Orthorexia

Orthorexia is an eating disorder characterized by an obsessive focus on eating “clean” and “healthy” foods. Generally speaking, eating disorders are mental disorders characterized by abnormal eating habits that negatively affect an individual’s physical or mental health.  

Although orthorexia often starts as an attempt to achieve a healthy lifestyle through a seemingly healthy diet, an individual with orthorexia may become obsessed with eating clean. Altogether, strict dietary restrictions and inflexible eating patterns can have adverse effects, such as nutritional deficiencies, malnourishment, or decreased quality of life, among other mental and physical health consequences.  

The exact cause of orthorexia is not entirely understood; however, like other eating disorders, orthorexia tends to affect young people who struggle with the social pressure to look a certain way and appear healthy.  

Risk factors for developing an eating disorder include biological factors, like genetics and hormones, as well as environmental factors, such as the psychosocial pressure to have the socially defined “ideal body” perpetuated by social media; or having careers that promote weight loss, like modeling and sports. Other factors related to one’s past experiences, including a history of bullying, loneliness, low self-esteem, and childhood trauma, are all linked to the development of eating disorders. 

The hallmark of orthorexia is an excessive concern about the quality and purity of the individual’s diet. Individuals with orthorexia may find themselves compulsively checking ingredient lists or nutritional labels and may avoid eating anything but a narrow group of foods that are deemed “healthy” or “pure.” Therefore, although weight loss may occur because of the individual’s food choices, it’s not usually the primary goal.   

Individuals with orthorexia may have ritualized patterns of preparing and eating food. They can become obsessed with researching food, measuring food, or planning their meals. When it comes to eating food, individuals with orthorexia might develop complex patterns and rules, such as processing food in a certain way (e.g., not cooking the food because they believe it decreases nutritional value).  

The individual’s beliefs about what is healthy may lead to cutting essential nutrients or whole food groups (e.g., sugar, carbohydrates, dairy products, meat, or all animal products) from one’s diet, which can lead to severe nutritional deficiencies or malnutrition. Individuals with this condition often limit their intake to foods that are organic, farm fresh, whole, raw, or vegan. After time, the individual’s self-esteem may become tied to the purity of their diet, and they may feel superior to others in regard to their food intake.  

Some people with orthorexia may experience anxiety simply by being around “unhealthy” foods and may feel an intense need to separate themselves from their forbidden foods. In certain cases, individuals may believe that breaking their dietary rules may decrease their overall health or lead to physical or mental illnesses. When individuals break their dietary rules and stray from their usual eating habits, they typically experience severe anxiety, distress, shame, or guilt. 

Because individuals with orthorexia tend to regard food as a source of health rather than pleasure, they often avoid social events where food is involved and may experience high levels of distress when “safe” or “healthy” foods are not readily available. Avoiding social events and self-isolation may eventually lead to depression, intensified thought disturbances, and adverse eating behaviors.  

Diagnosis of orthorexia is typically made by eating disorder specialists when someone presents with an obsessive focus on eating clean. Orthorexia nervosa is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5); however, it’s just as clinically significant as any other eating disorder and can have severe physical and mental health consequences if not treated.  

Eating disorders that don’t fit the criteria for anorexia, bulimia, or binge eating disorder might be diagnosed as “Other specified feeding or eating disorder,” according to the DSM-5.  Because orthorexia still does not have any formal diagnostic criteria, there’s still considerable debate about whether it’s a stand-alone eating disorder, obsessive-compulsive disorder (OCD), or an extreme form of culturally influenced behavior.  

Treatment of orthorexia involves a combination of nutritional rehabilitation and psychotherapy, such as cognitive behavior therapy (CBT), which is aimed at restoring and stabilizing eating patterns and changing the individual’s thoughts and beliefs about food and how it impacts their health.  

Additionally, individuals with severe depression or anxiety can be treated with antidepressants, such as a selective serotonin reuptake inhibitor (e.g., fluoxetine, paroxetine, sertraline), in combination with psychotherapy.