a Certified Domestic Violence Advocate. After obtaining her certification as a life coach, Courtney launched Lionheart Eating Disorder Recovery Coaching in 2015 and continues to be a passionate advocate for awareness and recovery.
References:
[1]: Fairweather-Schmidt, A.K., & Wade, T.D. (2014). DSM-5 eating disorders and other specified eating and feeding disorders: is there a meaningful differentiation? Int J Eat Disord. 2014 Jul;47(5):524-33. doi: 10.1002/eat.22257.[2]: Dunn, T.M & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors, 21, 11 -17.
[3]: Segura-Garcia, C., et al. (2012). Orthorexia nervosa: a frequent eating disordered behavior in athletes. Eat Weight Disord. 2012 Dec;17(4):e226-33. doi: 10.3275/8272.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on August 15, 2016
Published on EatingDisorderHope.com
The EatingDisorderHope.com editorial team comprises experienced writers, editors, and medical reviewers specializing in eating disorders, treatment, and mental and behavioral health.
