When I coined the term orthorexia nervosa 20 years ago, I did not intend to propose a new eating disorder.
At that time, I was a practitioner of “alternative medicine,” a medical subculture that includes herbal therapies, acupuncture, dietary supplements, and numerous other non-mainstream methods and theories.
The many schools of alternative medicine derive from a variety of locations in time and place and hold contradictory axioms. Yet, most share a belief that certain food choices are critical to wellness. Conventional medicine would agree, but its recommendations are relatively simple. The dietary theories associated with alternative medicine, on the other hand, tend to include numerous highly specific and often deeply challenging recommendations. This can lead to problems.
In the mid-1990s, I came to believe that many of my more diet-focused patients were inadvertently harming themselves psychologically through excessive focus on food. They had reduced the dimensionality of their human lives by assigning excessive meaning and power to what they put in their mouths. Their exuberant pursuit of physical health had spawned a rigid, fearful and self-punishing lifestyle that caused more harm than good.
As an alternative medicine practitioner, I believed first and foremost in “treating the whole person.” From this perspective, my patients needed to relax the dietary corset and live a little. This advice was difficult to carry across. My patients viewed healthy eating as a fundamental virtue. How can one lighten up on a virtue? To ask a patient to relax her diet is tantamount to suggesting she embark on a life of crime. I might as well advise, “Go and commit some larceny. Drive drunk a little. It will be good for you.”
To get around this I used the therapeutic trick of naming. With the help of a Greek scholar, I coined the term orthorexia nervosa, formed in analogy to anorexia nervosa, but using “ortho,” meaning “right,” to indicate an obsession with eating the right foods. From then on, whenever a patient would ask me what food she should cut out, I would say, half tongue-in-cheek, “We need to work on your orthorexia.” The word turned expectations upside down and opened a pathway to further discussion.
In these discussions, I frequently critiqued the theories of diet that my patients followed. My goal was to loosen the grip these theories held on my patients’ minds. I could do this because I was myself an “insider” to those theories and an expert upon them. In the initial essay on orthorexia I published in Yoga Journal in 1997 and the subsequent book length treatment Health Food Junkies in 2000, I devoted considerable attention to deconstructing dietary theories as well, still from the perspective of an insider [1, 2]. I had “permission” to criticize because I spoke the language and understood the viewpoint often even better than my readers did.
The book was also part of my personal journey.
I had originally joined the alternative diet subculture in the 1970s as an earnest young convert to the “back-to-the-land” movement. My professional practice of alternative medicine had logically followed. However, over a period of many years I intellectually deconstructed this adherence, through a process that involved direct observation and the composition of more than 20 books and a database on evidence-based evaluation of alternative medicine. By the time Health Food Junkies hit the shelves, I no longer found any alternative dietary theory credible. Nonetheless, I retained an understanding of the beliefs and a sympathy and respect for those who hold them.
In the subsequent decade, my therapeutic trick came to be analyzed in the literature as a possible eating disorder. I was not directly involved in this research, but I followed the publications with surprise and interest. One obvious observation was that those tackling the subject were writing from the outside; they had never lived within the world of alternative eating cultures, and therefore at times seemed to misunderstand them. For example, some writers mistook features of one or another specific dietary theory for a universal characteristic of all orthorexia. Others seemed to view belief in false theories as a sign of disordered thinking, and enthusiasm for these dietary theories as prima facie evidence of disordered eating.
This latter attitude found its way into popular media, where mere veganism or a desire to avoid processed foods was often reduced to orthorexia. In response, alternative medicine communities defended themselves against these caricatures, sometimes denouncing the concept of orthorexia as a construction designed by corporatist forces to encourage people eat unhealthy food.
These developments seemed to me to be dangerous and problematic: The very people who might most benefit from the concept of orthorexia were developing cultural antibodies against it.
In 2016, I responded to these concerns by working with Thomas Dunn to design new formal criteria for orthorexia nervosa that explicitly avoided these errors . In the paper that accompanied the criteria, I did not have space to provide the necessary background information. I provide some of it here.