Orthorexia Nervosa: When “Healthy” Becomes Dangerous

Woman deciding on healthy or unhealthy foodLast week, I had the privilege of presenting a web conference on disordered eating for Good Therapy. In the course of the web conference, I was asked a question about orthorexia. Thinking about what to write for this month’s article, this Q&A exchange about orthorexia popped into my head. I realized I’d not done more than mention it in passing in my Good Therapy articles, and thought I’d take this opportunity to explore the subject.

Orthorexia is not an “official” eating disorder, that is, it’s not mentioned in the Diagnostic and Statistical Manual of Mental Disorders (commonly known as the DSM). But it’s something that has become common and concerning enough that in 1996, practitioner of dietary medicine and author of “Junk Food Junkies” Steven Bratman, M.D., took notice and coined the term “orthorexia nervosa,” in his words, “to denote an unhealthy obsession with healthy eating.” His website devoted to orthorexia is the aptly-named orthorexia.com.

Bratman derived the term from the Greek “ortho,” meaning “right” or “correct.” Orthorexia can begin as a sincere desire to improve the quality of one’s diet, in much the same way that someone who develops anorexia or bulimia nervosa can start out by going on a diet to lose a little weight.  It progresses by a narrowing of the allowable types of foods, or the increase in types of foods deemed not healthful enough, so that the number of allowable types of foods decreases until the range of foods is very small.  For example, a person may decide to cut back on red meat, then eliminate it, then decide to become a vegetarian, then vegan, then a raw vegan, eating only raw plant-based foods. There is nothing inherently wrong with any of these types of diets: what distinguishes orthorexia from a healthful way of eating is the “unhealthy obsession” aspect.

Orthorexia involves preoccupation so strong that it becomes obession: a sufferer’s thoughts become focused on food, and his/her day comes to revolve around procuring and preparing food to the exclusion of other important activities and aspects of life. An orthorexic person may lose interest in hobbies or leisure activities, as his/her obsession with “healthy” eating increases. It can interfere with relationships: the inability to go out to share meals with friends and family at restaurants, to participate in social events where food is served, or to partake of and enjoy family dinners.

Merriam-Webster defines “obsession” as: “a persistent disturbing preoccupation with an often unreasonable idea or feeling.”  People with orthorexia, similarly to those who have anorexia nervosa, usually don’t experience their preoccupation to be “disturbing,” nor do they recognize it to be “unreasonable.” And this makes orthorexia, like anorexia, very difficult to overcome. Our culture values qualities like purity, self-discipline and control. Orthorexia, like most all eating disorders, involves ways of thinking that embrace these values as well. This allows eating disorders to camouflage themselves against our cultural backdrop, and supports the aspects of disordered eating that are ego-syntonic, that is to say, matching up with a person’s positive perception of his or her self. (Aspects of disordered eating that are ego-dystonic, such as overeating and inducing vomiting, are much more likely to feel “disturbing,” which often what motivates a person to get help.)

Orthorexia is sometimes present as part of, or along with, other eating disorders. I have worked with clients who’ve told me that as long as they adhere to their raw vegan diet, they have no problem with binge eating. The flip side of this is that if they deviate from their raw vegan diet, they binge, so they believe that the raw vegan diet is the solution to their binge eating disorder, rather than recognizing both as part of their eating disorder. I’ve worked with anorexic clients who have very orthorexic attitudes about food, wanting to eat (a narrow range of) only “healthy” foods, unable to recognize that eating habits that result in medical problems due to inadequate weight and food intake is anything but healthy.

Like any form of disordered eating, the way to “undo” orthorexia is to obtain proper psychotherapeutic help, so that the underlying issues driving the disordered attitudes about food and eating can be addressed and resolved. A person with orthorexia often struggles with accepting the parts of themselves that have qualities they don’t like. Banishing “unhealthy” foods is often a means of rejecting aspects of themselves that they think of as bad. True health means accepting ourselves entirely, including the parts of ourselves that have qualities we don’t like. Because to be human means to be complex and imperfect, and to be healthy humans means to regard ourselves with compassion and acceptance, just as we are.

