Horror, my brain and I  

It’s spooky season. Isn’t there a better time to cuddle up in front of your TV and watch a horror movie? Well, for that, you would need the desire to even watch a horror movie. While countless people enjoy being frightened, others cannot stand the thought of being scared on purpose.

But why is that? Why is the anticipation of perceived threat on screen exciting for some and the worst idea for others? And what happens in the brain while sitting in front of a TV, even though no actual threat to worry about exists? 

Why are scary movies exciting for one person and literally horror for the next? 

This question has concerned many researchers, and various ideas and suggestions have been proposed. One argument concerns male vs. female (only based on biological sex and does not include the entirety of gender identities), suggesting that men and boys are enjoying the horror genre more than women and girls. On top of that, not only do men experience more enjoyment from scary movies, but they are also less scared compared to women and prefer more graphic horror material. Interestingly, one study concluded that men are more distressed by fictional horror if they watch a movie with a woman expressing more fear than themselves. The fact that women appear more anxious than men facing a scary movie fits into the bigger picture that women are more prone to anxiety-related disorders in general (if you want to read more about the sex difference in fear, click here). Additionally, so-called disgust sensitivity has been measured as being higher in women; this might be a reasonable explanation for their greater disliking of horror movies. Because being more easily disgusted, makes it definitely less enjoyable to watch a violent horror scene. 

Furthermore, empathy has been explored in connection with horror movies as well. Suppose you are a person who is empathic and quickly feels with people surrounding you. In that case, you may enjoy suffering on screen less than thrilling scenes about impending danger for the main actors. In turn, low empathy levels are associated with more enjoyment of horror scenes.

Not surprisingly, your age matters whether you enjoy watching horror movies. The younger you are, the more frightened you are. This has been measured in terms of avoidance in children aged 11-12 years old compared to teenagers between 15-16 years. The younger group avoided scary movie material significantly more than the older group. Even though the liking of the horror genre increases early in life, later it declines, which means that older people enjoy horror cinematography less than younger adults. It has been proposed that this is in line with less sensation seeking as we age; older people do not look for the thrill through movies. 

Speaking of sensation seeking, this is another critical factor in whether we opt for a scary movie or not. But what is sensation seeking actually? It’s seeking novel extreme experiences which drive your adrenaline levels upwards. It peaks during our teenage years and declines with aging. While some people can be identified as low-sensation seekers, avoiding new and possibly frightening experiences, others may be high-sensation seekers. These high-sensation seekers are more likely to choose a thrilling horror movie than a rom-com. Once again, this is more common in young men and boys, and it has been suggested that this is associated with testosterone levels and a particular gene called D4DR linked to dopamine. 

What happens in your brain while you watch a horror movie? 

A study conducted in Finland tackled this question and let participants watch horror movies while lying in an fMRI scanner. They first had to find the best and most scariest movies in the past century through an online database and let the general public vote. This resulted in ‘Conjuring 2’ and ‘Insidious’ being chosen for their study. Then, the participants watched the full-length movies, meanwhile, their brain activity was captured with the help of an fMRI scanner. 

After a sudden shock, for example, due to a jump-scare scene, more brain activity was measured in brain areas involved in emotional experience, threat evaluation, and decision-making about rapid responses due to the sudden shock. For these processes, the frontal cortex is needed to put the experienced threat into context and evaluate whether we are actually in danger. And, of course, the amygdala in the limbic system is more active because it is implicated in fear processing (more general explanations about fear processing in the brain can be found here).  

During scenes where tension is slowly building up and the viewer anxiously awaits the next story turn, sensory processing, such as visual and auditory information is more active. Additionally, there heightened processing has been measured in the motor areas. The researchers concluded that this increased vigilance and processing of sensory information is needed to be able to attend quickly to threatening events while watching a horror movie. This might happen because the brain wants to prepare us to protect ourselves in case of actual danger. 

