Disordered eating is not something I ever thought I might be susceptible to. I upheld misguided, but common, prejudices about eating disorders, especially anorexia, which I associated with teenage girls – provoked by the trends and standards in popular visual culture – attempting to remedy their insecurities or worse, fulfil vanity. I struggled to understand why anyone would want to look emaciated. While these ‘initial motivations’ (skewed as they were in my head) are perhaps more prevalent and are far from being any less valid, I couldn’t identify with them personally. I hadn’t even heard about the dangers of Anorexia’s estranged cousin, Orthorexia, which would ultimately lead me down a similarly slippery slope, or the differences and alliances between the two.

My first year of university, to my surprise, turned out to have gone very well. While I was intellectually fulfilled, I still found time to relax, and when I got a top mark in my first year exams, it came as an exciting surprise and confirmed that everything had fallen into place. But during the long vacation, the high I’d felt at the end of my exams was wearing thin and expectations began to mount. I felt like a fraud: success in any arts subject being unavoidably subjective, I couldn’t see how I deserved to have done so well. Believing I could have, should have, worked harder, by the time I entered second year my personal standards had become unrealistic and unattainable.

In a desperate bid for self-worth, I turned a forensic focus to improving my lifestyle, and an addiction to exercise worked its way into my ever-stricter routine. The attainment was measurable in a way my artistic efforts could never be; I enjoyed the feeling of pushing myself to exhaustion to get better times for longer distances. My athletic family encouraged this new obsession, which, in their eyes, could only be good for me. With each faster time, each extra mile, I got a taste of the old ‘high’, which filled the hole left by my perceived ‘under attainment’ in my subject. Very quickly the need to ‘perfect’ my wellbeing became an end in and of itself – and consisted of rituals to be performed ‘right’ in order to create the ‘correct’ conditions for efficient work. I stopped listening to hunger cues. My eating became regimented. Slowly, I started to cut out foods I believed could be ‘contaminating’ me, ingesting only those that I thought were ‘healthy, ’beneficial’, ‘clean’; purifying both body and mind through what I ate.

This type of thought is insidious, but it’s not hard to see how it has crept its way in to our cultural psyche. The last decade’s health food boom has seen ingredients like kale, quinoa, and millet grain move from hippie communes to hip cafe menus. In a world where crash diets once ruled, food bloggers now present ‘raw lasagne’, ‘green smoothies’ and yoga as a one-way lifestyle overhaul. With millions of followers between them on multiple social media platforms, the choices of health and lifestyle bloggers are tracked with religious conviction. The concept of ‘clean eating’ and the quest to ‘eat well and live better’ is something people in wealthy societies are now conditioned to aspire to – because why wouldn’t we ‘better’ ourselves, if we can afford to? The implied converse impact, that if certain foods are ‘clean’ others must be ‘dirty’, is an unwelcome but inevitable side-effect of such thinking. While nutritional research is massively contradictory and largely inconclusive, different food groups have their fifteen minutes of fame, either acquiring miracle qualities (super-foods like wheatgrass) or playing the role of the devil (refined sugar, saturated fats). ‘Healthy eating’ really has become a way of life that, in our secular society, fulfils some of the same needs as religious faith, one in which our own bodies are temples, and lemon-infused hot water fills the role of a morning prayer.

Dr. Steven Bratman, who coined the term ‘Orthorexia’ in 1997, has a greater perspective on the issue after not only recognising the symptoms in his patients, but in his own approach to eating. Over Skype, Bratman explained to me how the problem of obesity in Western culture has caused the term ‘healthy’ to become conflated with foods which are low calorie. While it is true that this definition of ‘healthy’ might be useful in terms of helping to tackle over-eating, it is a definition that sticks even for those who don’t have a weight problem. According to Bratman, ‘health’, as we have come to know it, is really a capitalist construct: a political weapon for advertisers to use against the threat of obesity. But when obesity is not a concern, it is important to recognise that ‘health’ means something quite different – and much less to do with food than the ideal sold to us as consumers. Dislocated from our bodies and needs, ‘health’ has become yet another product, one that is much easier to sell when it takes the form of expensive ingredients, protein shakes, or gym memberships; we don’t need to ‘detox’ when our livers and kidneys do the job for us much more effectively.

