What is Orthorexia?

Woman pointing upThoughts about healthy eating are for most people synonymous with balanced diets, fruits and vegetables straight off the farm, and minimally processed foods. However, for some people, healthy eating is an eating disorder. Although healthy eating in itself is not a disorder, it becomes a problem when it turns into a fixation or an obsession. This obsession with a healthy diet has a name – Orthorexia Nervosa.

A person with orthorexia has an obsession with consuming only healthy food, such that their fixation interferes with their personal, professional and or social life. Although the term Orthorexia Nervosa translates to “correct diet”, the obsession with “clean” food turns a beneficial lifestyle into a destructive one.

The primary feature of other more common eating disorders such as bulimia and anorexia is the quantity of food. However, for orthorexia, the obsession is with food quality, not quantity. It is an unconscious behaviour arising from irrational beliefs about healthy eating.

Orthorexia is a diagnosis that fits easily into North American culture where Fad diets, clean eating and health are talked about non-stop. Patients with orthorexia themselves may be oblivious to the fact that their desire to live a healthy lifestyle has pushed them outside of the realm of healthy and has turned into a pathology.

Most patients fall into orthorexia slowly and gradually without realizing it’s happening or the intention of trying to lose weight. As they make changes to their diets, they often feel empowered, energized and receive positive feedback from those around them. These dietary changes expand over time and by the time orthorexia is fully affecting them, the foods remaining that they feel comfortable eating are next to none.

Another feature of orthorexia is a deep fear that “unclean” foods are negatively affecting their health and a delusion that they are responsible for any/all maladies they are experiencing from digestive upset, hormone irregularities, brain fog, low energy, insomnia, to mood. Because they believe that unclean foods are having such vast impact on their health, their anxiety around these foods becomes incredibly high and having to consume them is very distressing. In an attempt to avoid having to consume foods outside of their comfort zone, they stop participating in social activities involving food. Much of their free time is spent researching food and the abundance of information about food leads to the purchase, cooking and eating of foods to be hugely time consuming and all-encompassing.

The irony of orthorexia is that the pursuit of extreme health is ultimately damaging their health.

If you have orthorexia, your eating habits will revolve around a desire for pure, healthy foods. You will be obsessed with a perfect diet as opposed to an ideal weight. Thus, you may avoid food that, in your opinion, contains impure or unhealthy ingredients.

Such ingredients include:

  • Sugar, salt and/or fat
  • Artificial preservatives, flavours or colours
  • Dairy or all animal products
  • Gluten and gluten containing grains
  • Genetically modified foods
  • Pesticides
  • Other components that you consider to be unhealthy

Causes of Orthorexia

There is no scientific research that has produced evidence that correlates a specific cause to orthorexia. However, there are risk factors that can increase the likelihood of developing the disorder.

These factors include:

  • Fear of disease
  • Childhood illnesses related to diet or affecting the digestive system
  • Parents who overemphasize the need for healthy food
  • Adopting views that limit your food choices highly
  • Perfectionist personality, anxiety disorders, extremism and Obsessive-Compulsive Disorder (OCD)
  • Overwhelming societal pressure
  • Unhealthy relationships
  • An intense need for control
  • A long history of dieting
  • Unresolved personal issues

Orthorexia Diagnosis Criteria

With orthorexia, a diagnosis may not be immediate because there is no severe weight fluctuation. Over time, weight loss is a common side effect due to so little foods being considered “clean.” Orthorexia diagnosis therefore often happens after you develop anorexia nervosa.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not recognize orthorexia officially as a diagnosis. Therefore, the manual does not give any diagnosis guidelines. However, in 2016, Thom Dunn, Ph. D and Steven Bratman, M.D. proposed two criteria for diagnosing orthorexia. These are:

Criteria A

You focus obsessively on healthy eating based on varying theories and beliefs. You also experience exaggerated emotional distress when making unhealthy food choices. You may lose weight, but it is not the primary goal. Evidence of this behavior includes:

  • An obsession with restrictive and affirmative dietary practices that you believe can support optimum health
  • You feel ashamed, anxious, and experience negative physical sensations and fear of disease if you violate your diet rules.
  • You increase your dietary restriction over time, which may result in eliminating entire food groups. You also increase the frequency or intensity of detoxifying or purifying your body.

