Orthorexia Nervosa: When healthy eating becomes unhealthy

Orthorexia Nervosa

Important perspective on when eating healthy is no longer healthy.  Identifying signs of orthorexia nervosa orthorexia nervosa treatment options. 

It might come as a surprise that eating too healthy, too clean, too perfect is in fact, not healthy at all. Let’s dig deeper. Eating in a completely linear and specific way (allergies, and dietary restrictions aside) can manifest into toxic and disruptive behaviours that can then slowly develop into an eating disorder known as Orthorexia Nervosa. Although that description is an oversimplification of the development of this eating disorder, there is never a moment that a patient decides to have an eating disorder, choosing to engage or not on a whim. Some of us are more likely to develop eating disorders based on multiple factors; some acutely recognizable and some not. However, those of us who have a propensity to drift into problematic eating patterns can quite easily hide behind the guise of healthy or clean eating. An eating disorder is…an eating disorder and wrapping it in a narrative that society is more comfortable with only distracts us all from the reality that these disorders are serious and need direct intervention and layers of support to prevent further harm.  


What is Orthorexia?

Orthorexia is a part of the eating disorder spectrum characterized by an all-consuming obsession with clean or healthy eating. Not only clean, whole, healthy, but also pure. Pure being food in its most natural, raw state without any manipulation or additional ingredients. Orthorexia becomes orthorexia, much different than just a lighter option or lighter meal when it becomes an intrusive obsession; all food and every meal is calculated. Those with orthorexia are incredibly resistant or ultimately reject any food prepared for by others inclusive of family and friends or eating in a restaurant. A tenant of orthorexia is understanding exactly what is being consumed; not having this information is non negotiable. Although the foods that are selected by those with orthorexia are not problematic on their own; the problem is the unwavering and relentless pursuit to exclusively eat a very controlled and limited set of food, with absolutely no exceptions. A pursuit that takes top priority in one’s life, leaving little space for anything else. 

When does healthy eating become unhealthy?

Simply put when the pursuit of healthy eating becomes one’s only pursuit. Meaning, when healthy eating is the single driving motivator, consuming the person’s entire day, week, month…life. Eating healthy becomes unhealthy, otherwise known as Orthorexia, when healthy, green, pure choices are such intrusive thoughts, they end up being the person’s only important thoughts, consuming all emotional and intellectual space. Having to eat unknown foods or meals provokes such fear and anxiety that social life is greatly impacted, often skipping celebrations, milestones, etc. It is important to distinguish that when someone chooses to be mindful of their consumptive patterns, they allow themselves flexibility, however orthorexia allows nothing of the sort; strictly abiding by a very regimented list. As previously mentioned, the food choices themselves are not the problem, it is the complete lack of balance in one’s life that is unsustainable.

Why isn’t orthorexia nervosa clinically recognised?   

The official criteria for all mental health related diagnoses can be found in the DSM, Diagnostic and Statistical Manual of Mental Disorders. Although the DSM is used as an authoritative source for healthcare professionals, there is a lag and disconnect between what gets input into the DSM and what is presented to clinicians daily. This lag should not discount or disqualify those who are suffering from orthorexia and the stronghold it has on them or prevent intervention, even if it isn’t yet independently identified in the DSM. Orthorexia is recognized under OFSED (other specified feeding or eating disorder) and currently does not receive a stand-alone diagnosis. This should not prevent practitioners from treating and giving orthorexia the respect it deserves as an independent eating disorder. The outcomes of orthorexia can mirror those of anorexia, which are very dangerous and highly problematic. 

How does someone know when they need help?

When the thought of eating anything other than the purest, cleanest food is almost unfathomable, there is a problem at hand. Those with orthorexia are entirely consumed by intrusive thoughts to perpetually eat clean, to always eat perfectly. Food is never meant to bring anyone the intense anxiety that those with orthorexia are faced with. They feel out of control and deeply uncomfortable if they are presented with any option that is not included in their very strict and calculated list of safe foods. 


Q: How can we treat orthorexia nervosa?

A: Orthorexia nervosa, like all other eating disorders, are first and foremost treatable, and a full recovery is possible with commitment from the patient and often the patients support network. It is best treated on an individual case by case basis as eating disorders are presented differently in everyone. The treatment plan however is most often a combination of therapy and nutritional therapy. The reason for both is to address food symptoms and underlying psychological concerns that were present before the eating disorder fully emerged. 

Q: Is Orthorexia nervosa curable?

A: Yes! Although very curable, the road to recovery is not linear and not easy. Eating disorders are pervasive and can speak to the patient in such a strong, manipulative, and enticing way that it may feel like there isn’t any other option but to live within the confines of the eating disorder. This is, however, untrue. With the right team, and the right treatment a sustained recovery and a balanced relationship with food can become an everyday reality.

Q: Is orthorexia nervosa a form of OCD?

A: Eating disorders and obsessive-compulsive disorders can have comorbidity, meaning they can exist simultaneously in a patient; however, they are independent mental disorders and receive different diagnoses. Patients who are diagnosed with OCD experience symptoms that exist outside of food whereas eating disorders are intrinsically linked with food, or the lack thereof. It is not uncommon that those who develop eating disorders have displayed signs and symptoms of obsessive-compulsive disorder prior to developing a full-blown eating disorder.  

Dr. Natalie Mulligan graduated from the Canadian College of Naturopathic Medicine (CCNM). She completed her clinical internship at the Robert Schad Naturopathic Clinic with a focused interest in mental health. Prior to attending CCNM, she completed a Bachelor of Science degree at the University of Waterloo.