Are You Too Healthy for Your Own Good?
The Silent Sufferer
When a normal-weight friend skips one social event after another for Spinning class or looks visibly distraught after nibbling a brownie at an office party, you may think she's being too hard-core, but you probably don't suspect that she has an eating disorder. She might. Such behaviors are bigger red flags than a sinking BMI. In fact, a below-average body weight is no longer a criterion even for anorexia, according to diagnostic guidelines updated last year. And while someone with orthorexia may drop pounds as a side effect of restrictive eating, she's typically more focused on eating right and getting fit than becoming stick thin.
"When assessing a patient for any eating disorder, including orthorexia, we look for a fear of gaining weight, eating the wrong thing or not exercising. Is the person obsessively checking her body in the mirror? Is she dominated by thoughts of food?" says Jane Miceli, MD, the medical director of adult services for the Eating Recovery Center in Denver. Another sign that therapists watch for is a level of self-discipline that goes beyond what's rational. "Anytime someone is exceedingly strict about their eating or exercise habits to the point of neglecting close relationships or becoming agitated if they slip up in some way, it's a reason for concern," Dr. Miceli says.
What causes a health-food devotee and avid exerciser to cross the line from passionate and committed to pathologically obsessed? Heredity, for one. "Between 50 and 75 percent of the reasons some women develop eating disorders and others don't can be attributed to differences in their genes," says Kelly Klump, PhD, a professor of psychology at Michigan State University. "The specific genes involved are still being identified, but we know they are closely associated with those that control anxiety and/or depression." Women who exhibit certain personality traits are also at higher risk, research shows. Perfectionists, for example, may be vulnerable because they place a high value on self-discipline and attaining the perfect body.
When something stressful happens -- starting or losing a job, going through a breakup -- women who are genetically predisposed to these disorders may be more likely to turn to compulsive eating and exercising as a coping mechanism. "Transitional events like these can set off an eating disorder because they can leave a person feeling anxious and powerless," says Cynthia Bulik, PhD, the director of the University of North Carolina Center of Excellence for Eating Disorders and author of Midlife Eating Disorders: Your Journey to Recovery. Hypercorrect eating and exercise are ways to compensate -- and help sufferers regain a false and temporary sense of control.
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