New psychopathologies in the digital age: orthorexia and cyberchondria

Introduction

We inhabit an era characterized by continuous flux and the swift evolution of the digital landscape. This transition has spurred the emergence and evolution of unconventional health concerns that surpass conventional well-being boundaries. Two relatively recent terms, “orthorexia” and “cyberchondria”, have garnered substantial attention within the realm of psychopathology. These terms delineate two pathological expressions of excessive health preoccupation, capturing the interest of researchers, mental health practitioners, and the broader societal milieu^(1,2).

Originating in 1997 through the work of American physician Steven Bratman, orthorexia delineates an obsession with healthy eating⁽²⁾. The proliferation of public interest in dietetics and nutrition has elevated this condition, manifesting as an obsessive fixation on food quality and composition. Individuals afflicted with orthorexia progressively eliminate entire food categories from their diet, fostering increased dietary restrictions⁽³⁾. Consequently, this behavioral pattern may induce nutritional deficits, social seclusion, and psychological strain⁽³⁾. Contemporary research links orthorexia to anxiety, depression, and eating disorders such as anorexia nervosa⁽⁴⁾. However, diagnostic consensus within the medical community remains contentious, necessitating ongoing research to elucidate risk factors, ramifications, and optimal therapeutic modalities.

Simultaneously, the digital age has spawned cyberchondria, encapsulating the relentless and excessive pursuit of medical information online. This phenomenon amalgamates the realms of cyberspace and hypochondria, encompassing an obsessive quest for online medical data, often resulting in erroneous self-diagnosis. Individuals afflicted by cyberchondria endure profound health-related anxiety and persistent stress, perpetuated by incessant online medical inquiries that foster undue apprehension and deter engagement with healthcare professionals. Current investigations indicate a rising prevalence of cyberchondria, as individuals increasingly turn to the internet for health-related information. Nonetheless, detailed research on associated risk factors and consequences remains limited. Consequently, it becomes imperative for mental health professionals to acknowledge this trend and formulate tailored intervention strategies to aid individuals grappling with cyberchondria.

This article endeavors to delve deeper into these novel psychopathologies ingrained in the digital age, scrutinizing their risk factors, consequences, diagnostic methodologies, and extant therapeutic approaches. Through this exploration, the aim is to gain a comprehensive understanding of their impact on mental health and devise effective strategies to address these burgeoning concerns.

Orthorexia

The prevalence of orthorexia remains challenging to ascertain, yet burgeoning interest in healthy diets and wellness culture suggests a potential increase. Estimates diverge, spanning from 1% to 7% within the population^(2,3).

Orthorexia manifests as an obsessive fixation on food quality and preparation, culminating in a highly restrictive diet that excludes entire food categories, like carbohydrates or fats. Sufferers exhibit an obsessive preoccupation with food sourcing and processing, often leading to social isolation, avoiding communal eating situations^(4,5).

Diagnostic consensus on orthorexia remains contentious within the medical and scientific community. Notably, esteemed bodies like the United States Agency of Mental Health (APA) have omitted orthorexia from diagnostic compendiums such as DSM-5⁽⁶⁾.

Orthorexia frequently coexists with other eating disorders, like anorexia nervosa or bulimia nervosa, necessitating an integrated diagnostic and therapeutic approach.

The intricate interplay of factors influencing cyberchondria remains a focal point for ongoing investigation and scholarly inquiry. Research highlights several significant elements:

• Chronic fixation on health predisposes individuals to orthorexia, where on’s self-esteem intertwines with a perceived healthy dietary regimen⁽⁶⁾.

• Societal pressure, accentuated by the promotion of an idealized body image, contributes to the development of orthorexic tendencies⁽⁷⁾.

• The surplus of nutritional information accessible today often fosters confusion and anxiety, ultimately contributing to the emergence of orthorexic tendencies^(8,9).

Understanding and effectively addressing the influence of orthorexia within psychiatric practice stands as an imperative task.

• Psychiatrists assume a central role in the evaluation and treatment of orthorexia, frequently entwined with concurrent eating disorders. Collaborative efforts with mental health and nutrition professionals are pivotal in achieving comprehensive care⁽¹⁰⁾.

• Orthorexia manifests in heightened anxiety, depressive symptoms and compulsive behaviors necessitating psychiatric assessment. Therapeutic interventions predominantly involve psychotherapeutic modalities such as cognitive behavioral therapy (CBT). The multidisciplinary approach proves indispensable in addressing the complex dimensions of orthorexia and its associated mental health ramifications^(11,12).

Despite diagnostic challenges, researchers and practitioners have devised assessment tools like ORTO-15 or the Dusseldorf Scale for Orthorexia to gauge concerns about healthy eating. Diagnosis hinges upon excessive preoccupation significantly impairing social, occupational, or psychological functioning^(13,14).

While specific medications for orthorexia are lacking, psychiatrists may consider drugs like SSRIs, cyproheptadine or benzodiazepines to manage concurrent symptoms of anxiety or depression. These medications have shown efficacy in managing symptoms associated with this psychopathology⁽¹⁵⁾.

