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What is orthorexia? Learn about the signs of orthorexia and what you should do if you have this eating disorder.
Note: this post is for informational purposes only and is not intended as medical advice. Please consult your healthcare provider for recommendations related to your individual situation.
What is Orthorexia?
Orthorexia (Orthorexia Nervosa) is an eating disorder characterized by obsession or over-concern with the healthfulness of foods and eating habits. People with orthorexia become fixated on the healthful qualities of their food to the point where it becomes stressful and potentially detrimental to their health.
Orthorexia has been given more attention and recognition lately, likely due to the rise of popular restrictive diets such as the ketogenic and vegan diets. Relative to other eating disorders, orthorexia has been viewed as less severe and is met with less sympathy by some people. But, while orthorexia is not formally recognized in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), it is still a very real disorder with potentially dangerous consequences. Malnutrition, low body weight, and the associated consequences are a serious concern for those with orthorexia.
What is an Eating Disorder?
Eating disorders are mental and physical illnesses revolving around food and/or weight. They’re characterized by disturbances in eating behaviors and involve the individual having related thoughts and emotions around food. There are several types of eating disorders and cases can range in severity. Eating disorders are often treated with counseling of various kinds.
Since orthorexia is not defined in the DSM-5, keep in mind that there are no formal diagnostic criteria. However, there are common attributes among orthorexia sufferers. These include but are not limited to:
1. Severe Restriction on the Types of Foods Consumed
Often, individuals with orthorexia have characterized different foods as “good” or “bad” and will only consume good foods. This can mean cutting out entire food groups or types of foods, such as carbohydrates, meat, cooked foods, etc. to the point where they will refuse to consume those “bad” foods in any circumstance.
2. Anxiety Surrounding “Bad” Foods
Individuals with orthorexia can have severe emotional turmoil when it comes to consuming the foods they fear or have deemed unhealthy. Sometimes, this anxiety extends to simply being in the presence of those unapproved foods. A person with orthorexia may go out of their way to avoid being in the presence of these foods, even at the expense of normal social situations.
3. Inflexibility Around Food or Eating
Individuals suffering from orthorexia are often inflexible when it comes to the types of food they will eat, when they will eat, how they will eat, how they prepare food, etc. This inflexibility can be crippling to their daily lifestyle.
4. Obsessive Concerns about the Effects of Foods on Your Health
Although it’s a good idea to be mindful of the effects food will have on you, those with orthorexia take it to the extreme. Every bit of food they consume or don’t consume is rationalized by the effect it will have on their health, whether that concern is unfounded or not. They will also fixate on their chances of developing a disease or condition.
5. Obsessive Concern with Food Quality
Those with orthorexia are overly focused on the quality of their food. This often includes labels such as non-GMO, organic, raw, vegan, grass-fed, etc. While we want to be mindful of the quality of our food, orthorexics will refuse to eat anything that does not meet rigid quality standards. Often, quality is more important than quantity for them, putting them at risk for under-eating.
In addition to the above warning behaviors, here are some common emotions those with orthorexia may experience:
- Intense feelings of guilt, shame, or anxiety when they do not have their approved foods meal prepped or ready for them
- Avoidance of social situations and/or enforced isolation to avoid being in the presence of unapproved foods or eating foods prepared by others
- Distancing relationships with friends or family members based on beliefs around food
- The judgment of others who do not follow their notion of “healthy” eating
- Excessive amounts of time spent thinking about and planning food
- Feelings of satisfaction, pride, or calmness when consuming or planning approved meals
Since orthorexia is a relatively newly recognized disorder, there is not a standard treatment plan. As with most eating disorders, however, relief can come from a combination of different treatments. Keep in mind that a treatment plan should be individualized and monitored by a dedicated team, and treatment intensity will vary for each person. I really want to stress the importance of getting professional therapy for anyone suffering with orthorexia.
Here are some common treatment options for those with orthorexia:
Therapy or Counseling
Seeking the help of a therapist or counselor experienced with eating disorder recovery is crucial to recovery. An eating disorder is a mental condition that requires intervention and re-wiring of the brain’s existing thought patterns–this is also known as cognitive-behavioral therapy. A therapist can also offer a listening ear and tactics to help orthorexia sufferers deal with feelings of shame, anxiety, guilt, control, etc.
Dialectical Behavioral Therapy
This method of recovery adds practices like meditation to traditional cognitive behavioral therapy techniques to address and change thought patterns.
Some may benefit from counseling from a nutritionist. Often, those with orthorexia have skewed and unfounded beliefs regarding the healthfulness of different foods or eating behaviors. A certified and educated nutritionist can help shed some light on realistic and research-proven eating behaviors and food choices.