Author: Sophie Ruppert 

You're biking home alone through the dark and you're afraid someone will chase you. You are afraid of spiders, heights or small spaces. Do these things ever bother you? Probably the above fears appeal to you more if you are a woman, unless your amygdala is damaged.... But if so, are you never afraid again? Research showed the following:

Women are more anxious than men
Anxiety-related disorders are at least twice as common in women than in men. The amygdala is a small nucleus in the brain that is instrumental in regulating anxiety. This brain structure responds more strongly to fearful information in women than in men.

But why is that? In one study, 80 men and women were given norepinephrine and glucocorticoids; a neurotransmitter and a hormone released in the body in response to stress. There was also a control group administered a placebo. After this, the subjects had to indicate the degree of anxiety in an fMRI scanner for pictures of neutral and fearful faces.

What transpired? Noradrenaline increased amygdala activity in women, while in men it led to a decrease in activity. In women, moreover, it also caused reduced orbitofrontal cortex activity. Because the amygdala is more associated with a reflex response, and the orbitofrontal cortex then makes an analysis of the emotional information, norepinephrine thus caused the reflex system to be enhanced in women, while the system that makes a comprehensive analysis was attenuated. In men, on the other hand, norepinephrine caused a weakening of activity in the amygdala. This difference was also observable in behaviour; women scored faces higher on anxiety, while men gave lower ratings. The hormone had no effect on either women or men.

The difference in response to norepinephrine is likely the biological mechanism that may explain why women are more likely to have anxiety disorders than men.

The amygdala does not account for all anxiety
So, the amygdala plays a vital role in the perception of anxiety and panic. When people have damage to the amygdala, they do not respond to external fearful stimuli. Furthermore, they cannot assess danger in a threatening situation. But when this fear is triggered internally they do show an anxiety response.

Researchers showed this in a study where patients had to breathe air that consisted of 35% carbon dioxide (CO2) (for comparison, normal air consists of 0.03% CO2). This method is used more often in research to elicit an anxiety response. When a person ingests such a high level of CO2, a shortage of oxygen occurs, triggering a panic response. The researchers' expectation was that these patients would show a weaker fear response than people who still have an intact amygdala.

However, the opposite turned out to be the case. The patients did show a fear response as a result of the CO2 inhalation. This research shows that the amygdala is not necessary for experiencing fear. The researchers conclude that it appears that the amygdala is necessary for fear elicited by external stimuli (from the environment), but not for fear elicited internally (by the body).

But not everything becomes clear from anxiety studies yet, because....
Coincidentally, the subjects in this latest study were all three women. The question, then, is whether exactly the same outcome can be found when this study is conducted with men. Therefore, the lack of testing both male and female subjects in anxiety research is exactly what has concerned researchers in recent years. Even though there are several studies that show different fear responses between men and women, more research is needed to find out exactly how this is caused (on a hormonal level).  This is important information that is needed to properly help both men and women with anxiety disorders. 

This article is based on old published brainmatters articles written by Lorraine Fliek: Damage to the amygdala and still anxious (27-2-13) & Noradrenaline causes opposite fear perception in women and men (5-4-13) - Editor: Loes Beckers

References:

• Schwabe, L., Höffken, O., Tegenthoff, M., & Wolf, O. T. (2013). Opposite effects of noradrenergic arousal on amygdala processing of fearful faces in men and women. NeuroImage, 73, 1–7. https://doi.org/10.1016/j.neuroimage.2013.01.057
• Feinstein, J., Buzza, C., Hurlemann, R. et al. Fear and panic in humans with bilateral amygdala damage. Nat Neurosci 16, 270–272 (2013). https://doi-org.ru.idm.oclc.org/10.1038/nn.3323
• Velasco, E. R., Florido, A., Milad, M. R., & Andero, R. (2019). Sex differences in fear extinction. Neuroscience and biobehavioral reviews, 103, 81–108. https://doi.org/10.1016/j.neubiorev.2019.05.020

Where does the term come from?
Have you watched Marvel Movies? You might be familiar with the villain Thanos, who has such power that he can remove beings from existence. Sounds horrific right? The name for this character was actually derived from Thanatos, the Greek personification of death. While Thanatos’ role in Greek mythology was rather small, he was hated by most gods and mortals, mainly because he did not discriminate between who he reaped. And the second part of the word, phobia comes from phobos, the Greek word for fear. But enough background information, let’s discuss fear of death.

