Adult Selective Eating and Orthorexia: Are they real diseases?

Two new “potential eating disorders” have been in the news recently, and we here at want to set the record straight.

1. Adult Selective Eating: People who strictly limit their diet to foods that tend towards childhood favorites. Some common preferences include plain pasta, cheese pizza and french fries. If you have a 5-year old, this may sound familiar. In fact, much like little kids, those with “Adult Selective Eating” tend to limit themselves to a narrow range of un-adventurous foods. Some have questioned whether this population just hasn’t outgrown childhood patterns, or if perhaps these eating habits are a new twist on obsessive compulsive disorder. Unlike those who suffer from anorexia nervosa or bulimia, adult picky eaters are seemingly not worried about calorie counts or body image. Importantly, these people tend not to suffer very low body weight, and neither the short nor long-term consequences of this diet are understood.

2. Orthorexia: Identified in 1997 by Colorado physician Steven Bratman, MD, orthorexia is Latin for “correct eating.” Here, too, the focus isn’t on losing weight. Instead, sufferers increasingly restrict their diets to foods they consider pure, natural and healthful. Those affected may start by eliminating processed foods, anything with artificial colorings or flavorings as well as foods that have come into contact with pesticides. Beyond that, orthorexics may also shun caffeine, alcohol, sugar, salt, wheat and dairy foods. Some limit themselves to raw foods. Some researchers say that orthorexia may combine a touch of obsessive compulsive disorder with anxiety and warn that severely limited “healthy” diets may be a stepping stone to anorexia nervosa, the most severe – and potentially life-threatening – eating disorder. Credit to: Healthline, New Eating Disorders: Are They For Real? By Lisa Collier Cool, Apr 07, 2011, also see, Orthorexia: Can Healthy Eating Be a Disorder? By Bonnie Rochman, Feb. 12, 2010

Let’s get a few things straight: First of all, despite the fact that these “disorders” have scientific-sounding names, neither one of these is yet officially included in the Diagnostic & Statistical Manual (DSM), often considered the official “bible” of psychiatric diseases. Several groups of disease experts debate high-quality research papers for years before settling on a name and clinical criteria that define a mental disease. At this point neither of these “phenomena” qualify as eating disorders.

Second, it is often true (but not always) that for a “condition” to rise to the state of a “disease” it must negatively affect the patient in regards to their achievement of expected level of interpersonal, academic, or occupational success. This is doctor-speak for, “If the patient’s experience is not hampering their personal life, school work or career then it is probably not a disease.” This is controversial, and some have suggested that for many people it is possible to achieve success in these pieces of one’s life while still suffering from a legitimate disease. All we can say for sure is that neither one of the aforementioned “diseases” seem to pose significant dangers to the physical health or lifestyle of those affected – although they may experience hidden anxiety.

Third, both of these really do seem to be symptoms of anxiety, or some form of coping mechanism, rather than an intrinsic disease. What we mean is, our belief is that both of these point to an underlying stress reaction, and that both seem to be reactions to – rather than the cause of – the stress in question.

NONE OF THIS should suggest that, for people who experience these symptoms, that they are somehow “bringing it on themselves,” or that they are simply “acting out.” If you or a loved one are truly “suffering” in similar circumstances then we must wish you the best and insist you seek out quality therapy.

We here at hope you’ve learned a little about these recent “In the News” items. As always, if you have questions please do not hesitate to ask. Your contact info is held in confidence.

Michael Katz, MD, MS


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