Although a balanced diet and awareness about the nutritional quality of the food you eat are desirable due to their positive impact on health, obsessive fixation on so-called ‘healthy eating’ may become pathological and have negative effects on well-being. This condition is known as Orthorexia Nervosa or Orthorexia.

What is Orthorexia

American physician Steve Bartman defined orthorexia in 1997 in Yoga Journal, and subsequently in his book entitled Health Food Junkies.

The term orthorexia comes from the Greek words: orthos – ‘normal’, and orexia – ‘appetite’.

The Diagnostic and Statistical Manual does not formally recognize it. So, if someone with the symptoms visits the doctor, they would not officially diagnose them with “orthorexia,” although they may discuss the term.

A person with orthorexia is fixated on eating “pure” food to an excessive degree. They reject a variety of foods for not being “pure” enough. Unlike other eating disorders such as anorexia nervosa or bulimia nervosa, which focus on the quantity of food or weight control, orthorexia revolves around the quality of food. 

Eventually, people with orthorexia begin to avoid foods such as those with artificial additives, foods treated with pesticides, or particular ingredients (e.g. fat, sugar, or salt).

Related: Orthorexia vs. Anorexia

Orthorexia Nervosa Signs

There are various assessment tools available for orthorexia. A quick test can be assessed here.

The most common signs and symptoms experienced by a person with orthorexia are:

• Fixation over “quality” or “purity”: They eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’.
  Compulsive checking of ingredient lists and nutritional labels with concerns like: Were the vegetables treated with pesticides or artificial fertilizers? Are dairy products free from hormones? Were any nutrients lost during cooking? Were any preservatives added?
• Cutting out particular foods and food groups (processed foods, sugar, meat, dairy products, carbohydrates, and/or gluten) from their diet in an attempt to make their diet more healthy. More and more foods may be cut out over time.
• Judgment about the eating habits of others.
• Obsessive following of ‘health’ blogs on social media
• Their emotional well-being is dependent on eating the “right” food. Increased focus on what they’re eating may interfere with other areas of the person’s life, such as their relationships or work.
• If they break the so-called “rules”, they feel shame, guilt, or even self-loathing. They may feel the urge to punish themselves, which leads to stricter dietary restrictions or the use of purifying starvation diet.
• Anxiety about their food choices, particularly around their diet not meeting their personal high standards of ‘quality’.
• Social isolation due to withdrawal from activities that do not align with their strict dietary regime
• If someone with orthorexia is following a diet that cuts out important food groups or nutrients, this could lead to malnutrition, with signs such as weakness, weight loss, tiredness, taking a long time to recover from illness, low energy levels, etc.

Diagnostic Criteria for Orthorexia

Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not formally recognize orthorexia as an eating disorder, researchers have proposed diagnostic criteria to identify it. Some common criteria include:

• Preoccupation with Healthy Eating: Spending a significant amount of time thinking about, planning, and researching healthy foods.
• Severe Dietary Restrictions: Imposing strict rules and limitations on food intake, often eliminating entire food groups deemed unhealthy.
• Negative Impact on Life: The obsession with healthy eating negatively affects various aspects of life, including social interactions, work, and mental well-being.
• Physical Consequences: Experiencing physical consequences such as malnutrition, weight loss, or digestive issues due to dietary restrictions.

The Cultural Context Of The Spread Of Orthorexia

The recent global phenomenon of ‘clean eating’ celebrates and encourages orthorexia behaviors.

Studies say that an important role in the development of eating disorders is played by the media and the way in which information about “food purity” is disseminated.

Individuals influenced by this may unknowingly slip into disordered eating patterns.

Orthorexia Treatment

With the right support, many people who experience symptoms of orthorexia can go back to having healthy, joyful, balanced relationships with food.

Treating orthorexia typically involves a multidisciplinary approach that addresses both the physical and psychological aspects of the disorder. Some common treatment strategies include:

• Therapy: Cognitive-behavioral therapy (CBT) and psychotherapy can help individuals identify and challenge unhealthy thoughts and behaviors related to food and body image.
• Nutritional Counseling: Working with a registered dietitian can help individuals develop a more balanced approach to eating and overcome fears related to certain foods.
• Medical Monitoring: In severe cases where malnutrition or other physical complications are present, medical monitoring and intervention may be necessary to stabilize the individual’s health.
• Support Groups: Joining support groups or seeking support from friends and family can provide individuals with encouragement and understanding as they work towards recovery.

If you or someone you care about is potentially experiencing any of the symptoms above, it’s important to speak to a health professional as soon as possible.

Summary

• A person with orthorexia is fixated on eating “pure” food to an excessive degree.
• Warning signs include various behavioral, psychological, and physical changes.
• It is important to seek help.
• Recovery is possible with the right support.

References:

1. Gortat, M., Samardakiewicz, M., & Perzyński, A. (2021). Orthorexia nervosa – a distorted approach to healthy eating. Psychiatria Polska, 55(2), 421-433. doi:10.12740/pp/125387

2. Hyrnik, J., Zasada, I., Wilczyński, K., Jelonek, I., & Janas-Kozik, M. (2021). Orthorexia – current approach. A Review. Psychiatria Polska, 55(2), 405-420. doi:10.12740/pp/115149