Effective Strategies and Predictable Complications in the Treatment of Orthorexia

In our previous article about Orthorexia, we described this relatively unknown and misunderstood condition.  In this, the second and final installment in this series, we discuss strategies and pitfalls in the treatment of Orthorexia.

Orthorexia treatment

Orthorexia can be effectively treated with Cognitive
Behavioral Therapy (CBT) and Mindfulness

Orthorexia, being a somewhat new conceptualization of a psychological disorder, is under-researched and often misunderstood within the mental health and medical communities.  Many mental health professionals have found success treating individuals with Orthorexia using evidence-based treatment methods that are used to treat other Eating Disorders, OCD, and related OC Spectrum Disorders.

Cognitive-Behavioral Therapy (CBT) and Mindfulness are two highly effective treatment methods used to treat Orthorexia.  Using CBT, individuals with Orthorexia learn to challenge and change their distorted thoughts (cognitions) related to their body and the foods they eat.  Education about nutrition and what is considered “healthy” should also be integrated into CBT when treating Orthorexia, using logical, evidence-based strategies.

Using Mindfulness Based Cognitive Behavioral Therapies such as Acceptance and Commitment Therapy (ACT), clinicians can help those who suffer with Orthorexia to gain greater awareness and acceptance of uncomfortable thoughts, feelings, sensations and urges related to food and their body.  This approach also helps clients to become more aware of and conscious of their food consumption.  The goal is for clients to become more comfortable with their bodies and their actual health (as opposed to their feared bad health).  Using these techniques, sufferers can change their relationship with a variety of foods and with their food-related anxiety.

The primary behavioral component of treatment for Orthorexia is Exposure and Response Prevention (ERP).  Some common ERP assignments might include the following:

  • Gradually introducing a broader variety of foods into the client’s diet, including healthy foods that the client has previously decided were unacceptable;
  • Restricting, and ultimately eliminating time spent researching food;
  • Restricting, and ultimately eliminating time spent discussing the health values of food;
  • Returning to normal social interactions, including meals with others.

It is important to note here that clients are encouraged to eat a healthful diet.  Some mistakenly believe that giving up their Orthorexia eating style will be the same as eating a bad diet.  Nothing could be further from the truth.  The goal is not to help the client learn that all food is healthy – after all, there are foods that are legitimately unhealthy, especially if eaten to excess.  Rather, the goal is to help the client learn to have a more balanced perspective towards food, and to eat in a manner that is both healthy and enjoyable.  In other words, the goal is not to teach the client to eat a diet of Big Macs and Slurpees, but rather to be able to eat based on choice, not fear.

Orthorexia In Perspective

Diagnosing and treating Orthorexia can be complicated by a number of factors:

First, the culture at large, and the news media in particular, reinforce on a daily basis that we should be hyper-conscious of health, weight, and nutrition, and that we should eat as purely as possible.

Second, people who experience Orthorexia often do not see that their obsessive thoughts and compulsive behaviors are problematic.  They see their diets as ideal and healthy, and see others’ diets as disgusting and unhealthy.  Great pleasure and satisfaction are gained from the belief that they have mastered and will continue to perfect their diet.  This may become an issue during treatment, as sufferers are likely to initially reject any suggestion that their diet is problematic, and equally likely to resist the idea that change would benefit them in a positive way.

Third, those with Orthorexia may initially feel significant discomfort during the exposure therapy that is so critical to treatment.  Exposures typically involve eating foods that individuals with Orthorexia deem “unhealthy” or “impure”.  They may at first have a strong visceral reaction when trying foods that they have long identified as disgusting and toxic.  The ultimate goal of exposure is for the client to learn that they need not fear less-than-perfect foods, that they may actually enjoy such foods in moderation, and that eating them does not result in a catastrophic outcome.

Fourth, those with Orthorexia are even more likely than the average client to reject the use of anti-depressants and other medications that may potentially help to reduce their anxiety and obsessionality.  Individuals with Orthorexia frequently view such medications as “poison”, and clinicians should be prepared for the possibility that the client will never be open to pharmacotherapy in any way.

Orthorexia is a significant and growing problem that requires serious consideration by the medical and psychological communities.  While Orthorexia is not yet recognized by the APA as a formal, free-standing diagnosis, failure to accurately identify and treat the condition will result in serious problems for many people who don’t necessarily meet the requirements for a formal eating disorder diagnosis.  Fortunately, Orthorexia responds well to treatment with Cognitive Behavioral Therapy (CBT) and Mindfulness Based CBT, especially if the clinician is able to first help the sufferer recognize the excessive and distorted nature of their thoughts and behaviors related to food purity.

To read part one of our series on Orthorexia, click here.

Kimberley Quinlan, MA, is a 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 six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.