When health equals happiness, aspiring to greater ‘health’ when we are already ‘healthy’ seems logical. This may be to do with nostalgia, Bratman speculates. Subconsciously, we have always longed for a ‘golden age’ in which life was simpler, and we constantly look back to the past in order to cope with anxieties about the future. We are scared of technological advancement, a fear that extends to food processing. But this ingrained longing for simplicity is dangerous in a culture which sells these warped perceptions of ‘health’. Equally, the historical and ascetic notion that “delayed gratification accomplishes things”, that those who don’t give in to worldly pleasures show some sort of strength of character, intellect, or are on some kind of moral high-ground, is a toxic one in our individualistic era.

In my own experience, Orthorexia soon slipped into Anorexia. The range of foods I was happy to eat became so limiting that I was malnourished, and I started to experience the ‘hunger highs’ that often accompany starvation. I no longer had enough energy to think rationally, and became trapped in the addictive thought patterns that sustain eating disorders. Eventually, my hair was falling out, and my skin flaked off in the shower. I would wake up continually throughout the night in a state of stress and confusion, my body crying out for the food I was denying it. My hands and feet, drained of blood, went numb and tingled in the cold – and I was cold – constantly. But still, I couldn’t recognise that there was something wrong with my approach to ‘wellness’.

It is for these reasons that many clinicians choose to disregard Orthorexia, or persist in identifying it as a mere sub-category under the umbrella of Anorexia, which is seen as being chameleon-like, adjusting to the cultural climate. With gluten, dairy, and sugar-free foods appearing increasingly on restaurant menus and supermarket shelves, food intolerances are an easy and, importantly, acceptable mask for the Anorexic, or Orthorexic, to hide behind. There is such a plethora of individual motivations for Anorexia and its subsets that it would be impossible to come up with a label for every difference; ten years ago the ‘on-trend’ label was ‘the Female Athlete Triad’. There are many Anorexic patients that would strongly dispute that weight loss was an initial goal, and many Orthorexics for which ‘health’ and ‘weight loss’ were one and the same, in the way that ‘healthy food’ and ‘low calorie’ might be.

While Orthorexia is not yet in the DSM, Bratman hopes that it soon will be, simply for the better quality research that would follow its recognition. As he explained to me: “I’m not wedded to Orthorexia being a separate condition. I’m beginning to suspect that the border between the two [Anorexia and Orthorexia] is so fuzzy now, I’m not sure there is a useful distinction … [There’s this] substitution of one type of restriction for another, just a more socially acceptable one”. He points out that in the UK, some individuals are actually positively identifying with the term, proudly proclaiming “I’m Orthorexic” in a way that an Anorexic, with the condition’s attached social taboo, never would. It can be argued that restriction is restriction nonetheless, and that Orthorexic eating habits are simply “a way of deceiving yourself” when really Anorexia is working its way in. But I believe this ‘way in’ needs to be recognised and thus further understood. Debates surrounding these issues are ones we ought to be having, especially within a University demographic that, as high achievers and perfectionists, are already at high-risk.

So, where is the line between health conscious eating, and Orthorexia? I’m not sure there is one. In a society which sells a distorted perception of health, it is all too easy to slip right through the grey area of controlled consumption into a darkness that is all-consuming. It is normal to want to eat ‘healthy foods’ most of the time, but it is abnormal and problematic for unhealthy food to become scary. It is certainly problematic for a list of ‘unhealthy’ foods to become so vast that the prospect of eating out, even enjoying a meal prepared by a friend, becomes terrifying. Orthorexics are wracked with guilt at the idea of ingesting anything that might not fit their personal and highly rigid definition of ‘health’. Looking at food labels in Tesco, in itself, is not Orthorexia. Wasting hours researching nutritional values, finding decision making in the supermarket anxiety provoking, time consuming, and financially draining, probably is, and it might be time to re-assess whether this really is ‘health’. I say this because, from experience, people with Orthorexia don’t have a life, only a grocery list.

If you want more information about Orthorexia or eating disorders, contact BEAT

Image credit George Eastman House