If your avoidance of less-than-perfect meals means you’re missing valuable nutrients, you may have orthorexia.
Healthy eating is usually a good thing, unless you become too fussy about food.
Although it’s not listed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) as a distinct condition, orthorexia nervosa (ON) is not new. Physician Steven Bratman first named ON in 1997, using the Greek words “ortho” (“correct”) and “orexi” (“appetite”).
It’s unclear whether ON is a separate form of disordered eating, a subcategory of another eating disorder, or even a symptom of obsessive-compulsive disorder (OCD). But no matter how it is or isn’t classified, it can impact people’s lives.
Orthorexia nervosa (ON), or just orthorexia, is an obsession with healthy eating that can lead to nutritional imbalances and deficiencies.
Unlike anorexia nervosa (AN), in which the concern is food quantity, people with ON are concerned with the quality of the things they eat. So, if you have ON, you may eat a large amount of a certain food that you deem very “healthy” but none at all of another type of food you consider “unhealthy.”
Any kind of “clean” eating regimen can evolve into orthorexia if it becomes too rigid.
Similarly to those with AN and OCD, people with ON
Characteristics seen with ON include:
- obsessive-compulsive tendencies
- need for control
- orientation toward appearance
- attachment styles that are fearful and dismissing
Some people may be more prone to developing orthorexia.
For example, certain professions that have a strong focus on health, wellness, and athletic performance are linked to ON in older and more recent research, such as:
- healthcare workers like medical students, doctors, or dietitians and others involved in nutrition education
Some people with ON may also exercise compulsively. A 2017 German study involving 1,008 participants noted a connection between exercise addiction and orthorexia.
Social media also appears to play a part in whether healthy eating progresses to ON. A 2017 online survey of 680 social media users revealed that Instagram was connected to a tendency toward orthorexia, more so than any other social media platform at that time.
Orthorexia and OCD share certain symptoms and behaviors. For instance, obsessive and rigid behaviors are part of both ON and OCD.
One of the driving forces between obsessive behavior in OCD is the fear that something bad will happen without the performance of rituals. People with ON feel the same fear and guilt as those with OCD, but in the case of ON it’s food, rather than rituals, that affects anxiety.
Other similarities between ON and OCD:
- recurring thoughts that interfere with daily life
- stress about contamination
- compulsions to act in a particular way
- a need for control
Unlike the symptoms of some other eating disorders, such as AN, orthorexia symptoms aren’t always connected to body image. Instead, the primary focus of ON is on food quality.
If you have ON, you likely spend a lot of time reading labels and ingredients and thinking about the quality of the food you eat. You may be preoccupied with what other people eat, and you may follow many healthy eating accounts on social media.
Other signs and symptoms:
- cutting out entire food groups (like meat, dairy, or carbs)
- feeling excessive concern about what food might be served at social events
- experiencing stress when there is none of the “right” food available, accompanied by the inability to eat
- connecting self-esteem to “healthy” foods
- feeling guilt when you can’t maintain your dietary standards
Your food scrutiny may have begun with a well-intentioned goal of improving your health, but if it has progressed beyond balance, flexibility, and moderation, then you may have ON.
If you’ve experienced restricted eating, it makes sense that you may develop nutritional deficiencies. But you may not realize that ON can have psychological and social effects in addition to physical ones.
Extreme dietary restrictions like those seen in ON can have adverse health effects, including:
- significant weight loss
- bone mass loss
- low sodium levels
- low counts of platelets, white blood cells, and red blood cells
- slow heart rate
Even milder side effects like fatigue can interfere with your quality of life. You may think you’ll feel better once you’ve been strict with your diet long enough. However, you may be making the situation worse by not including enough of some important nutrients in your diet.
People with orthorexia may experience feelings of guilt and failure when they can’t maintain their rigid dietary standards. Fear of disease, as well as an effort to avoid shame and anxiety, may drive them to eat as “perfectly” as possible.
They may also experience emotional upset while watching other people eating food they consider substandard.
Fatigue and emotional instability are also common among people living with ON.
People with ON can spend a lot of time managing food. This includes researching, shopping, and preparing meals that live up to their high standards. This may take away from building and maintaining relationships.
If you have ON, you may catch yourself giving unwanted advice to others about how to eat. You may bring your own carefully sourced and prepared food to social events or avoid them altogether.
Whether you’re avoiding meals or lecturing about them, orthorexia nervosa can be very socially isolating.
Because people with orthorexia are concerned with optimal health, they may be more open to seeking treatment since it aligns with their wellness goals.
Orthorexia treatment is a multidisciplinary approach. You may see:
- medical doctors
- a dietitian
- a counselor or psychologist
If your restricted eating has led to medical complications, those will be treated by a medical professional and possibly even in a hospital or inpatient setting, depending on the severity. If it’s safe for you to be treated on an outpatient basis, you can benefit from nutritional education and counseling such as cognitive behavioral therapy.
Therapy can help you change the way you think about food. You can learn that it’s OK to be flexible and “imperfect.” Therapy can also help you uncover why you need to feel in control and how this anxiety may be connected to the way you eat.
You may try exposure response prevention therapy, which doctors use to treat OCD. This involves participating in a feared activity, such as eating anxiety-provoking food, and learning that the outcome isn’t as bad as you feared it would be.
Getting help for orthorexia starts with a visit to your doctor, who can refer you to a specialist.
Some resources to consider include:
- American Psychological Association psychologist locator
- National Eating Disorders Association (NEDA) Helpline
- NEDA Community
- NEDA Resources, in-person providers, and virtual providers
- Crisis Text Line
It may help to tell your friends and family what you’re experiencing. Many may want to offer help and support in your recovery.
Even though you’re seeking treatment for ON, you can keep your original goal of health and wellness. In fact, you may reach this goal faster when you learn to incorporate flexibility and moderation into your eating mindset.
Eating a broader range of less-than-“perfect” food will help you get the extra nutrients you’ve been missing. Learning to embrace a more realistic outlook on eating can ease some of the stress you’ve been feeling.
Just like other forms of disordered eating and mental health issues such as anxiety and OCD, orthorexia is treatable. You can live the healthy life you want, and achieving this goal may begin when you’re ready to accept help.