People who want to eat healthy food don’t become orthorexic unless there is something deeper going on. Often, that deeper something is best described as anxiety.
The most obvious anxiety related to orthorexia is fear of illness. You want to believe that if you are very careful with what you eat, you will be safe from every health problem that scares you, whether its cancer, bloating, blemished skin or depression. But it goes further than that. Whether you are conscious of it or not, somewhere along the line you began to use food as a primary strategy to fend off every kind of anxiety. When you are stressed about relationships, your job, the purpose of life or what your friends think of you; when it is guilt, shame, love or loss that has put you off balance, the magic cure is to eat pure food.
Deep down, you know perfectly well this is a lie you tell yourself in order to cope. While food is important for health, the slice of pizza you eat today is NOT going to give you cancer tomorrow, nor will eating the best diet in the world immunize you against illness. Furthermore, diet cannot give you love, friendship, meaning or happiness. Food, in the end, is just stuff you put in your mouth.
One residential treatment program for orthorexia I recently heard about uses a clever strategy to help people understand how they use food to fend off all forms of anxiety. In this program, the food is served by a chef closely advised by dietitians. The rules of the game are that the chef may not under any circumstances reveal whether the food served in a given meal is organic or not, whether it has preservatives, contains GMOs, etc. In point of fact, the food served in the program is mostly organic and chemical-free, but not 100% of the time, and there is no way for the people who eat the food to know when they are consuming substances that their theory of eating would forbid. (People in the program also keep a journal of how they feel, and it turns out that they do NOT guess correctly when they have eaten “impure” food.)
As you might imagine, for a person with orthorexia this is extremely anxiety-provoking. Not only does it stimulate food-related worries, it removes the possibility of using food purity as a coping mechanism against other forms of worry. And that is the real point: The experience forces participants to begin to develop a range of ways to cope with daily stress, rather than abusing food purity as the answer to every problem.
You might object that it is truly rational to be concerned about food additives, whether vegetables are organic, and etc. Wouldn’t any sane person would want to eat healthy food? Perhaps yes. But no matter what dietary rule you believe to be correct, it simply can’t be necessary from a health-related perspective to follow it without exception. The quantity of pesticides contained in a single serving of non-organic food is dwarfed by the quantity of chemicals taken in simply by living and breathing in the modern world. You focus on food because it’s something you can control. And that’s perfectly sensible — but only to a point. Past that point further purification of your diet won’t make you healthier; it will only make you more obsessive.
A mostly “pure” diet is good enough. Aiming for 100% is only an excuse not to come to terms with the elephant in the room: Life, in all its messy glory.
— Steven Bratman, MD, MPH
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