You Are More Than What You Eat

December 21, 2020
By: Stephanie Gallant, Therapist, PhD Candidate

Early in my undergraduate studies in psychology, I learned about the Yerkes-Dodson Law that describes the relationship between performance and stress. The law dictates that performance increases with stress, but only up to a point. Past this “optimal level of stress”, performance begins to suffer. One classic example of this is exam stress – some stress will keep you aroused and sharp, while too much stress will paralyze you and impair your concentration 

Our relationship with food is no exception. Some attention to how we eat and where our food comes from can have positive effects on our physical and mental health. Cross that optimal level of stress, however, and preoccupation with the quality of food can start to feel all-consuming. And understandably so! After all, we live in a society that praises “healthy” eating. We are bombarded with contradictory messaging about food and the advice can feel like it changes as quickly as the weather. Add to that the weight of climate change, which has many of us reflecting on the way we feed ourselves and its impact on our environment. For some, all this can start feeling like too much. The concerns build up, leaving little space for anything else. And at its worst, the preoccupation with eating starts to chip away at psychological, physical, and social wellbeing. This fixation on the quality of food that can feel obsessive is often referred to as “orthorexia nervosa” (1). 

Let’s get a few things straight about this “orthorexia nervosa” label. First, it does not suggest that paying attention to the health and ethical properties of food is problematic. Instead, the term was coined in 1997 by Dr. Steven Bratman to describe an excessive and unhealthy fixation with healthy eating, where extreme diets based on perceived quality of food consumed lead to distress and impairment (2). Second, it’s important to note that, at the moment, orthorexia is not recognized as a formal diagnosis and there is quite a bit of debate about its nature. Indeed, more research is required to determine whether it is a unique disorder or possibly a variant of an existing eating or obsessive-compulsive related disorder (3). While the jury is still out for an objective definition, descriptions have typically included these features (4): 

1) an obsessive focus on eating foods that are considered “healthy”, “pure”, or “ethical” (the focus on weight loss, if present, is not primary);

2) compulsive behaviours or preoccupation related to foods considered unhealthy (e.g., compulsively checking ingredients, removing an increasing number of food groups, excessive interest in what others are eating, spending hours thinking about what food might be served at upcoming events); 

3) the preoccupation becomes impairing in some way (e.g., no longer able to enjoy meals with others; nutritional deficiencies; financial strain due to costly dietetic foods; overwhelming guilt and feelings of failure when perceived dietary transgressions occur, etc.)

If things have been feeling this way for you for a while, know that you are not alone. And while the empirical debate is still underway, we can use what we know about human psychology in general, as well as what we know about similar conditions, to help relieve some of that distress. Here are some good places to start:

• Practice self-compassion. Chances are you have a self-critical voice that has gotten a lot of practice over the years. Practicing self-compassion means developing a kinder, more understanding, and ultimately more helpful voice (5). For some great tips, check out my colleague Lisa’s blog post, Bye-Bye Self-Critical Voice; Hello Caring And Helpful Voice! Part 2. You can also have a look at Kristen Neff’s (leading expert on self-compassion) website self-compassion.org that includes plenty of great resources on everything self-compassion.                                                                                                                                      
• Notice dichotomous thinking. This form of thinking is common in people who report an obsessive focus on food quality (4). That is, the habit of judging yourself or others in a dualistic way: right or wrong, good or bad, healthy or unhealthy, etc. Changing how we think is a process, but it starts with catching ourselves in thinking traps (like dichotomous thinking) and training ourselves to explore different options by asking ourselves questions like “are there other explanations?”, “is there any information that I’m ignoring?”, “is this a helpful thought?”, “how might I be thinking about this if I were feeling differently?”

• Be mindful of your social media usage. It can be helpful to remember that social media, by design, hooks you in by giving you more of what you’re interested in. If you’re interested in healthy eating, it can very rapidly start to feel like that’s all that people are caring about. Giving yourself time and permission to disconnect can go a long way! Consider cleaning out and reorganizing your social media to ensure that you’re talking with different people, hearing different perspectives, and remembering that other things matter. 

• Mind your comparisons. Social comparison is the innate drive that we all have to evaluate ourselves via comparison with others (6). Social comparison, however, can be quite painful if you’re constantly comparing yourself to the idealized version of who you believe you “should” be or to the unrealistic way others are portrayed on social media. Check out my colleague Simcha’s blog post, It’s All Relative: What Are Social Comparisons And How Do They Affect Us? for some helpful tips to deal with social comparison.

• Diversify your portfolio, and I don’t mean mutual funds! There are many domains of life: health, personal growth, relationships, leisure, work/education, spirituality, etc. When all our sense of worth and wellbeing is dictated by one domain, health for instance, it’s hard not to get down on ourselves when we feel like we’re falling short. Take a *self-compassionate* look at how you’re doing in these other domains. It can be helpful to start identifying your personal values in each domain (because we all have different ones!) and to start investing time and energy towards them. 

• Consider whether exposure and response prevention (ERP) might be for you. ERP involves gradual reduction of compulsive behaviours and obsessions through repeated exposure to anxiety-provoking situations without the use of compulsions to relieve the anxiety. For example, a person might choose to reintroduce an anxiety-provoking food into their diet and, with the help of a therapist, learn to sit through the anxiety without compulsively looking up the ingredients or seeking reassurance. ERP is an effective treatment for OCD and is often used, though less explicitly, in the treatment of anorexia nervosa (3). Given the similarities with eating disorders and OCD, ERP has been suggested as an intervention for people dealing with an obsessive focus on healthy or pure eating (3).

Conclusion

Trying to eat in a way that is healthy and sustainable is not problematic per se. For some, however, the preoccupation with healthy or ethical food can become overwhelming and negatively impact their mental, physical, and social functioning. The term for this, orthorexia nervosa, is not currently an official diagnosis and more research is needed to help us understand its exact nature. While the research is still underway, I hope that these tips based on what is helpful for people dealing with similar conditions will be helpful!

references

(1) Costa, C.B., Hardan-Khalil, K., & Gibbs, K. (2017). Othorexia nervosa: A review of the literature. Issues in Mental Health Nursing, 38(12), 980-988. doi: 10.1080/01612840.2017.1371816

(2) Dunn, T.M., Gibbs, J., Whitney, N, & Starosta, A. (2017). Prevalence of orthorexia nervosa is less than 1%: Data from a UD sample: Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 22(1), 185-192. 

(3) Zickgraf, H.F. (2020). Treatment of pathologic healthy eating (orthorexia nervosa). Advanced Casebook of Obsessive-Compulsive and Related Disorders (pp. 21-40). 

(4) Cheshire, A., Berry, M., & Fixsen, A. (2020). What are the key features of orthorexia nervosa and influences on its development? A qualitative investigation. Appetite, 155, 1-10. doi: 10.1016/j.appet.2020.104798

(5) Neff, K. D., Kirkpatrick, K. & Rude, S. S. (2007). Self-compassion and its link to adaptive psychological functioning. Journal of Research in Personality, 41, 139-154.

(6) Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7, 117-140.