Orthorexia: an Obsessive Relationship with Healthy Eating

Overhead view of fresh and colorful vegetables and fruits in a wooden crateWith obesity and other health problems on the rise, healthy eating has become an important goal for millions of Americans. Many diets claim to provide better health. Whatever the nutrition plan—from the Paleo diet to veganism—people are constantly bombarded with information about which foods are good or bad. Foods once considered healthy are now listed among unhealthy foods, leaving many people feeling uncertain of what to eat. This can create a confusing and neurotic relationship with food.

When taken too far, healthy eating can become an unhealthy obsession. It may even create the opposite effect and cause physical health problems rather than solve them. The line between caution and obsession can sometimes be hard to differentiate. For example, the avoidance of high fructose corn syrup alone does not amount to an eating disorder. But when it becomes a fixation that drastically affects quality of life, there may be cause for concern.

What Is Orthorexia?

Orthorexia nervosa is a term coined by physician Steven Bratman in 1997 to describe an obsessive preoccupation with eating pure foods and avoiding foods perceived to be unhealthy. Orthorexia literally means correct eating. Unlike those who have experienced anorexia—an eating disorder characterized by restricted food intake to achieve a smaller body shape—individuals with orthorexia are more concerned about the quality of food rather than the quantity. Potential sources for an obsession with food include recent health problems, social trends, family habits, economic problems, or simply hearing something negative about a specific food group.

A person with orthorexia becomes fixated on eating the right foods and avoiding the wrong foods. People with the condition typically do not fret over calorie. Instead, they think about the overall health benefits or potential health problems associated with certain foods. They often obsess over how food is prepared, processed, or digested in the body. Individuals with orthorexia tend to completely avoid eating at restaurants because they do not trust how the food has been prepared.

Orthorexia often begins as a genuine desire to live a healthy lifestyle but can become an unhealthy obsession. A person’s diet, for example, may become a strict dogma that must be adhered to at all costs. When the dietary restrictions of orthorexia become severe, it has the potential to morph into full-blown anorexia. The condition can lead to a lower caloric intake simply because of decreased availability of foods deemed to be healthy. Weight loss and severe malnutrition can result, sometimes leading to cardiac problems and even death.

Orthorexia is a serious condition that goes beyond a mere lifestyle choice. When a healthy diet no longer serves the purpose of improving health, the goal can become a fixation that interferes with other essential areas of life. An obsession with eating healthy foods can take time away from other interests and activities, impact personal relationships, and lead to serious physical and emotional health problems.

Despite the increased prevalence of individuals being treated for its symptoms, orthorexia is not a formal medical condition and has not been added to the Diagnostic and Statistical Manual (DSM). Those who experience orthorexia typically exhibit symptoms of anxiety similar to those with anorexia and other eating disorders. As such, they are often diagnosed with these conditions instead or may be diagnosed as Eating Disorder Not Otherwise Specified (EDNOS).

Research Examining Orthorexia

Orthorexia may be a relatively new definition, but its characteristics have been around since the 1990s. In an effort to find out if diagnostic criteria was needed for the condition, a 2004 study sought to verify its prevalence by asking random volunteers about orthorexia-specific behaviors and habits. Out of a total of 404 participants from different backgrounds and occupations, about 6% showed signs of orthorexia, suggesting prevalence of the condition was indeed significant enough to establish diagnostic criteria.

Orthorexia is a serious condition that goes beyond a mere lifestyle choice. When a healthy diet no longer serves the purpose of improving health, the goal can become a fixation that interferes with other essential areas of life.Social media has partly contributed to a rise in awareness of orthorexia, and various Internet personalities have brought even more attention to the condition in recent years. Blogger Jordan Younger was known as the Blonde Vegan for years before she recognized her health food obsession as orthorexia. She has now changed her Internet persona to the Balanced Blonde and has written and published a memoir—called Breaking Vegan—about her experience with the condition.

Following a particular diet such as vegetarianism or veganism does not mean the dieter will also experience orthorexia, but there may be some overlap between the condition and restrictive dieting. A 2012 study published in the Journal of the Academy of Nutrition and Dietetics examined the relationship between vegetarianism and eating disorders. More than two-thirds of the subjects reported a belief in a connection between the two issues, and 52% of those with a history of eating disorders had also eaten a vegetarian diet at some point in their lives (compared to 12% in a control group).

As orthorexia has become better known, more research has been conducted in an effort to understand the full extent of the condition. A 2014 study published in BMC Psychiatry found orthorexia was not only associated with obsessive health food choices, but also with other would-be healthy behaviors such as shopping at health food stores, decreased alcohol consumption, and increased exercise regimens.

Overcoming Orthorexia

Recovery from orthorexia can be a challenge, as diets can become a significant part of someone’s identity. Orthorexia often stems from an underlying fear of illness.

The first step is admitting the problem, which can often be difficult to do, as people with the condition typically believe they are doing the best thing for their bodies. In order to fully recover, the individual must be willing to establish a new relationship with food.

While nutritionists can help people with the condition to create balanced diet plans and medical professionals can treat physical illnesses concurrent with orthorexia, therapy can be a crucial aspect of the treatment process.

Chapin Faulconer, LPC reports seeing an increased number of people with symptoms of orthorexia in recent years.

“Orthorexia seems to have its roots in good intentions,” Faulconer said. “Individuals begin with a positive goal to eat healthfully, and over time they become fixated on food quality and purity to the point of obsessiveness.”