What leads us to fear death?
This question seems easy to answer, not wanting to die and avoiding things that could lead to death are beneficial for our survival. Yet, when this fear is predominant throughout daily life, it can reduce our mental health and make us over-evaluate risks which can lead to avoidance and isolation. 

A questionnaire among rural residents revealed that fear of death is affected by 3 big factors: meaning in life, mental health, and physical health. Where the first two have a negative correlation with fear of death, meaning that on average the higher your mental health and meaning of life are, the less you’ll experience fear of death. The third factor, physical health stands out mainly for having a strong positive correlation with the previous two. Thus, when physical health is high, the other two tend to be high as well, and vice versa.

What happens in the brain when we fear death?
An fMRI study was conducted to observe brain activity while participants were exposed to words related to their own death, death of others or words that were unrelated to death. The study shows that different parts of the brain might be related to different aspects of fear of death. It revealed that the Supplementary Motor Area (SMA) was inhibited during the existential aspect of thoughts about death. These are thoughts like what happens to our consciousness when we die. The SMA is important for planning and controlling movement. Perhaps the inhibition of this during fear of death can explain how these existential thoughts can be benumbing. The supramarginal gyrus (SMG), an area involved in language and emotion, could reflect a distinct response where we distance ourselves from the physical self to cope with it. Lastly the Posterior Cingulate Cortex (PCC), an area that is important for adapting our behavior to the environment, may be related to thoughts about fear of death and the image we have of our future. While these findings are an interesting starting point, more evidence needs to be gathered to provide stronger claims.

Does thinking about death give you a chilling? Here are some solutions.
An earlier segment of this article already hints us about the solutions. By increasing our physical health, our mental health, or our meaning of life, we can reduce our fear of death. Thus, improving our lifestyle and/or increasing social engagement in the community can help us reduce fear of death.. No more sleepless nights! 

Another path one could take to battle fear of death is through religion. A study investigated the effects of an intervention named the “death education project” among Italian high-school students. The intervention was about encouraging discussion about death and spirituality with the main goal of opening the conversation about the afterlife. When compared to a group of students who did not receive the intervention, it was revealed that the education resulted in reduced fear of death and observing one's death as the end and increased spirituality. While this sounds promising, the study was conducted by among others the Vatican, which could indicate a bias. Another study which investigated the role of religion in fear of death revealed that there is a need for more nuance in the relationship between religion and fear of death. They showed that fear of death was higher among moderately religious people and reduced in non-believers or highly religious individuals. Furthermore, they revealed that the naturalness of death, life span, experiencing death of others we knew, the goodness of life, and the hope to live on in others also provided acceptance of death, reducing fear of death.

If only the dinosaur in the image knew that it would live on in this article, it might have increased its acceptance of death. One thing is certain, when we eventually die, we are no longer able to experience the fear of death.

Author: Kobus Lampe

References:

• Ding, F., Tian, X., Chen, L., & Wang, X. (2022). The relationship between physical health and fear of death in rural residents: The mediation effect of meaning in life and mental health. Death studies, 46(1), 148-156.

• Fortuin, N. P., Schilderman, J. B., & Venbrux, E. (2019). Religion and fear of death among older Dutch adults. Journal of religion, spirituality & aging, 31(3), 236-254.

• Hirano, K., Oba, K., Saito, T., Yamazaki, S., Kawashima, R., & Sugiura, M. (2021). Brain activation during thoughts of one’s own death and its linear and curvilinear correlations with fear of death in elderly individuals: An fMRI study. Cerebral cortex communications, 2(1), tgab003.
  
• Testoni, I., Ronconi, L., Cupit, I. N., Nodari, E., Bormolini, G., Ghinassi, A., ... & Zamperini, A. (2019). The effect of death education on fear of death amongst Italian adolescents: A nonrandomized controlled study. Death studies.

It's nothing new, of course, but totally contemporary again: meditating. It is said to be good for body and mind, to provide relief, peace in this wild world... Whatever the case may be, meditating is becoming mainstream, and so it is being researched. 

