Are We Overdiagnosing?

A couple of my dear friends (read: Cory and Sarah) recently sent me an article on yahoo about orthorexia.  This newly-coined term is defined as a disorder in which the sufferer is fixated on healthy or righteous eating.  The sufferer has specific preferences about what goes into their body.  Some may avoid fat or additives, some may take veganism to the extreme; either of which may or may not lead to emaciation.  The supposed distinction between anorexia and orthorexia is this: anorexics want to lose weight, but an orthorexic desires to feel healthy, pure and natural.  The term was coined by Steven Bratman, and is not currently classified as a mental disorder in the DSM-IV, nor will be in the newest edition in 2013.

Now, let me throw out a disclaimer:  I feel so hesitant to assert my opinion here for fear of invalidating an individual who is beginning to engage in unhealthy eating behaviors.  However, I have begun to grow weary of over-diagnostic tendencies in the mental health field.  I tend not to be a big fan of diagnoses in general (as necessary as they are for our insurance company friends) because humans are…human, and often will not perfectly meet criteria for any disorder.  You treat the person and their symptoms, not the diagnosis.  This might not sit well with the medical community, as criteria is more cut and dry there, but social science has always been more grey. 

First example of sort-of-unbelieveable-diagnoses: Oppositional Defiant Disorder.  This is characterized by a pattern of defiant and hostile behavior towards authority figures.  Or is it just this seemingly recent trend of parents unable to set limits and parent?  Is the behavior the result of another diagnosis (ADHD, Learning Disorder)?  I am sure, that for every objection I have there is a specific example of a kid that completely fits criteria.  I’ve just always felt funny about that one.

Prior to it being labeled “orthorexia”, it was called disordered eating.  (And as a sidenote – in my work and experience I’ve met many diagnosed anorexics who wanted to feel pure as a result of starvation.  I’ve also met many normal eaters who wanted to feel healthy and natural as a result of their diet.)  I just wonder if this isn’t a byproduct of our society’s current fixation on vegan/organic/vegetarianism lifestyles, which I honestly feel, is trendy.  Orthorexia also sounds pretty Obessive-Compulsive Disordered.

Or, is a diagnosis of orthorexia the ED world’s response to alcoholism’s alcohol abuse?  (There are two classifications of alcohol addiction; one is alcohol dependence, and the other is abuse.  Dependence implies a bodily need, and abuse implies continued use despite its consequences.)  So, anorexia (akin to alcohol dependence) has medical criteria, while orthorexia (akin to alcohol abuse) does not.  Perhaps it is a step in the right direction.

Or, maybe, it is a response to corrupt insurance companies’ insatiable need for labels and criteria, criteria, criteria.  The more that is labeled = the more is treated. 

My intention is not to isolate those who might be on the verge of an eating disorder.  My intention is to encourage individuals to pay no attention to labels that supposedly define whether you suffer with something or not.  If you are hurting as a result of your eating behaviors, no matter what they are, that is more than enough reason to get help. 

Just some thoughts.  What do you think?

2 thoughts on “Are We Overdiagnosing?

  1. It is odd for me to think of vegetarian/vegan diet as trendy, because I arrived at mine (over 20 yrs ago!) by means of very private, internal drive. As the start of my ED pre-dated the exclusion of animal products by 5 solid years, &, during the start of my vegetarian eating, I was in a fairly good place/not severely restricting, I have always maintained, that my ED & my vegetarian diet, are coming from very different mental/physical/spiritual places.
    I guess I would worry, that in the absence of the other mental/physical trappings of currently established EDs, a person’s completely valid dietary choice may be medicalized as a disorder! For me, being forced to eat a sentient being would be every bit as repugnant as my being forced to physically harm/eat a piece of another person. It was extremely difficult to insist on this dietary “restriction” during treatment, but this new classification could make it all but impossible for others to adhere to a valid, personally held, principle.
    I, also, have no wish to invalidate any person who has begun to eliminate animal products as a component of disordered eating. I’m just saying, that as it could come from either a healthy or a disordered motivation, this may just be one of a plethora of personal dietary choices, that need to be assessed as a part of the person as a whole.

    1. Absolutely Michelle. I like what you said at the end – “assessed as a part of the person as a whole”. For some (like yourself), it is part of a personal, principled process that has nothing to do with an ED. I really think these terms like “orthorexia” or “drunkorexia” tend to be trendy, media-friendly terms that aren’t really going to make it into the DSM. Or at least, I hope so!

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