Can concern about diet really lead to an eating disorder?

As someone that has in one way or another been exposed to eating disorders and body dysmorphia for much of his life, I’ve always been acutely sensitive to the topic in general.  If you combine that with inheriting some of my mom’s hypochondria (albeit in what I consider to be a mild way) I’ve always been concerned about making sure I didn’t accidentally end up on the same road as so many others.  Yes, in the popular culture eating disorders are generally considered to be a female only disease.  However that is all changing, and the concept of body dysmorphic disorder strikes both sexes.  Almost everyone has some level of body image false perception about what they look like compared to others.  It goes back to the typical behavior of being harder on yourself than others.  While that’s true I think I go beyond what most people do in that regard, but still well short of an eating disorder or full blown dysmorphia.  However the road to that is gradual and self reinforcing negative mindsets can quickly spiral into a full blown problem.

While ever vigilant about avoiding those pitfalls, I didn’t realize there was a whole new classification of eating disorder called orthorexia nervosa.  Now this isn’t some DSM categorized eating disorder, it’s a newly proposed one going back a few years.  The main features of this is an extreme or excessive preoccupation with avoiding foods that are unhealthy.  It’s a bit different than other eating disorders which concentrate on quantity of calories ingested or processed.  In that way I think it is also different in that body image itself isn’t one of the drivers of the diet.  In extreme forms it can actually lead to malnutrition, starvation and long term ill health effects just like other eating disorders.

While that all may be true, I feel that I need to take exception with the looseness of some of the definitions used in the diagnosis.  According to some of the original researchers, Steven Bratman, who are pushing to have this added to the DSM, an initial self test to perform is to answer the following two questions: Do you care more about the virtue of what you eat than the pleasure you receive from eating it?  Does your diet socially isolate you?  Obviously both of those questions sound innocent enough.  Obviously someone who starts up a diet like Veganism or Paleo is going to experience some level of social isolationism with their existing group.  If you only care about the pleasure of eating food then you wouldn’t care about the quality or source of the ingredients.  Obviously in extreme that will cause problems.  Are you literally never eating with anyone or going out because you are afraid of running into “un-pure” ingredients?  Are you eating nothing but Solyent shakes rather than possibly running into some food that may taste “too good”?  Then perhaps you should look around.  However I can’t imagine that someone not heading to a steak house because they are vegan or skipping the trip to the cupcake store because they are Paleo is really worthy of being labeled as having an eating disorder.  Same for someone that would sub coconut ice cream for their Hagen Daaz even though the latter tastes a lot better.

WebMD provided a bit more granularity on the questions. They get to the heart of if you have a potential problem or not. Has the quality of your life dropped as your diet has changed? Do you feel guilty or self loathing when you stray from your diet? When you eat the way you are “supposed to,” do you feel in total control? In the end these are better indicators if you are engaging in a healthy and sustainable diet practice versus one which may have roots in potentially self-damaging cycles.  It’s unfortunate that the baseline of our society is so poor that any scrutiny to our diet looks like “extra” scrutiny or maybe even “excessive” scrutiny.  However I think if we look deeper than just the what and look more at the why then you can see clearly whether you may be suffering from or coming up on an eating disorder.

Some of the symptoms listed are ones that I would say I would definitely have.  I religiously food journal using FitDay, having recorded pretty much everything I’ve eaten since the beginning of 2011.  I don’t spend three hours a day obsessing about healthy food, but I do probably spend a good hour a day reading up on recipes, historical cooking practices, watching cooking shows et cetera.  I also plan my meals out ahead of time to some extent.  All of these are potential signs of a problem.  However when I get to the “why” questions, my mind is put at ease.

Do I feel in total control when I’m eating a certain way?  No, nor do I think I ever will.  I like having additional control over where my food is coming from but I have no illusions of control.  Likewise I don’t have some feeling of moral superiority about how I’m eating relative to anyone else.  I eat more junk food than I care to admit without batting an eye lash.  I’m about listening to my body.  If I’m “supposed” to be eating a certain number of calories on a given day but I’m feeling hungry then I’m going to eat.  If I’m at a nice restaurant and craving a slice of pumpkin cheesecake, then I’m going to have some damnit!  Lastly, has the quality of my life gone down as a consequence of this?  Quite the opposite actually. I’m enjoying food more than I ever have before.

It is overly reductionist to claim that there is nothing to this potentially new eating disorder.  The cases highlighted in articles are people suffering from real problems.  People that are only eating four or five foods every day of their life.  I’ve seen something like that in the form of anorexia first hand.  If the net effect is about being in “total control” over your life or your body image, then that is a big alarm sign.   People like this, or people that are almost agoraphobic about going out where there will be food, and so on, need to take a deep look at what is going on and be honest with themselves about if they are being truly healthy and conscientious or if they are actually in the middle of dealing with a problem.  These things can often spring up from the best intentions, and there is no shame in admitting that you have a problem if you do.  At the same time don’t assume you are in deep crap just because compared to the average Joe you look like a food Nazi or because you are eating something other than the standard American diet.



Picture of Me (Hank)

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