Balanced nutrition is essential for mind body health, but what happens when good intentions turn into an unhealthy obsession with eating healthy? Orthorexia is a serious condition characterized by an unhealthy fixation on healthy eating that may or may not lead to extreme weight loss. When left untreated, orthorexia can have long lasting effects on one’s physical health, social health, and psychological well-being. In this post we will explore the following:
- What is orthorexia?
- Orthorexia vs Anorexia
- Causes and Risk Factors for orthorexia
- 5 Common Symptoms of Orthorexia
- Diagnosing Orthorexia
- Health Consequences of Orthorexia
- Treatment for Orthorexia
What is Orthorexia?
The term orthorexia was coined in the mid-90s by Dr. Steven Bratman and means “fixation on righteous eating”. Although orthorexia is not an official diagnosis in the Diagnostic Statistical Manual (DSM-5), it is a widely accepted concept used by healthcare professionals working in the field of eating disorders and mental health. It is used to describe situations when healthy eating is taken to the extreme and ends up being unhealthy. Rather than focusing on how food affects one’s weight and shape, individuals struggling with orthorexia have an excessive focus on food purity and quality.
Orthorexia vs Anorexia
Many people associate orthorexia with anorexia nervosa. While orthorexia may lead to or coexist with symptoms of anorexia nervosa, subtle differences exist between these two conditions. Individuals with anorexia nervosa engage in restrictive diets and reduce the quantity of food consumed while those with orthorexia fixate on the food quality.
Differences between orthorexia and anorexia nervosa:
- Individuals with anorexia nervosa are highly concerned with how food impacts their physical appearance and body image while those with orthorexia nervosa are concerned about how food impacts their overall health
- Individuals with anorexia nervosa must meet certain weight criteria guidelines to be diagnosed while those with orthorexia nervosa may be at or above “normal” weight
- Individuals with anorexia nervosa skip meals and restrict calories while those with orthorexia nervosa don’t tend to do so
Similarities between orthorexia and anorexia nervosa:
- Both tend to categorize foods as being ‘good or bad’ and ‘unhealthy or unhealthy’, but for different reasons
- Both become highly anxious when needing to deviate from their food rules
- Both tend to avoid social events revolving around food
- Both tend to have intrusive thoughts related to food
Causes and Risk Factors for Orthorexia
There is a lack of current research on the exact causes and frequency of orthorexia, but there are common risk factors clinicians use to identify individuals at risk. As always, it is important to remember that orthorexia will present differently in everyone. There is no one-size-fits-all when it comes to eating disorders and mental health.
5 Common Warning Signs of Orthorexia Nervosa
1. Preoccupation with food and eating that dominates one’s life
Individuals with orthorexia become so obsessed with food and health that it dominates the majority of their time. Essentially, the orthorexia becomes their new identity, leaving little room for once loved hobbies, socially engaging with friends and family, or nurturing relationships.
2. Obsession with eating healthy and avoiding any ingredients deemed unhealthy or impure
Individuals with orthorexia tend to spend countless hours researching food and nutrition science in hopes of identifying the latest findings about which foods are ‘bad’ and ‘unhealthy’. They may excessively read and scrutinize nutrition labels or ask detailed questions about the preparation of food at restaurants.
3. Extreme anxiety when preferred foods are unavailable
It is normal to have more preferred foods and less preferred foods, but issues arise when extreme anxiety and distress present as a result of not having foods available that fit someone’s strict dietary rules. This often leads to avoiding all social situations that involve food or bringing one’s own food to social gatherings.
4. Constant worry about sickness and disease
Many individuals with orthorexia believe their “clean” eating and avoidance of “impure” foods helps prevent them from getting sick. They tend to have unfounded fears that certain foods or ingredients causes disease and illness. This tends to result in more and more dietary restrictions.
5. Criticizing others who do not follow strict dietary patterns
Individuals with orthorexia may see their eating patterns and lifestyle choices and superior to those around them. They often consider themselves the epitome of health even when their behaviors are leading to nutritional deficiencies.
Diagnosing Orthorexia
Orthorexia is not officially recognized as a clinical diagnosis in the DSM-5. Without formal diagnostic criteria, individuals with orthorexia often go undetected. Thankfully, Steve Bratman and Thomas Dunn have proposed a two-part diagnostic criteria that includes the following:
Criterion A: Obsessive focus on ‘‘healthy’’ eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue as a result of dietary choices, but this is not the primary goal. As evidenced by the following:
- Compulsive behaviour and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health
- Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame
- Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe ‘‘cleanses’’ (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy eating
Criterion B: The compulsive behaviour and mental preoccupation becomes clinically impairing by any of the following:
- Malnutrition, severe weight loss or other medical complications from restricted diet
- Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet
- Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined ‘‘healthy’’ eating behaviour
Health Consequences of Orthorexia
Orthorexia can be difficult for professionals to identify because healthy eating is revered in our society and many individuals do not experience significant weight fluctuations. However, when orthorexia goes untreated, an individual often develops similar medical consequences to those seen in other eating disorders such as anorexia nervosa. Common health consequences of orthorexia include the following:
- Malnutrition
- Nutrient deficiencies
- Impaired immune system
- Osteopenia and Osteoporosis
- Impaired heart function
- Problems with cognition
- Dry skin, brittle nails, hair loss
- Reduced metabolic rate
Treatment for Orthorexia
Current research shows there is no specified treatment plan for treating orthorexia, but medical professionals tend to use existing treatments for anorexia nervosa and obsessive-compulsive disorder due to similar symptoms and pathology. Thus, treatment usually involves a combination of psychotherapy and exposure and response prevention (ERP) therapy to help decrease anxiety with food, instill proper nutrition, and restore nutritional imbalances as needed. Further research is needed before health professionals will be able to determine whether orthorexia nervosa is an official eating disorder diagnosis.
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Kelly Melanson, Registered Dietitian
