Orthorexia nervosa, or orthorexia as its commonly called, is an unhealthy preoccupation with eating ‘healthy’ food. Of course, it’s great to eat wholesome and nutritious food as often as possible. But when you’re suffering from orthorexia, you’ll find yourself obsessing over what you put into your mouth so much it becomes detrimental to your overall well-being.
Picture someone who just went carb-free, gluten-free or any other popular ‘cut-thisout- of-your-diet’ fad of the moment. Most people who try this end up being frustrated with the difficulty of maintaining such diets in the long term, simply because it’s hard to exclude entire food groups from our day-to-day lives.
But some people, if they suffer from orthorexia, take it a step further. They’ll obsess over every single morsel of food they see. They’ll refuse to eat anything they haven’t cooked themselves. They’ll refuse to go to restaurants or social visits with friends out of fear of delicious temptations ruining their diet.
In short, those living within the confines of orthorexia will find their lives being controlled by something they wish to avoid—and their lives, well-being, and health will be worse off for it.
What are the negative health effects of orthorexia?
Everybody can fall into the trap of an eating disorder. Each one has its own list of different negative health effects, too. But for orthorexia nervosa, the common consequences fall into three categories.
Physical: A built-up shortage in essential nutrients caused by cutting out certain food groups can lead to anemia, malnutrition, heart, and digestion problems. These should not be underestimated.
Psychological: As the disorder is thought to be progressive, those suffering from orthorexia can find themselves becoming extremely obsessive, self-loathing, anxious, and finding a need to occasionally cleanse in the form of fasting. There is also evidence that orthorexia negatively affects the ability to perform complex problem solving and related tasks.
Social: Individuals with orthorexia might find themselves avoiding any and all events that involve food, as well as chastising friends and family when it comes to their own food choices, furthering their social isolation over time.
How is orthorexia diagnosed?
The term has been around since 1997 after Steven Bratman, MD, first wrote about the subject. However, as the research is relatively new and ongoing, the term orthorexia nervosa has not yet entered into the DSM-5 nor is it officially recognized by the American Psychiatric Society.
That being said, Steven Bratman and Thom Dunn proposed formal criteria for the disorder in the peer-reviewed journal, Eating Behaviors in 2016.
Criterion A: An obsessive preoccupation with healthy eating.
Compulsive behavior and obsessive thinking about eating food believed to be healthy.
Violation of self-imposed rules around eating that cause shame, anxiety, a fear of disease or infection, or negative physical sensations.
Escalating dietary restrictions that become more and more complicated and may lead to eliminating entire food groups or periodic fasts and cleanses without the direct desire to lose weight.
Criterion B: The behavior interferes with daily life.
Malnutrition, severe weight loss, and/ or other medical complications directly attributed to eating behavior.
Social, vocational, and academic activities suffer, while the obsession over eating takes precedence in every decision. Self-worth, identity, and body image is directly associated with adherence to the diet.
Two tests were developed based on the above criteria, the ORTO-15 and the Orthorexia Self-Test created by Dr. Bratman. However, the tests likely need further development before being considered complete.
A more recent test called the ORTO-R, developed in 2021, is waiting for more widespread adoption.
Who is affected by orthorexia?
According to one study based on the ORTO-15 diagnostic test, 6.9% of the general population might be affected by orthorexia nervosa.
Certain careers and professions also seem to be at higher risk for orthorexia than the general population. Dieticians and healthcare professionals are one group.
Performing artists such as musicians and ballet dancers, as well as athletes are also more likely to get the disorder. Some studies suggest people who follow a vegetarian or vegan diet and lifestyle are also at higher risk for developing orthorexia nervosa.
General risk factors include histories of altered eating patterns, obsessive-compulsive proclivities, and a higher socioeconomic status. Studies have shown a slight prevalence of orthorexia affecting men more than women.
What is the treatment for orthorexia?
As the diagnosis and studies of orthorexia nervosa are still ongoing, there isn’t yet a defined official guideline for treatment. If you recognize you have an unhealthy relationship with eating, the first course of action is to consult with a physician, a psychologist, and/or dietician. They might advise the patient of one or more treatments along the lines of:
Cognitive reframing: Therapy to help a patient identify thoughts and habits that lead to destructive behavior, replacing them with healthier thinking patterns.
Behavior modification: Therapy designed to help a patient realize the negative effects of current behaviors to avoid them in the future.
Exposure and response prevention: Exposing a patient to the undesired behavior (patient’s perspective) can help lessen the gravity of the disorder and lead to better behavior in the future.
Nutritional modification: By assessing what vitamins and minerals a patient is lacking from malnutrition, many of the underlying problematic desires and actions can be reduced or eliminated.
Relaxation training: Therapeutic practices like mindfulness, meditation, yoga, and breathing exercises can help calm the mind and lessen obsessive urges.
Orthorexia nervosa as a diagnosis has only been around for a bit more than two decades. But the prevalence of diet books, fitness trainers, gyms, and the bombardment of six-pack advertisements likely means eating disorders will be on the rise for the foreseeable future.
From my own extensive experience treating thousands of patients for more than two decades, I view orthorexia as an offshoot form of obsessive-compulsive disorder. OCD is usually defined as a collection of obsessive thoughts and compulsive behaviors.
But in orthorexia’s case, the preoccupation and fixated thoughts will consume hours per day focusing on what to eat, when to eat it, and admonishing the self for not ‘sticking to the plan’ in the past. People with an unhealthy relationship to food can eventually find themselves becoming anorexic, bulimic, or in this case, orthorexic. These food disorders almost always have one common underlying factor as well; malnutrition.
As these disorders become more and more profound over time, the greater the negative effect the lack of vital vitamins and minerals takes on the body. This only furthers the complexity of regaining control of a patient’s life.
If you or a loved one find yourself being affected by orthorexia or another diagnosis, please consult a physician to discover the next steps in the road to recovery. You just have to take the first step.
Dr. James Greenblatt is a globally recognized integrative medicine expert, educator, and author. He has lectured internationally on the scientific evidence for nutritional interventions in psychiatry and mental illness. Dr. Greenblatt received his medical degree and completed his psychiatry residency at George Washington University. He completed a fellowship in child and adolescent psychiatry at Johns Hopkins Medical School. Dr. Greenblatt currently serves as the Chief Medical Officer at Walden Behavioral Care in Waltham, MA and serves as an Assistant Clinical Professor of Psychiatry at Tufts University School of Medicine and Dartmouth College Geisel School of Medicine. He is the founder of Psychiatry Redefined, an educational platform dedicated to the transformation of psychiatry. To learn more, please visit www.JamesGreenblattMD.com.