Psychiatric disorders of the developed world: the case of orthorexia nervosa
A. PARASCHAKIS

New eating behavior disorders such as orthorexia nervosa (ON) are appearing in developed countries. This disorder has not been officially recognized so it is not classified as an independent entity in DSM IV TR or ICD 10.

The term "orthorexia" comes from the Greek word "orthos" (correct) and "orexia" (appetite). It is characterized by a pathological obsession for biologically pure food, which leads to important dietary restrictions (sometimes ON is defined as "a maniacal obsession for healthy foods").

It is believed that there is a genetic component in ON (it presents many common features with eating disorders and obsessive-compusive disorder), and that social habits also play a key role (eating well is regarded as something positive in our society).

Orthorexic patients exclude foods that they consider to be impure from their diets because they have herbicides, esticides or artificial substances and they worry in excess about the techniques and materials used in food elaboration. This leads, on one hand, to a loss of social relationships -their obsession prevents them from enjoying meals with friends and relatives- and, on the other, to affective dysfunction which, in turn, favors and obsessive concern about food. The motivation of these people is not mainly to lose weight, but to achieve a feeling of perfection or purity, to improve their health or treat a disease. Finally, diet becomes the most important part of their lives. Interestingly, the more restrictive and complicated the diet is, the more the person is attached to it. It seems that these people tend to be anxious, perfectionists, looking for ways to soothe themselves and the diet may have a calming effect.

Orthorexic patients frequently use special terms in order to express their "feelings" towards food (a conserved product is "dangerous", an industrially produced product is "artificial", a biological one is "healthy").

According to the only clinical study on ON, -published by the University fo Rome "La Sapienza" in Italy- carried on 404 subject with obsessive compulsive personality traits and an exaggerated healthy eating behavior pattern, 28 (a prevalence of 6,9%) were found to suffer from ON. The analysis of the psychological characteristics, the social-cultural and the psychological behavior that characterizes subjects suffering from ON shows a higher prevalence in men and in those with a lower level of education.

The differential diagnosis of ON is with chronic delusional disorder, anorexia nervosa and obsessive compusive disorder.

Patients suffering from ON rarely are in any physical danger (unlike those with anorexia nervosa for instance), but, psychologically, they suffer a lot.

As far as therapy of ON is concerned, all experts agree that cognitive-behavioral psychotherapy combined with selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, or paroxetine can be a very effective treatment. It is not a coincidence that the same treatment is also proposed for obsessive compulsive disorder, with excellent results in many cases.

However, orthorexic patients might be terrified with the prospect of putting prescription drug "chemistry" inside their body. Do not forget that they are the same people who try to stay completely clear of all artificial substances in their effort to achieve complete purity. Nevertheless, they are more open to receiving treatment than those with other eating disorders because they are actually very concerned about their health.

There is still a debate as to if ON is a real, unique disorder and worthy of its own categorization in the Diagnostic and Statistical Manual of Mental Disorders (DSM) alongside eating disorders such as anorexia and bulimia nervosa. Many experts also think that orthorexic patients actually suffer from obsessive compulsive disorder (OCD) instead of from a kind of eating disorder.

The most important point to be made is that extremism in dietary habits can vary greatly. Dietetics professionals are often the first line of defense in spotting these obsessive habits and giving the patient appropriate help, whether that is a referral to a mental health professional, primary care physician, or a combination of both. therefore, dietetics professionals and multitrionists need to be properly trained to identify the disorder.

Another key observation ids that symptoms of eating disorders are being seen more and more often in men, because of the importance developed societies are placing on healthfulness and body image (eating disorders were reported most often among women; anorexia nervosia is 10-20 times and bulimia nervosa 10 times more often seen in women than in men).

Health professionals need to be particularly alert in searching for patients suffering from these disorders regardless of their sex.

Key words: Eating behavior disorders, obsessive-compulsive disorder, orthorexia nervosa.