Orthorexia Nervosa: Medicine, Media, and the Co-Production of a Diagnosis

Ross Arguedas, Amy A.

doi:https://doi.org/10.21985/n2-zym9-6z55

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Orthorexia Nervosa: Medicine, Media, and the Co-Production of a Diagnosis

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This dissertation examines the birth and rise of orthorexia nervosa, a proposed psychiatric diagnosis described as a pathological fixation with healthy eating. Orthorexia made its first public appearance in the pages of a popular magazine for yoga practitioners in 1997, and later in a self-help book on the subject. Despite its origins outside of the medical establishment, orthorexia began to circulate in the popular media, and then made its way into the academic literature. More than two decades later, tens of thousands of posts on the social media platform Instagram carry orthorexia hashtags and an official task force is studying its inclusion into the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) of the American Psychiatric Association. This poses the question of how a diagnosis born in the popular media has come to circulate so widely in spaces both inside and outside the medical institution. To understand the process through which knowledge about orthorexia has been constructed and legitimized, I examine its co-production across four separate but interacting knowledge production assemblages: news media, scientific research, clinical practice, and social media. I show how distinct arrangements of knowledges and actors have come together in each assemblage, putting the term to use in somewhat distinct ways, but with sufficient overlap to enable a shared project in favor of its legitimation. I also document the emergence of specific diagnostic entrepreneurs, and their contributions to the process, including the doctor who first proposed the term, a vegan blogger, and multiple dietitians. More significantly, however, I argue that orthorexia’s legitimation and circulation has been inextricably tied to media and their logics. Media have not been simple mirrors of medical debates or even mere sites for claims-making to take place. Instead, as increasingly pervasive socio-technical assemblages in themselves, they have come to constitute relevant actors in knowledge production in their own right. Furthermore, media logics exert a hybridizing force that contribute to blurring the boundaries between science/non-science and lay/expert categories, while also straining professional jurisdictions. Finally, I posit that orthorexia sheds light on the growing anxieties around eating, as multiple valuation frameworks enter into conflict. Taking seriously the idea of entrepreneurship, I suggest orthorexia can be understood as a product of “creative friction” between alternate evaluations of what constitutes “good” eating and “health.” In the context of healthist imperatives surrounding nutrition and risk-avoidance, we can appreciate how orthorexia discourse asserts alternate values that re-center ideas like pleasure, moderation, and social connection, as central to “healthy eating.”

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