Stephanie Small is founder of Three Sisters Nutrition, a phone-based practice helping women improve their relationship with food, and blogs for holistic weight loss site 9 Weight Loss.
These days it seems as though most women have some sort of problematic relationship with food and their bodies. They may avoid carbs, fat, or calories. Perhaps they’re in the gym three hours a day to burn off their breakfast, or they’re vomiting, or using appetite suppressants. Perhaps they look in the mirror and see a large, bloated stomach and monstrous thighs while in reality an average or even slim build is reflected.
Some restrictive behaviors can be normal for the health-conscious. But when does it cross the line? How do you know if your behaviors are cause for concern?
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the American Psychiatric Association’s guidebook, describes eating disorders as “severe disturbances in eating behavior.” While anorexia nervosa is characterized as “a refusal to maintain a minimally normal body weight,” the hallmarks of bulimia nervosa are “repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.” The DSM-IV goes on to list many other features of each disorder, as they are not one-dimensional.
An “Eating Disorder Not Otherwise Specified” (EDNOS) is indicated when someone engages in a few, but not all, of these behaviors. For example, if your cousin eats very little, is afraid of gaining weight, and has irregular periods, yet remains within a normal weight range, she likely falls under this category. Similarly, your friend who binges without purging also may have EDNOS.
Interestingly, none of the above diagnoses address the quality of the food, but rather the behaviors around food. Orthorexia was coined in 1997 to indicate an “unhealthy obsession with healthy eating.” If an individual cares more about the virtue of what they are eating than the pleasure they derive from eating it, they may be orthorexic. If their diet isolates them socially, they may be orthorexic. This manner of eating has an obsessive-compulsive quality and anxiety results when the individual doesn’t eat the “right way.”
However, let’s place this in a cultural context by looking at the average American diet. If a health-conscious individual is living in a community riddled with fast-food chains, they may well look like the odd one out at social gatherings. They may not be super-excited about eating their steamed kale and pasture-raised chicken while everyone else is chowing on fried chicken and french fries, and their diet may isolate them from others. This is less likely to be orthorexia (although it still could be) and more likely to be a cultural mismatch.
Bottom line? It’s about your attitude to food. If, overall, you’re okay with your weight, your appearance and the choices you make about what you put in your mouth, you are probably doing fine. We all overeat here and there, or watch what we eat for a few days so we can fit into a dress. But if you find yourself consistently preoccupied with food and the way you look, it’s a good idea to consult a professional about your concerns.
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