SPOT­TING THE SIGNS

Good (UAE) - - THE GOOD LIFE -

Wor­ried your friend, col­league or daugh­ter is tak­ing clean eat­ing too far? Here are the warn­ings to watch for…

Dr Angela Guarda, as­so­ciate pro­fes­sor of psy­chi­a­try and be­havioural sciences and di­rec­tor of the eat­ing-dis­or­ders pro­gramme at the UK’s Johns Hop­kins School of Medicine, says many cases of what might be termed or­thorexia fall un­der the di­ag­no­sis of arfid (avoidant/re­stric­tive food in­take dis­or­der). Guarda says the be­hav­iour of some arfid suf­fer­ers is strik­ingly sim­i­lar to that of peo­ple with anorexia, and ar­gues that cre­at­ing a new la­bel risks mis­treat­ing them. She also wor­ries that or­thorexia has pos­i­tive con­no­ta­tions. “It can be seen as a virtue rather than a prob­lem. In some cases, it is used by peo­ple as a more ac­cept­able ex­pla­na­tion for what es­sen­tially looks like and is anorexic be­hav­iour.”

Pa­tients share “an over­val­ued be­lief they have to stick to a very rigid diet”. Arfid pa­tients may claim to be fo­cused on health rather than weight loss, but this is also true of anorexic peo­ple. “That is what they tell you, but when you watch both groups in an en­vi­ron­ment where they have to eat, they of­ten act in very sim­i­lar ways. Both have nar­rowed their food reper­toire down to very lim­ited foods. They have rit­u­alised eat­ing and prepa­ra­tion habits. They pro­long eat­ing. They gen­er­ally avoid calo­rie-dense food. The rea­sons they give you may be dif­fer­ent, but the re­stric­tive-eat­ing be­hav­iour is sim­i­lar.”

Guarda sug­gests that this is be­cause “in­di­vid­u­als with eat­ing dis­or­ders ra­tio­nalise their be­hav­iour in var­i­ous ways. Pa­tients with anorexia of­ten be­come veg­e­tar­ian and say it is be­cause they like an­i­mals, but it also al­lows them to limit what they eat, and ex­plain why they are only hav­ing salad when ev­ery­one else is hav­ing a ham­burger.” The same is true of some so-called or­thorex­ics. “They may say, ‘I only eat or­ganic food,’ but when you look at what they are eat­ing, it is low-fat, low-calo­rie and only what they pre­pare, so the end re­sult is the same: many of them lose weight. They will talk about be­ing veg­e­tar­ian be­cause it is healthy, how they de­vel­oped a lac­tose in­tol­er­ance, or how they had to cut out gluten. But this is part of their ra­tio­nal­i­sa­tion for why they have re­stricted their food reper­toire – a ra­tio­nal­i­sa­tion that seems more ac­cept­able both to other peo­ple and them­selves.”

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