What Is Orthorexia?
An eating disorder is a behavioral health disorder that impacts people of all ages and genders. Some of the more commonly known eating disorders are anorexia nervosa and bulimia nervosa, which interrupt the ability to eat food in a healthy fashion, resulting in unhealthy behaviors that either restrict food intake or engaging in excessive eating followed by purging the food afterwards.
One of the more recent eating disorders being recognized is a condition called orthorexia nervosa, which was identified in the late 1990’s. It refers to an unhealthy fixation on “eating healthy” or “pure” foods that are defined by the individual.
This type of food restriction uses the guise of healthy eating as a way to manage their internal need for control, which may or may not relate to physical body size or image. This is a stark change from previously identified and categorized eating disorders as the underlying anxiety appears to be more focused on the “healthiness” of the food being consumed versus the impact of eating as a whole.
There is little research to indicate why orthorexia develops. These factors include genetics of family history of eating disorders, obesity or being overweight, picky eating habits, feeding practices during childhood, fears of gaining weight, and a history of eating disorders among others. These factors can grow in severity if substance use is occurring concurrently or in history. Understanding these risk factors can assist in identifying and recognizing orthorexia early on.
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Dangers Of Orthorexia
It’s important to note that orthorexia is not the same as healthy eating, nor is a healthy eating habit. Orthorexia is categorized as having an “obsession” with healthy eating, so much so that it disrupts a person’s daily life and causes unwanted side effects. People who struggle with orthorexia experience extreme anxiety, exaggerated fears of disease and feelings of shame or guilt when they eat foods they perceive as “not healthy.”
Eating disorders are still being researched, however most of the research indicates anxiety and a need for control to be the primary drivers for these conditions. Symptoms of anxiety and depression around being “fat” or disproportionate to their ideal self-image often develops into unhealthy eating behaviors, to feel in control. These symptoms often result in substance use disorders developing concurrently, which can cause medical complications due to nutrition deficits.
It is important to recognize the distinction between eating healthy as a lifestyle behavior and a condition such as orthorexia. While one may opt to try and eat “healthy” based on their own perceptions of what healthy may be (e.g. vegan, vegetarian, etc.), someone who struggles with orthorexia will experience significant anxiety symptoms if they eat anything outside of their specified food groups. These food groups are already excessively limited due to both realistic and unrealistic reasons.
For most people who struggle with orthorexia, their anxiety stems from an extreme fear of eating foods that are not “healthy.” While it may seem obvious that this would include drugs or alcohol, studies have found that people with eating disorders are more likely to abuse laxatives or diet pills to control their weight, especially young women. For these individuals, the stress, anxiety, and panic associated with their eating disorder may drive them to use these drugs in an effort to abstain from food or lose weight they may falsely attribute with “unhealthy” foods.
Orthorexia is starting to get more recognition from healthcare professionals in both the medical and behavioral health fields; however, there is still no classification in the healthcare diagnostic systems for orthorexia, resulting in a lack of defined medical guidelines to diagnose the condition accurately.
Other conditions such as anorexia and bulimia have been medically cataloged for many years, which makes the process of providing a diagnosis more consistent and allows for a wider range of treatment services to exist. Even so, professionals and individuals in recovery from eating disorders such as orthorexia have indicated a variety of signs or symptoms of a potential orthorexia condition being present, which include:
- Avoidance of any foods that do not meet the perceived level of “healthy” regardless of others’ opinions.
- Unrealistic or overly fixated views that “healthy” foods can prevent or cure physical or mental health conditions outside of commonly held beliefs.
- Experience intense anxiety or fear of deviation from their list of “healthy” foods.
- Unhealthy fixation or obsession with nutrition, healthy eating, and dietary substitutions.
- Frequently checking and rechecking of nutritional labels while purchasing or preparing foods.
- Removal of entire food groups (sugar, meat, gluten, etc.) not related to any medical, religious, or cultural reasoning that presents as reasonable.
- Avoidance of outside food sources from restaurants or social events with food prepared by others. Even going as far as to bring their own premade food due to it being “healthier” than the options provided.
- Demonstrating severe critical views of other people’s dietary choices and habits.
- Spending large amounts of time focused on meal preparation, purchasing, and other related behaviors that results in consequences in daily life.
- Experiencing malnutrition or weight loss due to self-imposed significant food restrictions.
- Unhealthy substance use to control or maintain self-imposed weight/body image concerns.
When someone struggling with orthorexia is not allowed or is not able to follow their strict guidelines, severe levels of anxiety can occur which may result in behaviors such as panic attacks, self-harming behaviors, low self-esteem, and a high likelihood of demonstrating “corrective” behaviors to address any violation of their food beliefs. An example of this is if someone with orthorexia accidentally or is required to eat something outside of their list, they decide to fast for 24 hours to remove the “unhealthy” food from their system.
These behaviors are often performed when someone has rigid thinking that is inflexible to change and may be hyper focused on living by a defined set of perceived rules that they must follow to stay healthy.
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Treatment For Orthorexia
Even though there is no official diagnostic category for orthorexia, there are multiple treatment approaches that have demonstrated success in treating eating disorders which can be successfully applied to orthorexia.
These treatments include:
- Cognitive behavioral therapy (CBT), which helps individuals better understand their thought patterns and behaviors, to become more aware of their impact on each other and to provide healthier ways of moving forward in their dietary habits.
- Acceptance and commitment therapy (ACT) has also demonstrated effectiveness in helping individuals recognize their distressing thoughts and not engage in unhealthy behaviors to rectify them.
Other therapies may include behavior modification, exposure therapy to slowly bring in new food groups, and other appropriate therapies based on potential underlying behavioral health conditions that may be a driving factor in their orthorexia. Almost all therapies will also include a clinical team of a therapist, healthcare provider such as a physician, and a dietitian to assist with education as well as providing care for any physical malnutrition present.
Many of these treatments are also used for substance use disorders, so they are versatile in helping individuals who struggle with both conditions.
In recent years, online therapy has become a popular, reputable, and reliable way to receive mental health care support from the comfort of your own home. For many people, the varying forms of inpatient and outpatient treatment are not the only options and may not be the best fit for some depending on their situation. Individuals in rural areas, with busy work schedules, or who may simply not require inpatient services may benefit from online therapy for their orthorexia or other eating disorder. To learn more about online therapy for orthorexia, view a full list of options here.
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Ashish Bhatt, MD, MRO
Doctor of Addiction Medicine
Learn about Dr. Ashish Bhatt
Dr. Bhatt has been Addiction Center's Medical Content Director for more than three years, providing his expertise to ensure quality and accuracy.
Doctor of Addiction Medicine
Expert in adult and child psychiatry
Over 20 years of professional experience