ORTHOREXIA NERVOSA

"This is about the obsession with eating to improve your health."

Bratman is author of Health Food Junkies: Orthorexia: Overcoming the Obsession with Healthful Eating, scheduled to be released after New Year's Day 2001. He went through his own bout with the disorder while living in a commune in the '70s. He then moved on to medical school at the University of California-Davis and practiced for 13 years as an alternative medicine physician in California. He is author of two other books -- Alternative Medicine Sourcebook and The Natural Pharmacist -- and is medical director of The Natural Pharmacist, an alternative medicine information web site.

The obsession doesn't necessarily lie just between the mouth and the other end. An out-of-control healthy eater feels a sense of spirituality, he says. "You're doing a good, virtuous thing. You also feel that because it's difficult to do, it must be virtuous. The more extreme you are, the more virtuous you feel," Bratman says.

In his practice, Bratman tells WebMD, he has seen many patients with this condition. "I saw two or three people a day who would ask how they could be stricter in their eating."

Very often, Bratman says, the food preoccupation stems from a problem like asthma. "Among those who believe in natural medicine, the progressive view is to avoid medicine, which supposedly has side effects, and instead focus on what you eat. But everyone misses the fact that if you get obsessed with what you eat, it actually has a lot of side effects -- mainly, the obsession itself."

Orthorexia begins, innocently enough, as a desire to overcome chronic illness or to improve general health. But because it requires considerable willpower to adopt a diet that differs radically from the food habits of childhood and the surrounding culture, few accomplish the change gracefully. Most must resort to an iron self-discipline bolstered by a hefty dose of superiority over those who eat junk food. Over time, what to eat, how much, and the consequences of dietary indiscretion come to occupy a greater and greater proportion of the orthorexic's day.

The act of eating pure food begins to carry pseudospiritual connotations. As orthorexia progresses, a day filled with sprouts, umeboshi plums, and amaranth biscuits comes to feel as holy as one spent serving the poor and homeless. When an orthorexic slips up (which may involve anything from devouring a single raisin to consuming a gallon of Haagen Dazs ice cream and a large pizza), he experiences a fall from grace and must perform numerous acts of penitence. These usually involve ever-stricter diets and fasts.

This "kitchen spirituality" eventually reaches a point where the sufferer spends most of his time planning, purchasing, and eating meals. The orthorexic's inner life becomes dominated by efforts to resist temptation, self-condemnation for lapses, self-praise for success at complying with the chosen regime, and feelings of superiority over others less pure in their dietary habits.

This transference of all of life's value into the act of eating makes orthorexia a true disorder. In this essential characteristic, orthorexia bears many similarities to the two well-known eating disorders anorexia and bulimia. Where the bulimic and anorexic focus on the quantity of food, the orthorexic fixates on its quality. All three give food an excessive place in the scheme of life.

So what constitutes orthorexia?

Are you spending more than three hours a day thinking about healthy food?

Are you planning tomorrow's menu today?

Is the virtue you feel about what you eat more important than the pleasure you receive from eating it?

Has the quality of your life decreased as the quality of your diet increased?

Have you become stricter with yourself?

Does your self-esteem get a boost from eating healthy? Do you look down on others who don't eat this way?

Do you skip foods you once enjoyed in order to eat the "right" foods?

Does your diet make it difficult for you to eat anywhere but at home, distancing you from friends and family.

Do you feel guilt or self-loathing when you stray from your diet?

When you eat the way you're supposed to, do you feel in total control?

If you answered yes to two or three of these questions, you may have a mild case of orthorexia. Four or more means that you need to relax more when it comes to food. If all these items apply to you, you have become obsessed with food. So where do you go from there?

Treatment involves "loosening the grip," Bratman tells WebMD. "I begin by agreeing that the diet is important, but also saying, 'Isn't it also important in life to have some spontaneity, some enjoyment?'"

For most people, he says, making the change is a big step. "It doesn't happen in just one session. Once people recognize it, it's still very hard to change. It's been so long since they've eaten spontaneously. They don't know where to start. It's very tricky."

Bratman notes that sometimes orthorexia overlaps with a psychological problem like obsessive-compulsive disorder. Still, he thinks orthorexia "is its own illness as well."

Julie B. Clark-Sly, PhD, a psychologist at the Foundation for Change, a small medical facility in Orem, Utah, sees a common thread in orthorexia and other disorders. "It's being fixated on the food and having a limited range of what they eat -- that's very similar to what anorexic women do," Clark-Sly tells WebMD. "They do eat, but they don't eat fat, and they really restrict themselves calorie-wise. They say what they're doing is healthy, but they fool themselves. It becomes an emotional disorder."