What is Orthorexia Nervosa?

Orthorexia

You’ve heard of Anorexia Nervosa and Bulimia,  right? Anorexics restrict their eating whereas Bulimics go through cycles of binge eating followed by purging. But what is Orthorexia Nervosa? An eating disorder currently not recognized in the Diagnostic Statistical Manual of Mental Disorders, Orthorexia was first coined in 1996 by a physician who used it to describe patients who were overly concerned with their health. Orthorexia, which literally translates into “fixation on righteous eating,” begins with one’s attempt to eat healthy foods. But orthorexics then become obsessed with food quality and how much to eat. The more restrictive the diet, the greater one’s health suffers. Like anorexia and bulimia, there is no exact cause to orthorexia. Though the desire is to eat healthfully, there are other deeply rooted motivations, such as the hunger to be thin, the determination to be in control, and the need to improve self-esteem.

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Rachel Levine, a kindergarten teacher in Denver, Colorado, and an advocate for those suffering from eating disorders, has been in recovery from both orthorexia and anorexia for more than seven years. In the March 2015 issue of Self Magazine, she shares her raw story of how orthorexia “almost killed her,” starting from the very beginning, when her heart nearly stopped beating from nutritional deprivation. To learn more about how Rachel got her appetite for life back, I invite you to read her story, “What it’s Like to Care Too Much About Eating,” here.

 

 

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How to Write About Body Image

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If you had to write about your body, what would you say?

First, let me define body image: it’s how you think and feel about your body, it’s shape and size, how you see yourself in the mirror, how you feel in your body.

Writing about your own body might feel a lot like walking through town naked. But I’m not here to encourage you to strip on the page, though a certain amount of stripping is required in order for our readers to get to know us as real human beings. The more important question is, when writing about your own body, how do you avoid the pitfall of naval gazing? Through metaphor, imagery, the five senses. When writing the following piece, my aim was to do just that – become intimate with peaches – to smell, feel, taste, touch my way toward a more positive image of my body. I chose peaches because they are one of my favorite fruits, and it was a peach I last recall holding before an elderly driver ran into me at a farmers’ market several years ago. So I guess you could say I’m obsessed with peaches and what they, particularly the one I held at the market, mean to me: changes in the body,  acceptance, re-newal, survival. I wrote with those interpretations in mind when crafting the following narrative:

I gently roll a peach between my palms, its downy coat tickling my fingers. I study the curves and arcs of its plump body. I’m searching for the perfect peach: golden hued with no deformities. But I notice that it has  a soft spot with a purplish bruise, and place it back in the display. I stand among the peaches for another fifteen minutes, picking up a scarred one, a wrinkled one, then another with a slit in its skin. These damaged peaches must taste like wood, I think. I choose one more, and bring it close to my nose. I inhale, smelling earth. I’m tempted to buy it, but notice a blemish at the base, and motion to place it back among the ones that are disfigured. I pause, and tell myself to give this peach a chance. Maybe it will taste better than it appears. I buy it, and as I walk away from the farm stand, sink my teeth into it, its blushed skin forgiving. Pulp bursts with warm juice. I stop, swallow. Summertime trickles down my throat. Sweet. Perfect. 

Do you have a body image narrative to share? If not, I hope this post inspires you to strip, just a little.

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Force-Feeding: An Ethical Dilemma

What are your thoughts about the practice of force-feeding individuals who refuse to eat?

As nurses, we sometimes find ourselves in situations where we are asked to carry out clinical tasks we believe are ethically unsound. For instance, let’s look at the case of the Guantanamo-Bay prisoners who went on a hunger strike in June 2014. The military nurse assigned to them refused to force-feed the prisoners “because it felt wrong,” he said (http://www.washingtonpost.com/force-feed-detainees).

If he were to follow through with the orders to force-feed a suspected criminal, this is how it would likely play out: strapping the prisoner to a chair or bed, pushing a long rubber tube into his nose, down into his stomach, while he twists and flails, fighting to maintain a semblance of dignity.

Nurses choose to become nurses because they want to help those who are vulnerable, physically and emotionally. Nurses approach their patients as a whole entity, the mind and body a seamless system. They listen to their patients talk about their fears and anxieties. They sit with them during the night when they are awake in pain, and administer medications to ease their discomfort. They advocate on the behalf of their patients. The nursing code of ethics is clear about the role of a nurse:

The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems (http://www.nursingworld.org/Mobile/Code-of-Ethics).