Cybercondria

The elusive prevalence of cyberchondria persists due to various behaviors associated with seeking health information online. Recent studies illuminate the widespread engagement in obsessive searches for medical data, highlighting the pivotal need for a threshold where this preoccupation significantly impedes daily functionality to qualify as a diagnosable disorder^(16,17).

Cyberchondria encompasses an unremitting fixation on personal health propelled by relentless pursuit of medical data online. This behavior is characterized by a multifaceted spectrum:

• Pervasive online information quests – individuals spend extensive periods scrutinizing search engines and medical websites, often fixating on minute symptoms, which might exacerbate anxiety and distress⁽¹⁶⁾.

• Cognitive biases and misinterpretations – the process involves misinterpreting benign symptoms as markers of severe illnesses due to cognitive biases, potentially intensifying anxiety levels. This interpretation shift might lead to a heightened sense of medical urgency⁽¹⁶⁾.

• Reinforcing anxiety and health-seeking behavior – the prolonged exposure to medical information online might inadvertently reinforce health-related anxieties, fostering a continuous loop of seeking reassurance through medical consultations or diagnostic self-tests⁽¹⁷⁾.

Despite the gravity of its impact, cyberchondria lacks formal recognition as a distinct disorder in diagnostic manuals like DSM-5. Mental health professionals navigate diagnostic challenges using criteria reminiscent of hypochondria and somatoform disorders. Assessment tools, including the Cyberchondria Severity Scale (CSS), gauge the degree of health-related anxiety, concerns, and compulsive medical information-seeking behaviors^(18,19).

Understanding the complex interplay of factors contributing to cyberchondria remains an ongoing pursuit:

• Technological advancements and accessible information – the escalating sophistication of search engines and the omnipresence of medical information online might perpetuate the prevalence of cyberchondria by facilitating easy access to vast health-related data⁽¹⁶⁾.

• Psychosocial influences – stressful life events, societal pressures, and an individual’s predisposition to anxiety play pivotal roles in exacerbating health concerns, potentially fostering cyberchondria⁽¹⁶⁾.

In psychiatric practice, psychiatrists assume pivotal roles in the assessment, diagnosis and treatment of cyberchondria, employing therapeutic interventions, such as cognitive behavioral therapy. This approach aids in dismantling maladaptive thought patterns and behavior, alleviating health-related anxieties^(20,21).

The evolving landscape of cyberchondria underscores the intricate amalgamation of individual vulnerabilities, technological advancements, and societal influences. Further research endeavors, coupled with tailored therapeutic interventions, are imperative in comprehending and effectively addressing this burgeoning psychopathology⁽²²⁾.

Conclusions

Orthorexia and cyberchondria, though not officially recognized as separate clinical disorders, present complex and impactful challenges in mental health. These pathologies highlight the intricate interplay between hyperfocused health concerns and the pervasive influence of digital information on mental well-being. While these conditions are yet to be codified in diagnostic manuals, their recognition and study by mental health professionals and researchers underscore their significance.

Therapeutic interventions predominantly revolve around psychological treatments, specifically emphasizing cognitive behavioral therapy, often complemented by nutritional counseling. These approaches aim to address maladaptive behaviors, thoughts and anxieties associated with these conditions. The involvement of psychiatrists and allied professionals in the assessment and management of related symptoms, such as anxiety, remains instrumental, potentially necessitating pharmacological interventions in severe cases.

Tailoring treatment strategies to individual needs constitutes a cornerstone of effective management. Collaborative efforts encompassing a diverse array of mental health and nutrition specialists are essential for comprehensive care and holistic recovery. Within our digital milieu, raising awareness about the implications of excessive health pursuits and the responsible consumption of online health information is critical. Education initiatives that promote a balanced approach to health knowledge and nutrition are vital in preventing the emergence of these disorders.

By intensifying awareness campaigns, deepening scientific understanding, and implementing evidence-based therapeutic techniques, we aspire to provide a robust support system and foster recuperation for those affected by orthorexia and cyberchondria^(6,7,16). This proactive stance significantly contributes to their sustained health, psychological resilience, and overall well-being.

Recent studies by López-Gil et al. (2023) and Infanti et al. (2022) underscore the rising prevalence and psychological impact of these conditions, highlighting the urgent need for comprehensive approaches to their diagnosis and management. The evolving landscape of mental health necessitates ongoing research to delineate the multifaceted aspects of these disorders, guiding effective therapeutic interventions and preventive measures^(23,24).

In light of these, ongoing efforts to integrate updated findings into clinical practices and educational initiatives are pivotal, ensuring a holistic approach that prioritizes the mental health and overall well-being of individuals navigating the challenges posed by orthorexia and cyberchondria in the digital age.   

Corresponding author: Prof. Emeritus Dr. Gabriela Marian E-mail: gabi.marian@yahoo.co

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.