Orthorexia nervosa and comorbid depression successfully treated with mirtazapine: a case report

Abstract

Orthorexia nervosa (ON) is a recently proposed eating disordered behaviour characterized by an obsessional or exaggerated fixation on healthy eating. The published literature is scarce regarding its classification, clinical presentation, management and long-term outcomes. Herein, we present the clinical and follow-up findings of an 18-year-old woman with ON comorbid with depression, successfully treated with mirtazapine. The patient had a 12-month history of obsessional behaviours for "healthy food", characterized by suppression of sugar and fat from her diet, tightly counted meal calorie content, eating only self-made meals, avoidance of eating in public, unacceptance of other person's opinions on diet, social isolation and a weight loss of 15 kg (body mass index of 16.2 kg/m). A score of 19-points was initially obtained on the ORTO-15 questionnaire, suggesting the presence of orthorexic tendencies and behaviours. The patient also reported a 1-month history of depressed mood, anxiety, anhedonia, fatigue, insomnia with early morning waking, leading to the presumptive diagnosis of ON with comorbid depression. Treatment with mirtazapine for 11 months resulted in the remission of the disordered eating behaviour, a sustained regain of weight, a score of 41-points on the ORTO-15, and to the resolution of depressive symptomatology (including insomnia). To our knowledge, this is the first description of ON with comorbid depression successfully treated with mirtazapine. This case highlights the possible usefulness of mirtazapine as a treatment option for patients with ON. However, randomized controlled studies are warranted to confirm the current findings.

Are the Motives for Food Choices Different in Orthorexia Nervosa and Healthy Orthorexia?

“…After this initial description, several case reports followed. According to these reports, the desire to be thin did not seem to be the main motive, but rather the desire to eat healthily [4,5,6,7,8].…”

Relationship between Psychosocial Impairment, Food Choice Motives, and Orthorexic Behaviors among Polish Adults

“…The higher score of ORTO questionnaires correlated positively not only with health but also with weight control when selecting food. However, the previous studies have found that the nutritional limitations of people with orthorexic behaviors do not actually result from their anxiety about obesity, desire for weight loss, or a distorted image of the body [4,8], which are characteristics for those suffering from AN and BN [3]. Until now no correlation was found between the ON and BMI, which was the main factor used to differentiate the orthorexic behaviors from AN [43][44][45].…”

“…The sum of scores (ORTO-15) ranged between 15 and 60 points. During data analysis, the shorter version ORTO-7 [21] was created by removing eight items (2,5,6,8,10,12,14,15) from the original ORTO-15. The sum of scores (ORTO-7) ranged between 7 and 28 points.…”

“…However, there is no apparent association with body mass index (BMI) [6,7]. Some authors suggested that a thin silhouette does not seem to be the primary motive of people with ON [4,8]. In contrast, other studies indicate that the drive for thinness is positively associated with greater ON [7,9].…”

Evolutionary aspects of a new eating disorder: Orthorexia nervosa in the 21st century

“…A recent case study showed connection between major depressive disorder and ON (Lopes, Melo, & Pereira, 2018). It presents a set of orthorexic traits that the patient has had over twelve months, followed by symptoms of depression.…”