“When Are We Going to Hold Orthorexia to the Same Standard as Anorexia and Bulimia?” Exploring the Medicalization Process of Orthorexia Nervosa on Twitter

Abstract

This study contributes to understanding medicalization on social media, by using Conrad's concept of medicalization as a theoretical framework to explore the conversation about Orthorexia Nervosa (ON) on Twitter. The aim of this mixed-methods study was twofold: the quantitative component aimed to provide descriptive information on the type of tweets and users, as well as on the network structure of the ONrelated conversation on Twitter, while the qualitative component aimed to explore how the medicalization of ON unfolds on Twitter by performing a thematic analysis of original tweets about ON. Quantitative descriptive findings show that the most popular hashtags associated with orthorexia include #rdchat, #psychology and #doctors, which hints to a link between discourses around ON and the medical profession. Among the most active, prominent and visible users are news accounts, a registered dietitian, a researcher, a professor and an editor. Qualitative thematic analysis shed light on the discursive process of medicalization. Some users bring about medicalization by approaching ON as a medical entity; in contrast, other users resist medicalization by describing ON as a social phenomenon. A discursive struggle emerges, where certain individuals feel confused around what constitutes ON. This leads to stigmatization of non-traditional diets like veganism, which in turn triggers complaints regarding over-medicalization. As the first Twitter investigation on ON, this study serves the purpose of providing insights into how an emerging disorder develops in society in a time of social media.

Assessing the presence and motivations of orthorexia nervosa among athletes and adults with eating disorders: a cross-sectional study

“…To date, the relationship between orthorexia and weight is yet to be established, with some research suggesting that a lack of weight loss focus is a key distinction between orthorexia and other eating disorders [ 1 , 4 , 7 ]. Yet, other research indicates that a desire to manipulate weight and shape, and a drive for thinness and body dissatisfaction are core components of orthorexia [ 10 , 24 , 25 , 34 , 70 ], a theory supported by the findings of this study. Given that orthorexia is defined as the pursuit of optimal health, weight manipulation may be a component of orthorexia, as weight is commonly used as a proxy marker for health in an orthorexic society [ 19 , 51 ].…”

“…Healthism places the pursuit of health (and prevention of ill health) at the top of the moral virtue ladder, encouraging individuals to pursue it at all costs. In turn, an orthorexic society is created whereby orthorexic behaviors are normalized (and often praised), resulting in the development of a “socially acceptable eating disorder” or pseudo recovery for people experiencing diagnosable eating disorders [ 10 , 54 – 58 ]. In a systematic literature review on the psychosocial risk factors of orthorexia, McComb and Mills [ 2 ] reported that a history of an eating disorder is the strongest predictor of developing orthorexia, with previous engagement in dieting and poor body image also strong explainers [ 25 , 59 , 60 ].…”

“…Orthorexia is currently not recognized as a stand-alone eating disorder by the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ; [ 5 ]) or the International Classification of Diseases (ICD-11; [ 6 ]), and the relationship between orthorexia and other eating disorders (ED) is not well understood. Despite growing literature supporting the inclusion of orthorexia into revisions of the DSM [ 7 , 8 ], orthorexia research is limited by poor study designs, small sample sizes, inaccurate measurement tools, and a lack of consensus on the definition and diagnostic criteria [ 1 , 9 , 10 ].…”

The #orthorexia community on Instagram

“…dietitians, researchers), with a very small number of people suffering from the disorder actually joining the conversation. The ON-related conversation on Twitter has been proven to bring about the medicalization process of ON, and the network analysis has shown that actors engaging in the ONrelated conversation on Twitter appear isolated from each other, with no formation of peer-support communities [32].…”

Visions of recovery: a cross-diagnostic examination of eating disorder pro-recovery communities on TikTok

“…Analyses of Instagram posts tagged with #orthorexia suggest that this community is largely defined by positive conversation and support around recovery [ 48 ]. A more recent mixed-methods study of ON on Twitter emphasized the contested medicalization of this diagnosis in social media conversations, which often compared it to more established diagnoses like BN and AN [ 49 ]. In contrast, research on BED and social media has focused on the ways social media use may promote binge eating behaviors, and not on the online representation of BED culture itself [ 50 ].…”