What Is Orthorexia?

Orthorexia, a.k.a. orthorexia nervosa (ON), is an all-consuming obsession with healthy eating. People with this eating disorder become obsessed with nutrition and food preparation. This may lead them to eliminate entire food groups and constantly consider the food with the highest nutritional value and healthiest cooking methods. For example, people with orthorexia may eat only grass-fed, organic, non-GMO, low-carb, low-sodium, and non-dairy foods. If they deem the food available to be unhealthy, they may forgo eating.

Associated with the eating disorder anorexia nervosa (AN), where individuals restrict their food intake because of their distorted body image, orthorexia nervosa can adversely affect cardiovascular, gastrointestinal, neurological, and endocrine health and be fatally dangerous.

Symptoms

Symptoms may vary from person to person. They are influenced by cultural concepts of what is considered healthy. You do not need to experience all the symptoms to be considered orthorexic.

The symptoms of orthorexia include:

• Uncontrollable need to check labels and ingredient lists
• Anxiety over food quality, preparation, and freshness
• Cutting out food groups or ingredients like dairy, meat, or sugar
• Strong association between personal worth and what you eat (i.e., you are pure if you eat "clean")
• Avoidance of eating foods prepared by others, including restaurants, family members, and supermarkets 
• Obsessively research food and meal planning for perfection (several hours per day)
• Idolizing “healthy” social media influencers on Twitter and Instagram
• Criticizing other people’s food choices and even distancing yourself from people who do not eat “right”
• Mood swings regarding food choices and options, including extreme irritability, shame, and anger over foods eaten 

Complications

Orthorexia nervosa can cause nutritional deficiencies and lead to serious health complications, as well as interpersonal problems, including self-isolation in order to maintain self-imposed dietary compulsions and restrictions.

When self-esteem is so strongly intertwined with food choices, negative effects can wreak havoc on a person’s mental health. These consequences can be similar to those resulting from other eating disorders. 

Physical

The toll orthorexia can take on your body mirrors that of other eating disorders:

• Slowed digestion known as gastroparesis
• Chronic constipation
• Slowed heartbeat and lowered blood pressure due to caloric restrictions (risk of heart failure and death)
• Reduced resting metabolic rate as a result of the body’s attempt to conserve energy
• Dry skin and hair can become brittle and fall out
• Menstruation irregularities
• Growth of fine, downy body hair called lanugo to preserve warmth
• Without enough fat or calories, sex hormone production drops

Psychological

Any erratic eating, dieting, fasting, and self-starvation mean the brain isn’t getting the energy it needs, which can lead to obsession about food and difficulty concentrating. 

The psychological symptoms of orthorexia include:

• Obsessive thinking and hunger pangs before bed disrupting sleep
• Preoccupation with health and intrusive food-related thoughts and worries 
• Extreme fear of “dirty” food and food-manufacturing ingredients, including pesticides and herbicides

Social

Social implications vary based on severity of symptoms. People with orthorexia may experience the following:

• Spending a large portion of one’s income on foods
• Exclusion due to fixation on proper nutrition and healthy eating 
• Obsession with portrayal of health on social media platforms
• Following and idolizing health “influencers” despite them having detrimental effects on their self-perception, self-esteem, and food behaviors

History

Orthorexia is an eating disorder that was first defined by Dr. Steven Bratman and David Knight in the late 1990s as “a fixation on eating healthy food as a means of avoiding ill health and disease," and was later described in 2000 as a “disease disguised as a virtue.” 

"Ortho" has its roots in the Greek word “orthos,” which in English means “right.” The Greek word “rexia” means "hunger."

Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called healthy eating that they actually damage their own well-being.

Diagnosis 

Orthorexia is not recognized as a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5). It has been categorized as an avoidant or restrictive eating disorder, a lifestyle syndrome, and an extreme exercising habit.

Diagnostic criteria for orthorexia do not exist, so it can be difficult to identify. The following are some of the orthorexia nervosa diagnostic criteria proposed in 2014 by researchers at the University of Colorado School of Medicine:

• Obsessional preoccupation with eating “healthy foods,” focusing on concerns regarding the quality and composition of meals
• Obsessional preoccupation that becomes impairing
• The disturbance is not merely an exacerbation of the symptoms of another disorder, such as obsessive-compulsive disorder, schizophrenia, or another psychotic disorder
• The behavior is not better accounted for by the exclusive observation of organized orthodox religious food observance, diagnosed food allergies, or medical conditions requiring a special diet

Risk Factors

It's unknown what causes orthorexia, but it’s known that people with certain psychiatric disorders or personality traits appear to be at increased risk of this disorder, including:

• Obsessive-compulsive disorder (OCD)
• A history of other eating disorders
• Tendency toward perfectionism
• Anxiety
• Need for control
• Clean eating diets that cut massive amounts of foods or whole food groups
• Instagram use

People for whom health and weight control or appearance is professionally important, such as athletes, healthcare workers, social media influencers, and dieticians, are also at risk.

Treatment 

As with other eating disorders, the first step toward treatment is to admit there is a problem. Although there are not formally designated treatment regimens, as there may be for other eating disorders, experts suggest that the best approach to orthorexia involves receiving care from an interdisciplinary team that can address the disorder’s complexity. Connecting with a mental health professional, doctor, and dietician is advised.

Forms of treatment recommended for orthorexia include:

• Weight consultation and restoration as needed
• Psychotherapy, which can help increase the variety of foods eaten and exposure to anxiety-provoking or feared foods
• Inpatient eating disorder recovery programs or temporary hospitalization in severe cases