Elimination obsession

For the staff at the Eating Recovery Center of California in Sacramento—a facility specializing in eating-disorder treatment—assessing a patient who is suffering from an eating disorder often involves separating fact from fabrication.

For instance, many patients will insist they’ve adopted a harmfully restrictive diet due to a gluten sensitivity or intolerance, said Director Jennifer Lombardi during a recent phone interview. “But then we find out they’ve never been tested [for gluten sensitivity], that they’re using that as an excuse to justify their eating behaviors,” she said.

As diets that categorically omit certain food groups—such as the Paleo, gluten-free, raw, vegan and lacto-ovo diets—become increasingly popular, Lombardi’s staff has seen a mirroring trend: patients whose extreme approach to dieting becomes an unhealthy—or even deadly—obsession. Such behavior was first noted in 1997 by Steven Bratman, medical director for Integrative Medicine and Educational Programs at Prima Healthcare in Ohio, who coined the term orthorexia nervosa. “It’s not anorexia, it’s not bulimia, but it is disordered eating, nonetheless, and it can have very dire medical complications that go along with it,” Lombardi said.

While orthorexia has not been officially listed in the Diagnostic and Statistical Manual of Mental Disorders, a widely accepted standard in the mental-health industry, Lombardi explained that many in her field view orthorexia as a parallel disorder to anorexia. But there’s a clear distinction between the two: While those suffering from anorexia focus mainly on quantity of food consumed, those with orthorexia focus on quality.

“What I see is that they start out dieting in a purist mindset—they want to eat right, want to eat healthy, don’t want to put anything into their body that is impure,” she said. “What happens is that it spirals down, they continue to get more and more restrictive, and the end result is a loss of a significant amount of weight and or having medical complications.”

Lombardi believes that, just as a single glass of wine might trigger an individual biochemically predisposed to alcoholism, beginning an elimination diet can serve as a gateway for someone predisposed to disordered eating. “They get hooked,” she said. “When they start eliminating foods and engaging in intensive exercise, it becomes very difficult for them to stop.”

Curiously, Lombardi has noted that orthorexia does not go hand in hand with body-image distortion the way it does with anorexia. In fact, many orthorexia patients express embarrassment at their emaciated physical appearance, “but can’t stop their restrictive eating pattern, all because they can’t let go of the purist perspective on food intake.”

The key to successful treatment, she said, is breaking the pattern. In order for the patient to recover and regain a healthy relationship with food, they must abandon their rigid dietary approach and “learn to eat intuitively again.”

Lombardi should know. She began struggling with body image at age 11, dabbling in taking diet pills and compulsively exercising. By the time she turned 17, she had full-blown anorexia, beginning a five-year struggle with the disorder that nearly killed her.

As a young girl, Lombardi recalled, she was anxious and high-strung much of the time, and as she got older, became increasingly concerned with how she was perceived by others. That emotional hard-wiring, combined with a chaotic family dynamic that often felt out of control, led her to focus on an aspect of her life she believed she could manage—her weight and physical appearance.

Though she declined to get specific about how much weight she lost, she said that “as a professional in the field and knowing what I know now, I’m very fortunate to be alive. … If I had walked into our treatment center now, I would need 24-hour care. It was really that intense.

“I survived that, and I’m very fortunate, because not everyone does.”

A turning point for Lombardi came when she realized that her eating disorder would eventually interfere with her plans of raising a family.

“Not only was I putting the possibility of having a family at risk, I was [also] putting the possibility of me having any healthy relationships at risk, because the relationship I gave the most energy and attention to was the one I had with my eating disorder,” she said.

Though the road to recovery was “winding and bumpy,” Lombardi’s struggle with anorexia has been in the rear-view mirror for 20 years. She attributes her success to a strong network of support: “[I had] people who were willing to be brutally honest with me and not mince words about how much danger I was in,” she said. “It’s critical that people have a support system of people not afraid to stand up to the eating disorder.”

Given the shame and secretiveness associated with eating disorders in general, it’s difficult to gauge their prevalence in certain geographic areas or among age groups, and Chico State’s campus is no exception, said Stephanie Chervinko, a psychologist with the university’s Counseling and Wellness Center.

“There’s a lot more of it going on than there are people at a point where they’re ready to come in and seek help,” she said. “It’s really hard for people with eating disorders to admit that they have a problem.”

Indeed, the very root of many eating disorders—a desire for control—can be a roadblock to seeking treatment. As Chervinko explained, to ask for help is to admit “that this is something they no longer have control over.”

More than anything, both Chervinko and Lombardi emphasized that eating disorders, regardless of how they were triggered or how deeply engrained they’ve become, are treatable.

“Whether you’re 12 or 65, it’s possible to recover,” Lombardi said, “but the only way to get better is to let the people in your life support you and be willing to take the risk of doing something different.”