Faulconer’s main goal is to help people with orthorexia discover the underlying emotional issues behind the condition and then help them develop a balanced relationship with food.

References:

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association, 2013.
  2. Barclay, R. S. (2015, February 24). Orthorexia: The New Eating Disorder You’ve Never Heard Of. Healthline News. Retrieved from http://www.healthline.com/health-news/orthorexia-the-new-eating-disorder-youve-never-heard-of-022415#1
  3. Bardone-Cone, A., Fitzsimmons-Craft, E., Harney, M., Maldonado, C., Lawson, M., Smith, R., & Robinson, D. (2012). The Inter-Relationships between Vegetarianism and Eating Disorders among Females. Journal of the Academy of Nutrition and Dietetics, 112(8), 1247-1252. doi:10.1016/j.jand.2012.05.007
  4. Bratman, S. (2015, May 17). Anxiety and Orthorexia. Orthorexia.com. Retrieved from http://www.orthorexia.com/anxiety-and-orthorexia/
  5. Donini, L., Marsili, D., Graziani, M., Imbriale, M., & Cannella, C. (2004). Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, 9(2), 151-157. doi:10.1007/BF03325060
  6. Kratina, K. Orthorexia Nervosa. NEDA: Feeding Hope. Retrieved from https://www.nationaleatingdisorders.org/orthorexia-nervosa
  7. Marcason, W. (2015, June 1). Orthorexia: An Obsession with Eating Pure. Eat Right: Academy of Nutrition and Dietetics. Retrieved from http://www.eatright.org/resource/health/diseases-and-conditions/eating-disorders/orthorexia-an-obsession-with-eating-pure
  8. Orthorexia Symptoms and Effects. Timberline Knolls Residential Treatment Center. Retrieved from http://www.timberlineknolls.com/eating-disorder/orthorexia/signs-effects
  9. Richards, S.E. (2014, October 12). Orthorexia: When Healthy Eating Becomes an Obsession. Retrieved from http://www.cnn.com/2014/10/07/health/orthorexia/
  10. Varga, M., Thege, B., Dukay-Szabó, S., Túry, F., & Furth, E. (2014). When eating healthy is not healthy: Orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry, 14(59). doi:10.1186/1471-244X-14-59

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  • 11 comments
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  • Janice

    Janice

    December 23rd, 2015 at 4:07 PM

    I think that a lot of ladies that go to the gym with me have this!

  • Sadie

    Sadie

    December 24th, 2015 at 7:14 PM

    I am only saying this in jest, but wow there are times when I only wish that I had a little more self control and more of a habit of eating healthier or even having the desire to eat healthier. I have been sliding pretty much of out control with horrible eating habits now, so this one looks attractive even though I know that it is to the other extreme and in the end wouldn’t end up being any healthier than the other patterns that I find myself giving into.

  • Ellis M.

    Ellis M.

    December 25th, 2015 at 8:43 AM

    Whenever you become fixated on anything like this then you know that it could have terrible consequences on your health.
    At first you don’t see that, you only see that you are eating healthy and doing what you presume to be good for the body, and not thinking about the damage that you could be doing both physically and mentally.

  • geneen

    geneen

    December 26th, 2015 at 11:01 AM

    I guess I am not at all sure how this differs from anorexia?

  • Brad

    Brad

    December 27th, 2015 at 8:29 AM

    It would be hard to know if someone that you love is suffering with this because how can you really fault someone for always wanting to eat healthy? I mean, how can you tell the difference if someone is just trying to take care of their bodies or if they have really gone kind of overboard with the whole health food kick?

  • Callie

    Callie

    December 28th, 2015 at 6:34 AM

    I have been down this road before myself- when this is something that interferes with you going out and doing anything, then yes, it is a huge problem. It kept me from going out unless I could totally control where we went so that then could control what I ate. I lost a part of me during this fixation, and it was never “healthy living” like it appears to be. MY whole life became quite unhealthy actually.

  • monica

    monica

    December 28th, 2015 at 3:15 PM

    It is crazy just how quickly this can get out of control.
    You think that you are going to be healthy, get in shape and lose weight and you do but then you lose sight of the end because it never seems to be good enough what you are doing. It always has to be eat less, eat better, lose more weight and things suddenly spiral and they feel so out of control.

  • heather o

    heather o

    December 28th, 2015 at 5:28 PM

    If you are hanging out with the right group of people (or the wrong group) they will actually find something to praise about this kind of behavior.

  • Gaston

    Gaston

    December 29th, 2015 at 7:46 AM

    We usually think that this is about the relationship with food when truthfully it is usually caused by some other underlying issue. This is simply how that is manifesting itself in your life.

  • janet

    janet

    December 30th, 2015 at 10:35 AM

    Are there many therapists out there who are well trained to help with all of the different eating disorders? Are some specialists with one area and not the others or do they all tend to fall under one blanket?

  • Sally Ramsey

    Sally Ramsey

    January 2nd, 2016 at 8:11 PM

    When a set of habits or beliefs is fear driven, and becomes obsessive, limiting, and imprisoning, it’s time to get help. It is very powerful and effective to work with identifying and changing the underlying beliefs operating orthorexia or anorexia. Both are very complex profiles, and good care is important. I am glad to have survived anorexia at an age when no one really knew what it was or why it was happening. Others died. I was lucky and willing to change. Now as a therapist, I am very compassionate and clear about the getting well process.

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