Who is Dr. Steven Bratman?
Dr. Steven Bratman is an American physician and author renowned for identifying and naming orthorexia nervosa. As a practitioner of alternative medicine, Bratman's observations in the 1970s and 80s revealed a growing preoccupation among individuals with the perceived purity and healthfulness of their diet. This went beyond typical healthy eating, becoming an intense focus on food quality and sourcing.
Bratman noted that this fixation was often driven by a quest for moral or virtuous eating, which, in some cases, became so severe it caused significant psychological distress and even malnutrition. His work was instrumental in bringing attention to this pattern of disordered eating within the medical community, although orthorexia is not yet listed as an official diagnosis in the DSM-5.
From Healthy Eating to Obsession: The Emergence of Orthorexia
Dr. Bratman introduced the term orthorexia nervosa in a 1997 Yoga Journal article. He combined the Greek words orthos ("right" or "correct") and orexis ("appetite") with nervosa (signifying a psychological state) to describe the condition: an unhealthy obsession with consuming only "correct" foods.
In 2016, Bratman collaborated with Dr. Thomas M. Dunn to propose formal diagnostic criteria for orthorexia. These criteria emphasize the qualitative focus on food, distinguishing it from disorders centered on quantity or weight. Key features include:
- Obsessive Focus: Intense preoccupation with dietary practices deemed optimally healthy.
- Exaggerated Distress: Significant anxiety or guilt from breaking self-imposed food rules.
- Escalating Restrictions: Increasingly severe dietary limitations over time.
- Clinical Impairment: Negative impact on social life, health due to malnutrition, or daily functioning.
Orthorexia vs. Anorexia: A Critical Comparison
While both involve restrictive eating, orthorexia and anorexia differ fundamentally in motivation and presentation. The table below outlines these differences:
| Feature | Orthorexia Nervosa | Anorexia Nervosa |
|---|---|---|
| Primary Motivation | Obsession with food quality and purity for optimal health. | Fear of weight gain; obsession with body shape and weight. |
| Body Image Concern | Not the main focus; focus on feeling healthy or pure. | Central feature; distorted body image. |
| Food Relationship | Fixation on qualitative aspects (e.g., organic, clean). | Fixation on quantitative aspects (e.g., calories, portions). |
| Ego-Syntonic vs. Ego-Dystonic | Often seen as rational and superior (ego-syntonic). | Often recognized as harmful (ego-dystonic). |
| Self-Worth | Based on adherence to dietary rules. | Tied to body weight and appearance. |
Risk Factors and Societal Influences
Certain factors increase the risk of developing orthorexia. These include personality traits like perfectionism and obsessive-compulsive tendencies, a strong need for control, and high anxiety levels.
Modern culture, especially social media, significantly influences orthorexic tendencies. The promotion of strict "clean eating" and wellness trends by influencers can set unattainable standards and heighten food-related anxieties. This environment can be particularly challenging for vulnerable individuals. Professions requiring a strong focus on nutrition, such as dietitians, athletes, and fitness professionals, may also face higher risks. Exposure to conflicting online nutritional advice further contributes to confusion and rigid dietary choices.
Diagnosis and Treatment
Since orthorexia is not in the DSM-5, healthcare providers use screening tools like the ORTO-15 questionnaire and Bratman's test to evaluate behaviors and beliefs about healthy eating. Diagnosis typically involves assessing both physical health, to identify potential malnutrition, and mental health.
A multidisciplinary treatment approach is essential, often involving a team of experts. Key components of treatment include:
- Psychotherapy: Cognitive Behavioral Therapy (CBT) helps challenge distorted thoughts about food. Exposure and Response Prevention may be used for fearful foods.
- Nutritional Counseling: A registered dietitian guides the patient towards a balanced and flexible diet, addressing restrictions and nutritional gaps.
- Medical Monitoring: Physicians monitor and treat physical issues caused by malnutrition.
- Medication: Antidepressants may be used for co-occurring anxiety or depression.
- Mindfulness: Encouraging intuitive eating helps patients find joy in food beyond purity.
Conclusion: The Lasting Impact of Steven Bratman's Work
Dr. Steven Bratman's identification and naming of orthorexia nervosa were crucial steps in recognizing this form of disordered eating, often hidden within the guise of healthy living. While not an official diagnosis, his framework allows healthcare professionals to better understand and help those struggling with obsessive dietary perfection.
The ongoing discussion around orthorexia highlights the need for public awareness about the difference between healthy eating and rigid, damaging dietary rules. Bratman's legacy serves as a powerful reminder of the connection between mental health and our relationship with food, advocating for balance over the strict pursuit of dietary purity. His work continues to influence discussions on wellness, diet culture, and eating disorder recovery.
For support, resources are available through organizations like the National Eating Disorders Association NEDA resource.
