One awful day, D.C. Copeland recalls, her perspective on her "pure" diet had become so distorted that she found herself crying in the produce section of a grocery store because she could not decide whether the kale or the chard was "better."
Jennifer Lombardi had so limited what she considered healthful that she found herself fending off others' questions about her diet. So she fabricated all sorts of food allergies — so no one would challenge her.
Both women say they were struggling with orthorexia, a condition that had them so consumed with a health food diet — or, as many people now term it, a clean diet — that the list of foods they'd eat shrank and shrank.
Their initial impulses might have been fine: perhaps cutting out processed foods or eating only organic food. But what if someone believes she absolutely cannot touch carrot juice if it's not organic? Or that she can eat only vegan raw food or not a single carb? The result, says Sondra Kronberg, a registered dietitian and nutrition therapist based on Long Island, can be malnutrition, brittle bones and other problems.
Our culture is immersed in advice and admonitions about the "right" way to eat: Juice, Paleo, low-carb, no-fat and GMO-free diets abound. So perhaps it's no wonder that the terrain gets dicey for some people.
Orthorexia "absolutely" is growing, says Kimberley Quinlan, a psychotherapist at the OCD Center of Los Angeles, an outpatient clinic that specializes in obsessive compulsive disorder.
People who struggle with anorexia or bulimia generally have a preoccupation with their appearance and sometimes cannot rightly judge if their weight is appropriate. Those with orthorexia "are not looking to lose weight or are not fixated on a number on a scale," says Lombardi, who now is executive director of the Eating Recovery Center of California in Sacramento. "They say, 'I want to look at the value of food, and I want to look at an altruistic approach.'"
For Copeland, who had obsessive compulsive disorder as a child and later had problems with alcohol and drugs, getting sober in her 20s also meant that it was important to eat healthfully.
"I got into raw veganism, colonics, enemas and a whole way of life. It was so insanely pure. There was no room for error. I couldn't even work. All the energy went into making my green smoothies and doing a yoga class," she says. "I was addicted to this feeling; I had to be pure."
A hallmark of orthorexia is perfectionism, finding the "perfect" foods. "Theoretically, if we do things right or perfectly, people will be less upset with us, we will experience less adversity," Lombardi says. "There's no room for imperfection, and there's no room for enjoyment."
Orthorexia was named in 1996 but has yet to be accepted as a formal diagnosis in the Diagnostic and Statistical Manual, the bible of psychiatric illnesses. Some therapists see it as an eating disorder, others as a manifestation of OCD. Some doctors think a separate diagnosis is unnecessary. There's no estimate on how common it might be.
Whatever it's called, therapists say, there are people whose rigid attention to what to eat, its nutritional content and how the food is grown and processed can put themselves in danger. A person might start "by getting rid of processed foods, then sugars and gluten, and little by little most things get taken out. They'll take out meat. Only raw foods, only fruit. There are no real rules, but it usually gets down to a very small number of foods," Quinlan says.
In addition, sufferers generally think there's nothing wrong with their behavior.
Copeland, a Yale graduate, says she was sure that her "pure" diet would help her reach her potential, but she now sees that it left her enervated, isolated and unwilling to leave her house without bringing her own food.
"If I can fill my whole mind with food and the purity of the food and the green smoothies, then I can stay sober," Copeland says in describing her thought process.
The day she couldn't choose which greens to buy, she called her Alcoholics Anonymous sponsor and began to get the help she needed, eventually seeing Quinlan and undergoing therapy that included learning to eat foods she had rejected.
Today, at 32, she is a playwright in Portland, Ore., and tries daily to eat when she's hungry. It's still not easy. But she had a recent victory at an event where others were drinking alcohol. She chose a Coca-Cola, not the seltzer, picking a treat and enjoying it.
Signs of orthorexia
Here are some indications that a person may be suffering from orthorexia: