Orthorexia

What Is Orthorexia?

Orthorexia is an unhealthy focus on eating in a healthy way. Eating nutritious food is good, but if you have orthorexia, you obsess about it to a degree that can damage your overall well-being.

Steven Bratman, MD, a California doctor, coined the term in 1996. It means “fixation on righteous eating.” Since then, many medical professionals have accepted the concept.

It isn’t an official diagnosis. But the basic idea is that it includes eating habits that reject a variety of foods for not being “pure” enough. Eventually, people with orthorexia begin to avoid whole meals that don’t meet their standards or that they don’t make themselves.

Some experts think there are similarities between the constant worry about food seen in orthorexia as in eating disorders like bulimia and anorexia nervosa. All are about food and control.

Orthorexia Signs and Symptoms

If you have orthorexia, you might:

  • Worry about food quality. High levels of concern about the quality and source of foods you eat could lead to anxiety.
  • Avoid going out to eat, or avoid eating food prepared by others out of fear that foods you don’t prepare yourself won’t meet your standards.
  • Fear sickness -- worry about how “clean” food is, or if it’s “bad” for your health.
  • Show physical signs of malnutrition. When you limit the variety of foods you eat, you may not get all the nourishment you need. You could lose weight as a result.
  • Bury yourself in food research. It’s one thing to spend a few minutes scanning a product label or surfing the web for more information on ingredients. But with orthorexia, you may spend hours thinking about food and planning meals.
  • Refuse to eat a broad range of foods. It’s normal to pass on some foods because you don’t like the way they taste or the way they make you feel. But with orthorexia, you might decide to drop whole categories of foods from your diet -- grains, for example; or any foods with preservatives, gluten, or sugar; or all foods that just don’t seem “healthy”; or all of the above.
  • Fear losing control. You feel that you’re doing the right thing by eating healthy. But you may also be afraid that eating even one meal you didn’t prepare -- including dinner at a restaurant -- can be disastrous.
  • Be overly critical of your friends’ food choices. At the same time, you may have no rational explanation for your own.
  • Find yourself in a vicious circle. Your preoccupation with food causes you to bounce between self-love and guilt as you change and restrict your diet.

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Orthorexia Causes and Risk Factors

Anyone can get an eating disorder. Though the causes and risk factors vary from person to person, they fall into three main groups:

  • Biological: Having a close relative with an eating disorder, a history of dieting, or type 1 diabetes
  • Psychological: Perfectionism, dissatisfaction with your body, or a history of anxiety
  • Social/cultural: Being teased or bullied about your weight, having had family trauma that spans generations (as Holocaust survivors do), or buying into the idea of an “ideal” body

Orthorexia Diagnosis

As with bulimia and anorexia, your doctor or nutritionist may be able to help with orthorexia. Because of the emotional parts of the condition, they may ask you to see a mental health professional.

Right now, there are no official criteria for making a diagnosis because orthorexia isn’t included in the DSM-5, the guidelines doctors use to diagnose mental health conditions.

In 2016, Bratman and Thomas M. Dunn, PhD, a professor at the University of Northern Colorado, proposed a two-part diagnostic criterion for the condition:

Criterion A says the person will have an obsessive focus on healthy eating and get distressed over food choices they feel are unhealthy. They’ll lose weight as a result of food choices, but not because they’re trying to. In addition:

  • They’ll compulsively follow and be obsessed with rules about food that they believe will promote health.
  • Breaking the rules will create fear of disease along with anxiety and shame over their food choices.
  • The rules will get harsher over time. The person may do cleanses.

Criterion B says the person my notice mental health and physical problems:

  • The restricted diet can lead to malnutrition, severe weight loss, or other medical problems.
  • Their rigid beliefs and rules can cause problems with social relationships, or at work or school.
  • Their body image and sense of self-worth could depend on how well they follow their healthy eating rules.

Orthorexia Treatment

The key is to recognize that even though eating healthy food is good for you, the way you’re going about it is causing harm. You’ll need to train yourself to think differently about it.

If you feel you have an unhealthy relationship with eating, your doctor may suggest mindful eating strategies. Common treatments include:

  • Exposure and response prevention: The more you’re exposed to the situation that causes you anxiety, the less it’ll upset you.
  • Behavior modification: Understanding the negative effects of your actions so you can change what you’re doing
  • Cognitive restructuring or cognitive reframing, which helps you identify habits and beliefs that cause stress and replace them with less rigid thoughts and actions
  • Various forms of relaxation training, like breathing exercises, guided imagery, mindfulness meditation, yoga, and tai chi

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on September 09, 2020

Sources

SOURCES:

National Eating Disorders Association: “Orthorexia Nervosa.”

Academy of Nutrition and Dietetics: “Orthorexia: An Obsession with Eating Pure.”

Palo Alto Medical Foundation: “Orthorexia Nervosa.”

Zeratsky, Katherine, RD, LD: “Orthorexia: When healthy eating becomes extreme,” Mayo Clinic Nutrition-Wise Blog, Nov. 15, 2016.

American Psychiatric Association: “Orthorexia: Can Healthy Eating Become Unhealthy?”

National Eating Disorders Association: “Orthorexia,” “Risk Factors.”

Neuropsychiatric Disease and Treatment: “The clinical basis of orthorexia nervosa: emerging perspectives.”

Bradley University: “Orthorexia.”

University of Northern Colorado: “Thom Dunn.”

Foundations Recovery Network: “Exposure and Response Prevention Therapy (ERP).”

StatPearls: “Behavior Modification.”

American Addiction Centers: “Cognitive Restructuring.”

Harvard Health Publishing: “Six relaxation techniques to reduce stress.”

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