Criteria B

Your preoccupation and compulsive behaviour become clinically disabling through any of these symptoms:

  • Your restricted diet causes you severe weight loss, malnutrition or other medical issues
  • Your actions or beliefs about healthy eating impair your professional, academic, or social life.
  • Your body image, identity, or self-worth depend highly on your compliance with a self-defined, healthy diet plan.

Signs and Symptoms of Orthorexia

The predominant characteristic that distinguishes orthorexia from other more prevalent eating disorders is the focus of your obsession. If you have orthorexia, you will demonstrate obsessive behaviors towards the types of food you consume. These behaviors include:

  • Compulsively checking nutritional labels and ingredient lists on food packages
  • Excessive concerns about how food groups affect your health and the possibility of developing illnesses such as anxiety, digestive problems, allergies, and asthma.
  • You keep reducing the number of food groups excessively, which leads to severely restricting the food types or ingredients that you consume to less than 10.
  • Avoiding some foods as a result of allergies that are not medically diagnosed
  • An obsession with avoiding foods containing animal products, salt, fats, sugar, dyes, food coloring, or pesticides.
  • Obsessively consuming supplements and herbal remedies that you believe are healthy
  • Irrational concerns about food preparation procedures such as kitchen cleanliness, sterilization of utensils and food cleaning methods
  • Avoiding food prepared or bought by others, made away from your kitchen, or avoiding social events because you will be unable to follow your eating plan.
  • Spending excess time and money on food choices and meal planning

There are also emotional symptoms of orthorexia. They include:

  • Feeling guilty or ashamed when eating food that you do not consider pure or healthy
  • Feeling satisfied, happy, and in control after what you think to be pure, healthy or clean eating, and losing interest in other activities
  • Allowing your daily schedule to revolve around food
  • Regularly planning your meals in detail and feeling guilty and unhappy when you do not plan
  • Spending excess time thinking about food
  • Being critical and judgmental of others who do not follow pure, healthy eating plans
  • Isolating yourself from family and friends whose beliefs about food are different from yours.
  • Mood swings, anxiety, and depression
  • Feeling ashamed and hating yourself when you do not stick to your diet plan.

Co-occurring Disorders

Often, other mental health conditions occur together with orthorexia. These conditions include:

  • Post-traumatic Stress Disorder
  • Depression
  • Obsessive-Compulsive Disorder
  • Panic attacks and Anxiety Disorders
  • Obsessive-Compulsive Personality Disorder
  • Bipolar Disorder

Orthorexia Treatment

Orthorexia can cause severe physical and mental health consequences. If you have any of its symptoms, you need to seek professional help. A qualified dietitian, nutritionist along with a psychotherapist or other therapy professional will help you reshape your incorrect dietary beliefs and eating patterns, and change your opinion about food.

Orthorexia is a medical condition, not a choice. It develops gradually and is an indication of underlying negative emotions and experiences that you need to address healthily. Seeking treatment is the first step in identifying the triggers of your orthorexia. You will learn coping skills to handle stressful experiences in the future.

Orthorexia affects different people in different ways. Therefore, you will receive a customized, comprehensive treatment plan that mainly includes talk therapy sessions and nutritional counseling. We aim to provide treatment that goes beyond interrupting your symptoms and refeeding you. Our goal is to help you gain control of your eating habits and feel safe around food.

Get Help From a Professional

If not checked, orthorexia can lead to long-term physical and psychological problems. If you notice symptoms or behavior that suggests orthorexia, we can help you overcome the problem. Talk to our dedicated professionals about your concerns, and we will create an individualized treatment plan that will work for you, and support you until you recover fully.

Also Read: What Causes Eating Disorders?