Diagnosis du jour? Considering Orthorexia Nervosa
by Barbara Rittner
It is always tempting to try to predict the next psychiatric diagnosis du jour. I have watched autism replace bipolar which replaced ADHD as the front runner in the race for popularity in children and adolescents diagnoses. It is clearly incumbent on us to view these emerging trends with healthy skepticism. To put it in perspective, in the last 20 years autism rates increased from 1 in 10,000 (1990s) to 1 in 68.
The shift in autism diagnosis rates certainly should raise questions about how valid the diagnosis is when what was once considered a rare condition is now so common that it occurs in 1.5% of the population. That makes it as common as red hair (estimated at 1-2%).
Increases in autism as the diagnosis du jour follows on the heels of diagnosing acting-out adolescents as bipolar and encouraging the use of medications until the medication side effects were tied to increasing rates of tumors and diabetes (Harley, et al, 2007; Pfeifer et al 2010; van Winkel et al 2008) in these youth.
But I confess that the latest diagnosis du jour to emerge caught me completely by surprise. An article in BMC Psychiatry reported on the partial validation of an instrument (Ortho-15) that supposedly supports the existence of Orthorexia Nervosa (ON), a newly invented diagnosis for people who are too concerned about their healthy diets. (This diagnosis is not in the DSM-5 but may come under consideration).
There is no question that we all know people who endorse very restricted diets, many of whom might even meet criteria for this “alleged” diagnosis using the Ortho-15. Some restrict their diets because of a desire to eat healthy, some because they have a medical condition that limits what they can eat or made them re-evaluate how they eat, some because of their religious or spiritual beliefs, and some because they have an eating disorder (either anorexia nervosa or bulimia nervosa – AN or BN) often co-morbid with obsessive compulsive disorder (OCD) and obsess about health foods.
Any of these reasons for restricting a diet to health foods would probably meet the clinical criteria for this “alleged” ON diagnosis but technically only those who meet criteria for co-morbid AN or BN and OCD should. It is easy to challenge the criteria in the Ortho-15 as flawed but it is the premise that is flawed because there is nothing new here.
Relabeling the well-documented eating disorder co-morbid with OCD using a new label does not provide any useful clinical information. In fact, this co-morbidity is so well documented in the literature that in the last 15 years there have been 250 peer reviewed articles published globally on comorbid OCD and AN.
It begs the question of how the newly labelled Orthorexia Nervosa needs to be differentiated from the well-known co-morbidity of eating disorders and obsessive compulsive disorders. This, hopefully, will never become the next diagnosis du jour.
Do you have a favorite “diagnosis du jour”?
What do you think of the new Orthorexia Nervosa diagnosis?
Let us know – leave a comment!
Barbara A. Rittner, PhD, LCSW, is Associate Professor and Associate Dean for Advancement at the UB School of Social Work. She teaches Psychopathology online, and was past Director of the PhD program. Formerly, she chaired the Group for Advancement of Doctoral Education, and has served on CSWE’s Board of Directors and Commission on Research.