There is a necessary overlap between nutrition and mental health when it comes to dealing with disordered eating. Disordered eating is any form of eating that causes “disorder” in a person’s life. Maybe it contributes to emotional problems, relationship difficulty, further health problems that then perpetuate the problem. Most people are familiar with the term “eating disorder,” and have at least a basic understanding of the three most common eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder. Disordered eating also includes things like emotional eating, night eating syndrome or selective eating disorder. It is an adaptation of using food in a way other than simply for nutrition.
Eating disorders are incredibly common in the United States, with more than 30 million people dealing with an eating disorder. Eating disorders affect both men and women, across all races, ethnic groups and ages. Personality, environment, social circumstances and genetics all contribute the risk of developing an eating disorder at any given time. As the information age has made it possible to gain access to a wide variety of information with incredible ease, we are seeing eating disorders develop at even younger ages. Sadly, eating disorders have the highest mortality rate of any mental illness, and they are under-recognized among health professionals.
Part of the reason they are under-recognized is because disordered eating is something that is typically done in secret. Unless a client sitting across from me has dwindled down to 80lbs, anorexia nervosa isn’t an obvious diagnosis. Eating disorders are typically comorbid with mood disorders such as depression, anxiety or even Obsessive Compulsive Disorder, meaning they present concurrently and are often tangled up together. Clients are much more willing to acknowledge their depression than to jump right in and talk about how they only allow themselves to eat 500 calories a day, so it takes a fair amount of inquiry to figure out if disordered eating is a contributing problem.
I want to take an extra minute and talk about a lesser known form of disordered eating that is becoming more common in our culture, called Orthorexia Nervosa. Orthorexia nervosa is characterized by a fixation on a particular way of eating and an obsession with a single view of what is “healthy eating.” A person struggling with orthorexia nervosa is 100% committed to the way of eating that they have determined is the best, regardless of what research says. In our current culture, we see many people obsessively passionate about eating keto, or Paleo, or the Mediterranean Diet, or insisting that the only way to be truly healthy is to follow a strict vegetarian diet. Check out any nutrition message board or Facebook page, and you will be able to spot the zealots within minutes. Following their diet rules so strictly gives those with orthorexia nervosa a feeling of control and superiority, while any variation away from their idolized eating plan causes feelings of failure, low self-worth and punishment. They may correct their perceived failure with excessive exercise, fasting and increased restrictions labeled as “cleanses” to help them “get back on track.” Their eating habits become almost religious. Health problems can develop because the overly-restrictive eating means that they no longer takes in enough calories or the right variety of nutrients for the body to function well.
Orthorexia nervosa is characterized by a fixation on a particular way of eating and an obsession with a single view of what is “healthy eating.”
Orthorexia nervosa may be overlooked as an actual problem because so many people find health and recovery in these eating plans they adopt. Truly, restricting sugar from your diet or eating organically grown, natural foods is an excellent choice for your health. If you truly have an allergy or sensitivity to gluten or dairy or nuts, certainly avoid them. This becomes disordered, however, when a person develops a fear of eating those things they restrict, if even accidentally. She may isolate herself so she isn’t tempted to go “off plan” or only spend time with others who share her opinions about food and health. Perceptions become distorted and an obsession grows. Without proper, balanced perspective on food and nutrition, these diets become a means for control, a source of one’s identity and self-esteem, or a way of pacifying a fear of illness. It takes real honesty to determine if healthy eating has become a dangerous obsession.
Eating disorders are complex, and they are not usually the thing that will bring a person in to my office. Clients come to work on their struggles with depression, anxiety and even trauma, and it will be several weeks before we peel back the onion enough to find patterns of disordered eating. It’s my opinion that an eating disorder is a symptom of a larger set of problems. One of the first women I ever worked with described her bingeing as an “itch” she had to scratch. If she had a stressful day at work, she’d stop at the grocery store on the way home and buy gallons of ice cream, boxes of cookies and brownies and eat all of it in one sitting that night. Even when she had a good day, she’d keep the “high” going by grabbing dozens of gas station donuts and pastries afterwards. She was embarrassed to confess her habits, and felt stuck, hopeless. She was in a career that required a certain level of physical fitness. Despite her eating disorder, she could run fast and maintain an acceptable weight, but she couldn’t lose any weight or inches, which was obviously distressing. She came for help with anxiety due to job pressures, but after a couple of sessions, we focused our attention on finding the causes of her disordered eating. This shift in attention brought about the results she was looking for. Not only did she have significant nutritional deficiencies that contributed to her anxiety and depression, but her thought patterns were persistently negative, devoid of truth and full of self-sabotaging lies. She was lacking meaningful relationships, in part because of the isolating effects of the eating disorder she developed to cope with her lack of emotional control. It takes looking at a person wholly in order to offer help for total healing – mind, body and spirit.
The one thing all disordered eating has in common is this: food begins to control you. It’s foremost in your thoughts, conversations and behaviors. Food has become your life, instead of merely being a part of it. If this sounds like an uncomfortably familiar problem to you, please go talk to someone. There is a way out of this tangled mess! You can take the Eat26 Eat Attitudes Test anonymously online if you aren’t sure about your own patterns and thinking. The bottom line is this – life is more than food. If food is controlling you, there are people who can help!