According to that code, the nurse at Guantanamo acted within his rights. He acted with respect, and preserved the prisoners’ autonomy to make decisions on their own behalf. By refusing to force-feed the prisoners, he was protecting each of their individual rights.

The Guantanamo Bay case is clear-cut, but what about circumstances that are not so black and white, like force-feeding a patient with Anorexia Nervosa?

Withholding feeding, and fluids, is common practice in the terminal stages of an illness. But anorexia is not considered a terminal disease, yet patients do die from poor nutrition. Thus, feeding them is a life saving measure. But, unlike the Guantanamo prisoners, what if anorexic patients are not competent, meaning they cannot express their wishes due to cognitive impairment from severe malnutrition? What if these individuals had already displayed, through aggressive behavior, that they did not want to be fed? Do medical professionals, and family members heed those pre-incompetent wishes? But most people with anorexia have difficulty making decisions, so though they are fearful of gaining weight, and therefore starve themselves, they are not necessarily suicidal. So it’s hard to know the exact wishes of the patient (https://www.childrensmercy.org/ forced feeding in anorexia nervosa.pdf).

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Other than force-feeding someone as a means to save a life, how else does this benefit a patient who is uncooperative, who has been administered feedings and intravenous nutrition numerous times without lasting success? When does the intended beneficent act venture into an act of great emotional, and physical, harm for the patient (https://www.childrensmercy.org/ forced feeding in anorexia nervosa.pdf)?

The ethical questions are endless. But, for nurses, and other medical professionals treating those with anorexia, they are worth examining.

 

Please note: the information set forth in this post is not representative of the opinion of the author, Melissa Cronin.

 

 

 

 

 

 

 

 

 

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Walking Toward Understanding: A Review of the Movie Wild

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“I’m sorry you have to walk a thousand miles just to …” Cheryl Strayed’s ex-husband, Paul, tells her. But “just to” what? Early in Wild, Strayed finishes the sentence for her ex-husband: “Why do I have to walk a thousand miles?”

At mile one, Strayed is not sure why. She’s not even sure at mile eight, twenty-eight, or thirty-six. She lumbers around sharp curves and up and down rugged terrain in order to find the answer, or answers. Strayed’s father was an abusive alcoholic. Her mother, whom she calls “the love of my life,” died of cancer at forty-five. Strayed sought refuge in heroin, and sex with multiple partners, which is what led to the demise of her marriage. She finds the answers to the why part of her hike only at mile one thousand. Strayed hikes toward an understanding of her tumultuous life that seduced her into the woods. Much like how the memoir is structured, the movie depicts both her physical and emotional journeys, the present and past paralleling one another the entire one thousand miles. Of course, we can’t help but lumber along with her.

Wild is not only about Strayed’s yen to find the answers as to why she chose to venture into “wild” territory. It’s about identity, the body, forgiveness. Several tropes represent these themes: the heavy weight of her backpack on her shoulders and back calls to mind the burden of her guilt for past wrongs. The bruises she is left with remind us of the pain of her present, and past, life. Lifting herself up under the weight of the pack, then again when she slips in a river signifies perseverance. The pruning of the pack partway through her trek can be likened to the shedding of her guilt.

The sex scenes reveal Strayed’s confusion: she conflates sex, her body, with worthiness. When a reporter pulls his car over to the side of the road – Strayed is hoping to catch a ride – he interviews her for an article and calls her a hobo. Strayed is quick to clarify that she is not a hobo, that she’s simply hiking the PCT. But she has no place to call home, no anchor, no words to describe who she is. Strayed is not a mother or a wife, labels her mother once assigned to herself.

A series of metaphorical purges (guilt purges) take place: when strayed vomits after a night of drinking with other hikers, when she erases her ex-husband’s name from the sand, and when she finally breaks down sobbing, and says, “I miss you Mom.”

I could share more, but if you have yet to see Wild, or read the book, I don’t want to spoil the ninety-four day hike for you – the one hundred degree afternoons, the sweaty silences, the blue nights and sun-bleached mornings.

So, lace up your hiking boots, strap on your backpack, and join Cheryl Strayed at the head of the PCT.

 

Wild Director: Jean-Marc Vallee. Staring Reese Witherspoon, Laura Dern, and Gabby Hoffman.

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