Consequently, research shows with some regularity that meditating, such as focusing attention on the here and now, on breathing, or on one's own body, can indeed have positive effects. For example, it can relieve stress and anxiety symptoms. But how does that work?

Brain waves in the Anterior Cingulate Cortex

Brain research points to two "candidates" for neural mechanisms behind the effects of meditation. There is some evidence that activity in the so-called "anterior cingulate cortex" is involved, and that brain waves at theta frequency (6 brain waves per second) are important. One hypothesis, for example, is that meditation creates more theta waves and that these waves provide better connections between the anterior cingulate cortex and, among others, the well-known amygdala. Since the amygdala is intimately involved in anxiety, this complex story could indeed explain why meditation is so calming. But how do you investigate such a thing?

Meditating mice

American researchers decided to try to create a so-called "mouse model" for meditation: you have a mouse meditate and then watch what happens in the little brain. This could be useful to then do further research on the neural effects of meditation in humans. But how do you get a mouse to meditate? Well ... not so ... but in a mouse today we can stimulate theta waves in, say, the anterior cingulate cortex. And that is exactly what the scientists did using optogenetics: they made that area sensitive to light, and then stimulated it with rhythmic flashes of light in the theta frequency.

Less anxiety behavior

The exciting result was that after 20 days, with 30 minutes of this kind of "meditation simulation" per day, the mice did indeed show less anxious behavior. How do these mice feel now? No one knows, of course. However, with this mouse model it will be the closest we can get in order to model the effects of meditation.

Accordingly, the findings have been published in the leading journal PNAS.

Author: Tom de Graaf
Translated by: Joyce Burger

If your mom is afraid of spiders, then there's a good chance you are too. We already know from previous research that parents' fears are transmitted to their children in different ways. This happens through genes, but also through the behavior parents show to their children. A study with rats has shown that smell also plays a role in this. Babies can smell by the scent of their fearful mother whether their mother is afraid. As a result, fear is transmitted from mother to child at a very early stage of development.

A previous study has already demonstrated the relationship between maternal odor and fear in infants. In this, rats were taught to be afraid of the smell of peppermint by having them smell this odor while giving them mild electric shocks. All this was done before the rats were pregnant. After the little rats were born, the researchers again made the mothers smell the peppermint scent without the shocks to trigger the fear response. The mothers gave off an odor that taught the babies to fear the smell of peppermint. The study also used a control condition of rats that had not been frightened by the peppermint scent.

In a follow-up study, the American scientists discovered a specific brain region that plays a role in this transmission of fear at a very young age. The researchers focused on lateral amygdala, an area involved in fear learning. The scientists gave some rats a substance that blocked activity in the amygdala. These rats did not learn to fear the peppermint smell. So, this shows that the amygdala is involved in this transmission.

What makes this finding so interesting is that babies at such a young age cannot learn based on their own experiences, but apparently can learn based on their mother's experiences. These results offer a new perspective on how mothers can transfer their fears to their children. This may help to devise new therapeutic treatments. The only question now is, does smell also play a role in this process in humans? Or is this way of transferring fear only possible in rats?

This article is a previously published brainmatters article written by Lorraine Fliek (14-8-14)

Reference:

Debiec, J., & Sullivan, R. M. (2014). Intergenerational transmission of emotional trauma through amygdala-dependent mother-to-infant transfer of specific fear. Proceedings of the National Academy of Sciences of the United States of America, 111(33), 12222–12227. https://doi.org/10.1073/pnas.1316740111

Discussion around the topic of psychedelic drugs tends to trip people up a lot, but with its increasing acceptance in the scientific and therapeutic field, there is more information than ever on the uses, dangers and apparent benefits of a mind-altering experience. Where before we feared what these substances could do to us, now various groups have been exploring what these substances can do for us and our fears. The research is ongoing, of course, and will be for a long time; the stigma of psychoactive drugs cannot be overturned easily. But, with the help of mouse models and human trials, can we make overcoming our deepest fears a little easier?