A nutritionist or dietitian will also likely be able to explain the negative health consequences of chronically under-eating, including hormone imbalance, anxiety, low bone density, and other serious issues. Interestingly, women with PCOS are more likely to experience eating disorders. A qualified practitioner can help women in this category to find the best diet to manage both PCOS and disordered eating patterns. Read more about the best diet for PCOS.
Participating in a support group can be very helpful for recovery from an eating disorder. The sense of community and shared experiences may alleviate feelings of shame or isolation.
Depending on the severity of the eating disorder, treatment may be completely immersive. Those with a mild case of orthorexia may find relief with outpatient recovery and regular counseling, while those with a more severe case may require hospitalization and fully immersive inpatient recovery at a recovery center.
Those who have recovered may find it helpful to continue recovery activities such as participating in support groups and regularly attending counseling sessions to help reduce the chances of a relapse.
How do you know if you have orthorexia?
There are several potential symptoms of orthorexia and they vary among individuals. Some common symptoms include:
- Anxiety and control regarding the healthfulness of foods
- Avoidance of several different food types
- Obsessive planning and thinking about food
- Labeling foods as “good” or “bad”
- Inflexibility regarding consumption of “bad” foods
In general, these behaviors will negatively impact the individual’s daily life and overall health.
How is orthorexia treated?
As with other eating disorders, orthorexia is best treated by a combination of different methods. These should include cognitive behavioral therapy from a therapist experienced in eating disorder recovery, counseling, and even nutritional counseling. Those with orthorexia need to have a strong support network of friends, family, and professionals. Those with a strong team behind them will be more successful in recovery.
Which eating disorder is the most common?
The most common eating disorder in the United States is Binge Eating Disorder or BED. This is a disorder characterized by eating large quantities of food in a short period of time to the point of discomfort. Those with BED often feel out of control when binge eating and feel shame, guilt, or fear during and after the event. It’s not uncommon for individuals to develop more than one type of eating disorder, however, so one may suffer from a combination; such as orthorexia, restrictive eating, and binge eating.
Anorexia and bulimia are two other common eating disorders, along with binge eating disorder.
Is Orthorexia in the DSM-5?
Orthorexia is not formally recognized in the DSM-5 as an eating disorder. However, this does not detract from its validity as an eating disorder with dangerous consequences.
Can I follow a vegan diet if I’m orthorexic?
Due to the restrictive origins of orthorexia, any type of restrictive diet is not recommended. Those with orthorexia have skewed views on the healthfulness of food and restrict or eliminate any foods they deem unhealthy, sometimes without any scientific or nutritional basis. Individuals with orthorexia should focus on a balanced diet including as many food choices as possible. Read my article on how to eat clean without starving yourself.
A healthy diet should include a variety of different food types. If all of an individual’s dietary needs are not met through a specific diet, it should not be recommended as a long-term diet. A vegan diet, in particular, is becoming increasingly popular. Due to the highly restrictive nature of a vegan diet, it may not allow for full recovery from orthorexia. Read more about the health risks of a vegan diet.
The keto diet is also really popular right now. It would not be advisable for anyone with a history of an eating disorder to follow the keto diet. Read more about who should not do keto.
I am not a licensed healthcare provider and the information in this post is not intended as medical advice. However, I do want to stress the importance of finding professional help if you or someone you know is suffering.
Here are some resources for the treatment of orthorexia and other eating disorders (I have no professional association with these organizations):
- National Eating Disorders Association (they have an eating disorders otline)
- Psychology Today referral service for psychologists and therapists
- Re-Find Health referral service for functional health providers
- The Institute for Functional Medicine for referrals to functional medicine specialists
I have a history of eating disorders, starting with binge-eating disorder during my early adolescence. I had a very chaotic childhood with parents who were preoccupied with their own problems, including a bankruptcy. I comforted myself with candy. I couldn’t control myself and would often eat bags of candy in one sitting, to the point of making myself sick.
As I grew into early adulthood, my habits diminished. I met my husband and learned how wonderful and comforting it can be to have a solid, healthy relationship. Then, in 2012, I was diagnosed with and treated for thyroid cancer. My tendency toward eating disorders came back, this time in the form of orthorexia. I became convinced that even a small bite of sugar would cause my cancer to come back, and I became obsessive about every ounce of food I ate.
During the two year time span of when I had orthorexia, I was on a strict, oil-free, vegan diet, and I was under the influence of others in the same community who had the same restrictive mindset.
It took a whole life change to break free. I had to find new friends, build a new community, stop being vegan, and find the help of medical specialists, including an eating disorders counselor. I also wanted to add that it can be helpful to take a break from social media during recovery from orthorexia. It wasn’t easy to recover from orthorexia, but the freedom and better health I experience now was worth the effort.
Read more about my clean eating journey.
I hope this article has helped shed some light on the topic of orthorexia. As someone who has gone through the hell of eating disorders and is now in recovery, I cannot emphasize enough how important it is to get help. There is nothing shameful about asking for help and it really is the first step to getting better.