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Orthorexia, or orthorexia nervosa, is not officially diagnosed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Yet it is a severe eating disorder that can be life-threatening.
Orthorexia and Its Connection to Healthy Eating
When someone has orthorexia, they are fixated or obsessed with healthy eating, such as only eating the right food. They have an unhealthy preoccupation with food that must be of the highest possible quality to be consumed. Among the prerequisites are that the food must be raw, organic, fresh, free from GMOs, and clean.
This obsession with only eating certain foods and severely restricting or eliminating all others interferes with the person’s quality of life. Sometimes, they can become so ill after severe weight loss that they die from starvation, exhaustion, and infection. By contrast, healthy eating consists of various foods in a diet with flexibility, balance, and moderation.
Recognizing the Signs and Symptoms of Orthorexia Nervosa
If someone you know has significant weight loss or is overly preoccupied with what, how, and when they eat, be alert for these warning signs of orthorexia:
- Avoiding entire food groups deemed by social media, influencers, and health groups as unhealthy
- Restricting and then eliminating particular food considered not pure (including food made with preservatives, artificial flavors and colors, GMOs, chemically modified, and pesticide-treated)
- Decreased food varieties (no dairy, meat, sugar, carbs, animal products)
- Won’t eat food they didn’t prepare
- Refusing to eat food not prepared to their “pure” standards (such as it wasn’t farm-to-table food)
- Will not eat food at restaurants or places where they’re unsure how it was made or what’s in it
- Compulsively checking nutrition labels and ingredient lists
- Hours spent thinking about food that may be served at a family dinner, outing, or event
- Distress when their healthy, safe foods are unavailable
- Obsession with the healthy lifestyle and food blogs and posts on social media
- Displaying an unusual interest in the food health of what other people are eating
Remember that someone with orthorexia nervosa may be in denial. They don’t believe that they have a problem with disordered eating. To them, they are proactive with their health. They may dismiss your concerns or tell you to stay out of their life. Note that there may or may not be body image concerns.
Understanding the Risks of Orthorexia and Its Impact on Mental Health
Someone with orthorexia doesn’t start out trying to damage their physical or mental health. On the contrary, they adamantly believe that their way of eating is the best and healthiest way to care for their body and mind.
Social Media Use and Orthorexia
Young adults, in particular, may be influenced by social media celebrities who praise specific food-restrictive diets. How low of a caloric intake can you get in one day? How few food groups can you eat? Can you eat only fruits and seeds and improve your life? The allure of the claims of benefits from restrictive eating and pure, clean, unmodified foods is like an addiction to some. They’ll pursue it no matter what.
A 2017 study in the United Kingdom found that social media use, particularly Instagram, was linked with a higher prevalence of orthorexia nervosa symptoms. The social media site is primarily an image-based platform. The #food hashtag is one of Instagram’s top 25 most popular. Researchers said their #fitspiration hashtag analysis revealed a majority of the Instagram images with the tag were of thin, toned women. Still, there were objectifying elements “which could have negative effects on body image and self-esteem.”
Researchers highlighted other study findings, including:
- Higher use frequency of Instagram is directly associated with increased levels of depression.
- Greater unfavorable social comparison is linked to following a greater list of strangers.
- Social comparison plays a crucial role in body image disturbance.
Most disturbing is the trend of users to follow the advice from Instagram celebrities and influencers and try to imitate what they eat. This often leads to recommendations to eliminate food groups, which could result in diet imbalance and deficiencies. The unscientific advice may further promote food psychological problems, leading to orthorexia nervosa or anorexia nervosa.
Physiological, Social, and Medical Complications
Many physiological, social, and medical complications emerge once individuals severely restrict the variety of foods they eat and their overall caloric intake:
- Health is compromised by nutritional deficiency.
- All the organs and bodily systems suffer from insufficient energy.
- The initial goal of eating and being healthy becomes the opposite.
- Furthermore, many individuals with orthorexia exercise to an extreme. They exercise more often and with greater intensity, causing further harm to their depleted bodies.
Clean Eating Becomes a Religion
For some with orthorexia nervosa, clean eating becomes a way of life, almost a religious pursuit. Every waking moment is cluttered with thoughts about restrictive eating to the point that such nonstop obsession is toxic.
For example, teen girls contemplating prom night and talking with friends about losing weight can cause someone on the brink of orthorexia nervosa to spiral out of control. This results in drastic meal changes, elimination of unwanted food groups, and severe food portion limitations.
Parents might notice the sudden weight loss and urge their daughters to eat more. She, on the other hand, sees their good intentions as interference. As compensation for when she eats something “bad,” she exercises for hours, thinking she has some control. Instead, she descends into a full-blown unhealthy eating disorder.
Obsession Over a Perfect Body
Some people who engage in severe food-restrictive diets do so over an obsession to achieve a perfect body. Being obsessed with eating healthy and cleanly leads to an overwhelming preoccupation with counting calories and tracking weight.
Eating something outside of the permitted range creates anxiety, along with feelings of guilt and uncleanliness. Calm is challenging to achieve. The physical and mental battle wears the person down. They become exhausted physically, emotionally, and mentally.
Challenges in Treating Orthorexia and Co-occurring Disorders
Since there is no current clinical treatment program for orthorexia, it may be challenging to find help. It isn’t like an addiction to alcohol or drugs that requires detox before a clinical treatment program can begin. However, experts in treating other eating disorders recommend psychotherapy to help individuals better understand orthorexic meaning and deal with food-related issues and anxieties.
Some studies have found that those with orthorexia have a co-occurring obsessive-compulsive disorder. Therefore, simultaneously getting treatment for this mental health disorder and orthorexia nervosa may make sense.
However, if severe weight loss is involved, nutritional counseling will be required for safe weight restoration. The combination of a therapist and nutritionist specializing in eating disorder treatment is highly recommended. These trained professionals can work with individuals with orthorexia to help them achieve recovery. Psychotherapy and various talk therapy approaches, such as cognitive behavioral therapy (CBT), enhanced cognitive behavioral therapy (CBT-E), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT), may be appropriate.
Rebuilding a Healthy Relationship with Food
It is possible to enjoy eating again and eat healthily. This starts with education about healthy eating and learning that food is essential to life. Leading by example is also vital in guiding someone with orthorexia to a healthy relationship with food.
Family and friends’ support is crucial to recovery from orthorexia nervosa. This is especially true during stress and anxiety when having someone trusted to talk with is life-affirming. Learning to have a positive relationship with food means enjoying many foods and food groups without guilt.
Emphasizing Balance and Moderation in Nutrition
As with all things in life, balance and moderation in nutrition offers the best opportunity to ward off and recover from orthorexia nervosa. It’s tempting to go all out and eliminate entire classes of foods because of published reports that they’re wrong or unhealthy. Such an all-or-nothing approach seldom works.
Food research has often reported that many foods are unhealthy and should be restricted or avoided. Then, subsequent analysis claimed the opposite. The foods formerly called harmful were healthy and could be consumed in moderation. Or the claims that they were unhealthy were debunked.
For those with orthorexia nervosa, the goal must be learning to balance and moderate nutrition and working with appropriate psychological and nutritional counseling. Family support is also essential to a healthy recovery from orthorexia.