Arguably the most famous and successful research being undertaken at the moment is on the therapeutic use of MDMA with patients suffering from post-traumatic stress disorder (PTSD). This disorder is often characterised by the victims re-experiencing an event from the past vividly, as if it is occurring at that very moment. There is a deep, primal fear associated with such a memory, one that usually requires many years of conventional therapy to overcome. From initial trials of a psychedelic-assisted therapy technique, it appears that being on MDMA during a therapy session helps to relieve the fear in a participant more permanently than talking therapy alone. 

To answer the question of why this should happen, several studies have experimented on giving psilocybin based compounds to mice, which have been conditioned with a triggerable fear response. Without the dose of drug, the mice display typical fear-response behaviours. However, during and after the dosage, the mice display less to no fear-response behaviour when encountering the previously conditioned fear trigger. A similar response as seen in PTSD-sufferers. Further investigation reveals that a serotonergic receptor type 5-HT2A in the amygdala is blocked by the psychoactive molecule, which reduces the sensation of fear during the event, or in the case of PTSD, during the retrieval of the traumatic memory. But incredibly, this phenomenon doesn’t only occur during a trip, but is maintained even when the psychoactive substance has left the system. As a result, the mice in the trial no longer show as pronounced a fear-response behaviour to the trigger following the psychedelic event. 

Psilocybin and other hallucinogenic compounds have been shown to promote neurogenesis in the brain, with new dendritic spines forming from established neurons (more on this in the future); perhaps then it’s no surprise that they also influence the systems governing our memories and how we respond to them. Yet, does this mean that we should all be taking magic mushrooms to develop our brains and overcome our fears? Well, no. The main takeaway from these studies is that we are establishing a better understanding of the molecular and neurological responses in mice models, which in turn help us to understand what we see in assisted therapy trials. However, (and I cannot emphasise this enough) we aren’t mice, so further studies on human participants will be required to understand the brain chemistry. Moreover, psychedelic-assisted therapy is conducted in a safe environment where participants are made as relaxed as possible and are in the presence of licensed psychotherapists. Abusing these substances outside of a safe setting can be dangerous, especially when one has an underlying mental instability, such as forgotten traumas, strong anxiety, etc. 

Like with all good things, moderation is key, and if we can one day learn to apply a moderation of useful hallucinogenic experience to our therapies, maybe we can help to abate the fears that plague so many. 

Author: Thomas von Rein

References:

Byok, I. Taking Psychedelics Seriously. Journal of Palliative MEdicine. 21(4) (2018).

Daneluz, D.M., Sohn, J.M.B., Silveira, G.O. et al. Evidence on the impairing effects of Ayahuasca on fear memory reconsolidation. Psychopharmacology 239, 3325–3336 (2022).

de la Fuente Revenga, M., Zhu, B., Guevara C.A. et al. Prolonged epigenomic and synaptic plasticity alterations following single exposure to a psychedelic in mice. Cell Reports. 37(3).(2021)

Pędzich, B.D., Rubens, S., Sekssaoui, M. et al. Effects of a psychedelic 5-HT2A receptor agonist on anxiety-related behavior and fear processing in mice. Neuropsychopharmacol. 47, 1304–1314 (2022).

Prouzeau, D., Conejero, I., Voyvodic, P.L. et al. Psilocybin Efficacy and Mechanisms of Action in Major Depressive Disorder: a Review. Curr Psychiatry Rep 24, 573–581 (2022).

Walking down the street by yourself late at night, until in the distance you see a person standing in the shadows. With a pounding heart, you ponder your decision. Do you cross the street? Do you turn around? Or do you ignore the unsavory type?

Now compare this scenario to the following. You are walking down that same street again, but this time you are startled by the sound of squealing tires. In the corner of your eye you see a car coming toward you, and you can barely jump aside in time.

