Orthorexia – The Not-So-Healthy Obsession with “Healthy” Eating

Orthorexia = Eating Disorder + OCD

Individuals suffering with Orthorexia exhibit symptoms
similar to those of OCD and Eating Disorders.

Orthorexia Nervosa (also simply known as Orthorexia) is a relatively new term within the psychological and medical fields. Simply defined, Orthorexia is an eating disorder in which an individual has an excessive and ultimately unhealthy obsession about maintaining a diet that is totally “healthy” and “pure”. Because of their extremely restrictive eating, individuals with Orthorexia are often severely underweight, and frequently lack the proper nourishment to perform basic daily activities. Like most cases involving an eating disorder, the outcome of Orthorexia can be severe malnutrition and a significant reduction of one’s quality of life.

Orthorexia has not yet been accepted as a formal diagnosis by the psychiatric community, and has not been defined within the Diagnostic and Statistical Manual (DSM-IV). However, since first being described by Dr. Steven Bratman in 1996, many health professionals have observed the often debilitating results of this condition.

Symptoms of Orthorexia

Like Obsessive Compulsive Disorder, Orthorexia can be conceptualized as a constellation of obsessive thoughts and compulsive behaviors. The most prominent obsession seen in Orthorexia is an excessive concern about the healthfulness of food. Those with Orthorexia often spend many hours of the day planning and obsessing about what foods they have eaten or will eat, the nutritional content of that food, and how that food has been grown, processed, and/or prepared. Individuals with Orthorexia may obsess about any number of nutritional aspects of food, including, but not limited to the following:

• Calories
• Sugar (especially “refined” sugar)
• High fructose corn syrup
• Fat
• Hydrogenated or partially hydrogenated fat (trans fats)
• Protein
• Carbohydrates
• Glycemic index
• Salt / sodium
• Fiber
• Gluten
• Dairy products
• Fatty acids
• Vitamin and mineral content of the food
• Whether or not a food is “whole” or “organic”
• Whether or not a food is sufficiently vegan, vegetarian, or macrobiotic
• Whether or not a food is genetically modified

The most obvious behavioral symptom of Orthorexia is the compulsive avoidance of foods that the sufferer deems unhealthy or impure.  Individuals with Orthorexia may at first simply eliminate a few specific foods from their diet, but over time, their diets often become more and more restrictive. Eventually, they may eat only a select small number of foods that have been prepared in a manner that they have decided is “correct” or “pure”. At the same time, they may also purchase many expensive, “natural” or “organic” health food products and supplements that they perceive as more pure and/or healthy than traditional foods.

In addition to food avoidance, individuals with Orthorexia will often spend excessive amounts of time researching food issues related to the above concerns. This research may include many hours of internet searching, buying and reading an excessive amount of food, health, and nutrition related books, and near-constant examination of food labels when shopping for groceries at the market.

For individuals with Orthorexia, the obsessive concern with what goes into their bodies may also extend to other, non-food related health issues. Often, they have a disproportionate level of fear related to the possibility of exposure to what they perceive as pathogens in everyday products and in the environment. This may result in compulsive avoidance of certain soaps, shampoos, perfumes, and deodorants, as well as x-rays, vaccinations, or even mercury in dental fillings. They may broadly reject much of western medical science in favor of homeopathy, osteopathy, and other “complementary” and “alternative medicine” approaches.

It is also common for those with Orthorexia to spend much of their social time discussing food, and attempting to convince others of the “correct” way to eat. This may result in conflict with families and friends who do not agree with their views, and who take offense when the person with Orthorexia repeatedly criticizes their food choices. Likewise, those with Orthorexia may take offense when friends and family express their concerns about the health and dietary choices of the sufferer.

On a more internal, psychological level, those suffering with Orthorexia often experience significant guilt and shame when they do not maintain their purist dietary rules. They are usually extremely strict with themselves about their diet and their overall health, and are often overly judgmental towards themselves and their ability to control what they eat. Frequently, much of their self-esteem and sense of identity is rooted in their diet and in their success in satisfying their high levels of self-discipline.

Diagnosis and Relationship to Obsessive-Compulsive Disorder

While some see Orthorexia as an eating disorder, many mental health experts agree that it is best conceptualized as a hybrid of an eating disorder and Obsessive Compulsive Disorder (OCD). Like OCD, Orthorexia is defined by the individual’s obsessive thoughts (in this case, thoughts about certain foods being Mindfulness Workbook for OCDdangerously unhealthy), and the compulsive behaviors done in an effort to minimize the anxiety caused by those obsessive thoughts (in this case, food avoidance, as well as the other behaviors noted above).

The food avoidance seen in Orthorexia also has an obvious relationship to Anorexia. In fact, many with Orthorexia are eventually diagnosed with Anorexia as a result of weight loss related to their food avoidance. And some mental health clinicians see Orthorexia as a behavioral symptom of Anorexia in which the individual uses the issue of “healthfulness” as a justification for not eating.

It is also worth noting that some with Orthorexia will resort to purging behaviors similar to those seen in Bulimia in an effort to rid their bodies of impurities that they believe they may have ingested. Purging behaviors may include vomiting, use of laxatives and emetics, and use of colon cleansers to rid themselves of alleged toxins. Likewise, similar to those with Anorexia and Bulimia, individuals with Orthorexia often perform other compensatory behaviors such as compulsive exercising in an effort to make their bodies as perfect and pure as possible.

Symptoms of Orthorexia also overlap with those of other Obsessive Compulsive Spectrum Disorders. The excessive focus on “healthfulness” leads many to develop a distorted over-concern with their actual health, not unlike those with Hypochondria (also known as Health Anxiety). Likewise, many with Orthorexia have a distorted body image, much like those with Body Dysmorphic Disorder (BDD).

Because of the extreme restrictions commonly seen in this condition, it is often very difficult for those with Orthorexia to eat socially, or even be in social places at all. As result of trying to avoid being confronted about their food obsession, many with Orthorexia develop a pattern of social avoidance similar to that of Social Anxiety. The result is often a reduction in social interaction, and in some cases, a complete severing of friendships and relationships in order to maintain and protect their diet.

Finally, it is worth noting the overlap between phobias and Orthorexia. The two primary distinguishing features of phobias are the sufferer’s irrational fear of a specific object or event, and their subsequent efforts to avoid exposure to that object or event. Some conceptualize Orthorexia as essentially being a food phobia, in which the individual is terrified of being exposed to foods that they irrationally see as imminent threats to their well-being.

Click here to read part two of this series, which examines the treatment of Orthorexia utilizing Cognitive Behavioral Therapy.

Kimberley Quinlan, MFT, is a licensed psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions, including Orthorexia.  In addition to individual therapy, the center offers four weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.