Diagnosis
Since orthorexia nervosa lacks official criteria and is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is unclear whether this condition is a distinct eating disorder, part of a specific eating disorder, or a subtype of obsessive-compulsive disorder (OCD). Nevertheless, there are numerous diagnostic tools that healthcare professionals can use to diagnose it, including the following:
1. ORTO-15 and ORTO-R
ORTO-15 is a screening tool used to identify symptoms and behaviors related to orthorexia nervosa (consisting of 15 questions). However, its weakness lies in its inability to differentiate between eating behaviors due to certain medical conditions and food-related values such as beliefs, culture, or ethics.
Due to its limitations, a newer screening tool was developed to refine ORTO-15, known as ORTO-R. This tool is an updated version of ORTO-15, covering the 6 most relevant questions related to symptoms and behaviors of orthorexia nervosa.
2. Bratman Orthorexia Test (BOT)
This screening tool consists of 10 questions with "Yes" or "No" answers. The questions are based on obsessive thoughts about food, beliefs about nutrition and health, specific restrictions, and other factors. This screening tool is not commonly used.
3. Eating Habits Questionnaire (EHQ)
This questionnaire contains 21 items to measure knowledge, positive and negative feelings, and problematic behaviors related to healthy eating. However, based on research findings, this questionnaire needs to be revalidated before being used to diagnose orthorexia nervosa.
Orthorexia Nervosa vs Healthy Eating Patterns
To further clarify the difference between orthorexia nervosa and a healthy eating lifestyle, Bratman and Dunn proposed 2 diagnostic criteria parts, which include an obsessive focus on healthy eating patterns and behaviors that disrupt daily life.
1. Obsessive Focus on Eating Patterns
- Behavior or thought: experiencing compulsive behaviors or mental preoccupation related to food choices believed to enhance health.
- Self-anxiety: feeling anxious, ashamed, self-blaming, or fearful of illness when violating self-imposed dietary rules.
- Strict limitations: strictly limiting food consumption, whether by eliminating entire food groups, adding "cleansing," or a combination of both.
2. Behaviors That Disrupt Daily Life
- Health issues: severe unintended weight loss, malnutrition, medical complications.
- Lifestyle disturbances: decreased productivity, difficulty socializing.
- Emotional dependence: self-esteem, identity, body image, and personal satisfaction dependent on adherence to self-imposed dietary rules.
Two specific criteria for orthorexia nervosa are an obsessive focus on eating patterns and behaviors that disrupt daily life.
Treatment
Orthorexia nervosa can be addressed through various steps, but the primary step is identifying its presence. This is quite challenging because sufferers tend to be unaware of its negative impact on daily life. Therefore, they need assistance from a multidisciplinary team including doctors, psychologists, and nutrition experts.
Treatment typically involves psychological therapy, reintroduction of foods, behavioral modifications, and evidence-based nutritional education. However, unfortunately, the effectiveness of these treatments for orthorexia nervosa has not been scientifically confirmed. This condition does not only occur in individuals with specific body shapes, so recovery is not always focused on weight gain.
The primary step in treating orthorexia is awareness of its presence followed by multidisciplinary treatment.
To diagnose orthorexia nervosa, despite the lack of official criteria in the DSM-5, several screening tools can be used, including ORTO-15, ORTO-R, BOT, and EHQ. It is important for us to differentiate between obsession with healthy eating patterns and a balanced healthy lifestyle. Awareness and comprehensive approaches are needed to address this condition.