Danger

Both scenarios describe an instance in which your brain perceives danger. Yet there are important differences between the types of danger. In the first case, the source of possible danger is at a distance, giving you time to think out a strategy. In the second case, there was no time to think; you had to act immediately. This suggests that fear and danger are not regulated by just one network of brain regions, as is often assumed. In a recent study, American scientists show that two different brain networks are indeed involved. The cognitive-anxiety network is responsible for processing fear at a distance, and consists of the hippocampus, posterior cingulate cortex and ventromedial prefrontal cortex. The reactive-anxiety network is engaged when immediate action is required, and consists of the midcingulate cortex and the periaqueductal gray.

Game in the scanner

Participants in this study were placed in an MRI scanner in which their brain activity could be measured. Since it is not ethical to put these volunteers in serious danger in the lab, a video game was chosen to simulate danger. In the game, the goal was to hold a small triangle in the middle of the screen for as long as possible. The longer this succeeded, the more money could be earned. Unfortunately, there were two colored circular bad guys programmed, and this villain was targeting the triangle's life. The red round robber could only attack at close range, so you could see him coming from afar. The blue villain, on the other hand, was able to attack from a greater distance, so you had less time to react.

Brain activity 

The researchers saw in the brain data that when the dangerous blue enemy appeared on the scene, the reactive-anxiety network activated, while activity in the cognitive-anxiety network actually decreased. When the less dangerous red circle made its entrance, the cognitive-anxiety circuitry was in full action, and the reactive-anxiety network was not.

This study shows that the brain has more than one fear network. Depending on the context of danger, the brain uses a different neural pathway to act. This is important information for future treatments for anxiety disorders, for example.

See a funny visual summary of the study here:

This article is a previously published Brainmatters article written by Job van den Hurk (19-3-18)

Reference: Qi, S., Hassabis, D., Sun, J., Guo, F., Daw, N., & Mobbs, D. (2018). How cognitive and reactive fear circuits optimize escape decisions in humans. Proceedings of the National Academy of Sciences of the United States of America, 115(12), 3186–3191. https://doi.org/10.1073/pnas.1712314115

Have you ever fallen in love? If yes, then you probably know how exciting and all-encompassing this experience can be. But falling in love also seems to be a very stressful experience, or at least that’s what research on neurotransmitters  and hormones tells us…

First falling in love with someone is, arguably, one of the most exhilarating human experiences. The other person makes you feel euphoric about life and your potential future together. This early joy is thought to be linked to an increase of phenylethylamine (or PEA), a neurotransmitter with a structure similar to amphetamines (= strong stimulant drugs!). You might also think of your partner many times a day. This obsession seems to be caused by lower serotonin activity in the brain. Serotonin is involved in regulating, for instance, sleep and emotion, and interestingly, lowered levels of this neurotransmitter are often seen in depressed patients. Overall you can see that falling in love can be quite intense…although, new lovers hopefully aren’t actually feeling depressed!

But how is falling in love related to fear and stress then? Well, this is where cortisol comes in. Cortisol is a hormone produced in the adrenal glands above your kidneys during stressful or threatening situations.* Precisely these increased levels of cortisol were for instance found in a study which compared people who had recently fallen in love with ones that were single or in a longer-lasting relationship. When testing the same people one to two years later, their cortisol levels had gone back to ‘normal’. It makes sense that first getting to know and love someone would be a fearful situation too. For example, you may be scared that they don’t like you as much as you do or wonder whether you can trust them. In other words, forming an attachment can be a bit overwhelming!

Interestingly, the stress experienced together seems to be important for building attachment: Research on humans has shown that being in a high-stress situation together seems to help with developing a better relationship. Thus, the stress of falling in love with each other and the stress of (for example) riding a rollercoaster together may improve your bond to someone.

In conclusion, falling in love can feel wonderful and scary at the same time. But as we’ve seen this is perfectly normal. So, trust your brain, and try to enjoy it!

 *If you want to know more about cortisol and the nature of fear, check out this article on fear in the brain! 

Author: Melanie Smekal

References

Association to PEA: Liebowitz, M. R. (1983). The chemistry of love. Little, Brown.