© Copyright 2011 by Deborah Klinger. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • joey boyce

    June 16th, 2011 at 5:35 PM

    So what would it take for this to be officially recognized and included in the Diagnostic and Statistical Manual of Mental Disorders?

    Because I can think of at least one woman who fits the description of orthorexia perfectly and am sure there are many more out there that need help with this.

  • Janis Crump

    June 16th, 2011 at 8:46 PM

    “True health means accepting ourselves entirely, including the parts of ourselves that have qualities we don’t like. Because to be human means to be complex and imperfect, and to be healthy humans means to regard ourselves with compassion and acceptance, just as we are.” Amen to that, Deborah!

    Gone are the days when if you were thin it meant you were poor or sick, not that you looked that way by choice. My heart goes out to all these girls and boys that feel they need to damage themselves to such an extent in order to feel good about themselves.

  • Janet

    June 17th, 2011 at 4:32 AM

    It is such a fine line though. You want us to start thinking a little more about the ffods that we are feeding our bodies but when it comes to thinking about this to the exclusion of anything else then that is where the serious problems arise.


    June 17th, 2011 at 2:56 PM

    Is this also related to food fad? Because I have come across lot of people who have food fad and they will think twice before they even eat anything that is not on their list of ‘healthy’ or “this is not expensive so it may may be a good health food”.

  • Buzz Brown

    June 17th, 2011 at 9:22 PM

    @joey: my guess is it’s because the condition itself presents no actual danger to the individual, and has no direct negative effect on their health. If it’s not causing problems, then there’s no need to list it as a problem.

    (Plus it’s a made-up word, apparently…)

  • Jacqueline Watt

    June 17th, 2011 at 10:00 PM

    Some conditions have been taken out of the DSM because they simply decided that certain symptoms don’t negatively impact folk’s lives enough as to be classified as a disorder.

    Let’s get real. If they listed every little nuance in the DSM, then they would have to document every single personality quirk and little habit it’s possible to have. It has to be updated periodically.

  • joprescott

    June 18th, 2011 at 1:29 AM

    @Buzz: I have to disagree on that, I’m afraid. It can present a danger and not a small one either. A strict vegan diet isn’t suitable for all, and it can have adverse health risks in certain individuals. Heck, we’re not built to survive on such a restrictive diet.

    Those who are affected may be in as much of a minority as those who would have this disorder, but it still happens.

  • flora hanks

    June 18th, 2011 at 3:49 AM

    Even if this isn’t harmful, it’s very clear to me that it’s much like OCD as an eating disorder. You need to eat healthier and healthier and instead you end up eating grass for the rest of your short life.

    I really don’t follow how these eating disorders even
    come about where you can go from wanting to lose a couple of inches from your waistline to full-blown anorexia or bulimia.

  • Salana

    June 18th, 2011 at 5:13 AM

    I personally fail to see how thinking about ways to be healthy can be a bad thing. Sorry but I think there is some faulty logic with that theory.

  • Kjc

    June 19th, 2011 at 10:06 PM

    Wow i found this to be very interesting and enlightening I would like to offer something that may help in eating healthier to all..

  • Russ Parkinson

    June 20th, 2011 at 12:03 AM

    @flora hanks: With all the work that’s going into researching eating disorders, we might finally determine(or have we already?) what parts of the brain are making these disorders kick in.

    I think there was an article on that here that noted they were related to OCD like you said. Food becomes an obsession rather than a mere source of sustenance.

  • Deborah Klinger, M.A., LMFT, CEDS

    June 20th, 2011 at 7:51 AM

    Thank you all for the thoughtful cooments! I’ll just say that the very reason the term “orthorexia” was coined was because Dr. Bratman observed the paradox a focus on eating healthful foods becoming mentally and emotionally unhealthy.
    Simply because a behavior has no negative impact on physical health, it doesn’t mean it’s not psychologically unhealthy. In the case of orthorexia, this obsession may or may not lead to negative physical consequences, but it is mentally disordered. It has to do with the obsessional quality and the effects of that on a person’s mental and emotional states and daily functioning.
    Foods aren’t healthy or unhealthy, they are healthFUL or unhealthFUL. Attitudes and behaviors can be healthy or unhealthy. An obsession with eating healthful foods is unhealthy– because obsession is unhealthy!

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