Cortisol Study: Marazziti, D., & Canale, D. (2004). Hormonal changes when falling in love. Psychoneuroendocrinology, 29(7), 931-936. https://www-sciencedirect-com.mu.idm.oclc.org/science/article/pii/S0306453003001616?casa_token=lwc6kvtcjGkAAAAA:ZRB8qYqpuTCssi_hLfr0E0PSCAdR-rXQewxKQtPvLYMuK45_cfaE2PoBy99hHVrdsVWZGcee#BIB36

Partial  image by upklyak on Freepik: https://www.freepik.com/free-vector/set-people-slip-wet-floor-stumble-vector_28590660.htm#query=danger%20fall&position=3&from_view=search

Nowadays, social media is full of ‘fitgirls or boys’. At first glance, this seems of no harm, especially with obesity being a worldwide problem among the youth. However, this promotion of a healthy lifestyle has its dark sides as well, since the prevalence of an eating disorder called ‘Orthorexia Nervosa’ has increased over the past years. Orthorexia can best be described as the unhealthy obsession to eat and live healthily. A patient suffering from orthorexia explains; “it is literally as if a parrot is screaming in my head that after eating this piece of cake, I am getting fat and I have to run 10 kilometers to make up for it”.

What is then the difference with other eating disorders (Anorexia nervosa or Bulimia nervosa) you may wonder? Well, in contrast to these eating disorders, Orthorexia has not yet been included in the DSM (the handbook used by psychologists to diagnose patients with various psychological disorders). 

Besides that, a lot of debate is going on if Orthorexia could be seen as an eating disorder or as an Obsessive Compulsive Disorder (OCD). OCD is a disorder where people experience severe obsessions, for example the fear of catching a contagious disease, combined with a certain compulsion to decrease this fear, like washing your hands a hundred times a day.   Just as with OCD, patients suffering from Orthorexia have an immense phobia, however in the case of Orthorexia this is the fear of eating “non-pure” food. When they do not stick to their strict eating regime, they compensate with excessive exercise. 

Actually, this comparison with OCD is not strange since research has shown that individuals that scored higher on OCD symptoms, also showed more symptoms related to what people with Orthorexia suffer from. Moreover, it has been reported that individuals with Orthorexia have a 11-69% higher chance to also have OCD. This has led researchers to the idea that Orthorexia can evolve into OCD. This is portrayed as the excessive preoccupation with healthy food together with the fear for ‘unhealthy foods’ and the repetitive actions and routines surrounding the preparation of the food. 

However, I would like to point out that individuals with orthorexic tendencies also showed higher rates of symptoms of other eating disorders. This association with other eating disorders was even stronger than that of orthorexia symptoms and OCD symptoms. Besides that, in contrast to OCD where the patient realizes that the obsessional thoughts in their heads are unreasonable and untrue but gives them feelings of distress, thoughts surrounding food are perceived as normal by patients with Orthorexia. Therefore, Orthorexia nowadays is seen and treated as an eating disorder whereby the risk for developing OCD as well is higher compared to most people. 

Nonetheless, even when Orthorexia is treated as an eating disorder, research is still debating if Orthorexia can be seen as an eating disorder or if it should be seen on a spectrum together with OCD. An interesting theoretical approach which really resonates well with the current time frame of social media and all the ‘fitgirls and boys’ promoting a healthy lifestyle, is the idea that Orthorexia can be seen as an ‘accepted’ way by society to express symptoms similar to what is observed in the case of Anorexia. Nonetheless, hopefully we can spread the word about this disorder whereby we can detect it in an early stage. The take-home message will then be that eating healthily and doing some sort of exercise in any shape or form is of no harm, however too much of it can be harmful in the long run.

Author: Joyce Burger

References:

• Brytek-Matera, A. (2012). Orthorexia nervosa–an eating disorder, obsessive-compulsive disorder or disturbed eating habit. Archives of Psychiatry and psychotherapy, 1(1), 55-60. 
• Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric disease and treatment, 11, 385. 
• Zagaria, A., Vacca, M., Cerolini, S., Ballesio, A., & Lombardo, C. (2022). Associations between orthorexia, disordered eating, and obsessive–compulsive symptoms: A systematic review and meta‐analysis. International Journal of Eating Disorders, 55(3), 295-312.