Orthorexia nervosa is a condition that involves an unhealthy obsession with proper or healthy eating habits. The definition of orthorexia comes from the Greek word meaning “correct diet.” While orthorexia nervosa is not formally recognized in the Diagnostic and Statistical Manual of Mental Disorders(DSM-5) (though it can be covered under the diagnosis of Unspecified Feeding or Eating Disorder), orthorexia is recognized by the National Eating Disorders Association and has been gaining more attention in the last several years.
The term ‘orthorexia’ was coined in 1998 by Dr. Steven Bratman, author of the book Health Food Junkies. Dr. Bratman wrote about the condition as not simply conscious, healthy eating, but rather an obsession that closely resembles other eating disorders and ultimately leads to a harmful, unhealthy lifestyle.
The definition of obsession is an idea or thought that continuously preoccupies or intrudes someone’s mind. In terms of orthorexia nervosa, the constant thought and fixation on healthy, clean eating invade the individual’s mind. The obsession ultimately causes distress and damages their own well-being. The obsession often leads to high-risk choices, creating rules that are impossible to follow, and feeling guilty if failure occurs.
What is Clean Food
Individuals who suffer from orthorexia nervosa have a fixation on eating “clean” food. They feel that if they do not eat clean food they are at immediate risk of falling ill or contracting a disease. In some instances, the quest for clean also embodies a need to feel pure or without toxins, although the concept is magnified in individuals with orthorexia. In general terms of orthorexia nervosa, “clean foods” are organic, whole foods that are free of antibiotics or preservatives.
Most commonly, an individual with orthorexia nervosa will eliminate the following:
Artificial colors, flavors or preservatives
Pesticides or genetic modification
Fat, salt, and/or sugar
Animal and/or dairy products (typically both)
Other ingredients deemed to be “unhealthy”
However, this short list is taken to the extreme. Individuals with orthorexia will cut out entire food groups, labeling that them as “bad” until there are hardly any “good” food groups left. Individuals will also often experience severe anxiety when eating out and in regards to how their food was prepared. We’ll get more into this and other symptoms in the next section. Ultimately, there are many of us who have weird food habits, but wouldn’t be classified as having orthorexia. However, it is important to be able to understand the warning signs of the condition and recognize whether you could potentially be heading in a dangerous direction.
There are several warning signs and symptoms of orthorexia that you should be on the lookout for in terms of the condition.
Typically even if you are on a relatively strict eating regimen, you can make an exception here or there. However, individuals suffering from orthorexia nervosa do not make exceptions. Not for anniversaries, weddings, birthday, nothing. Because of this, individuals with orthorexia often don’t participate in group events (particularly when food is around).
Traveling = Anxiety
Traveling often creates anxiety for many individuals, but for people with orthorexia nervosa, this anxiety can go through the roof. Of course, traveling to uber health-conscious Los Angeles or New York may be no problem, but traveling to an unknown place can be terrifying.
Money & Time in Preparation
Individuals with orthorexia nervosa may spend extreme amounts of time and money on meal prepping and making sure that their food choices are appropriate for the lifestyle they want to live. This amount of time and money consequently takes away from spending their time and money doing just about anything else.
Obsessively Reading Labels
People who suffer from orthorexia nervosa will often obsess over labels. In part because of this fixation on ingredients, it is possible that individuals with orthorexia nervosa may consume less food than needed to sustain themselves.
Inflexible Eating Patterns & Creating Rules
You will often find an individual with orthorexia nervosa developing inflexible eating patterns and creating stringent rules that they force themselves to follow. For this reason, you likely will not find someone with orthorexia attending social gatherings centered around food.
Emotional Turmoil & Guilt
There is severe emotional turmoil and guilt that an individual with orthorexia experiences if they accidentally “cheat” on their strict regimen. Additionally, if the “cheating” comes by force, the individual may feel extreme resentment toward the source of that pressure.
Food, Food, Food
You may also recognize orthorexia in the way and the extent to which an individual obsessively talks and thinks about food. Somehow they are able to slide health and diet into just about any conversation.
Loss of Interest
The obsession with eating healthy can also take away from activities and other things that were once enjoyed by the individual. Now, most of their time is consumed by what they are going to eat next and obsessing over whether it fits into the mold of disordered eating habits that they created.
You may find people with orthorexia nervosa judging others for their eating habits. For this reason, it is common for people with the condition to distance themselves from family and friends who don’t have the same viewpoints on healthy food.
An obsession with the gym and working out can also be signs of orthorexia when paired with an all-encompassing fixation on healthy food choices.
Eliminating “Bad” Food
Another tell-tale sign of orthorexia is when an individual cuts out all “bad” food to the degree that eventually even food that is perfectly healthy, such as fruit, will be eliminated due to extreme reasons such as sugar content (even though the sugar is all natural). Eventually, all “good” food will be up for elimination as well on the quest for healthy eating. This is one of the ways that orthorexia resembles other symptoms of another eating disorder as well as obsessive-compulsive disorder.
Of course, the elimination of so many vital food groups leads to weight loss. When food groups are cut out abruptly and without replacing the necessary caloric intake with another source, weight loss can be rapid and very apparent.
We understand that a lot of people have diet choices that may come off as “weird” to others. This is not to say that those individuals have orthorexia, anorexia or bulimia. Furthermore, diets such as the paleo diet may seem extreme to some although it seldom leads to an eating disorder. However, there are several instances where diet can absolutely be a risk factor.
An extreme diet such as fruitarianism encompasses the condition of orthorexia nearly 100%. More often than not, a person who is a fruitarian has obsessive tendencies when it comes to food which has taken them in a direction where they are now living a dietary lifestyle that has ultimately become extremely unhealthy.
Raw Foods Veganism
Raw foods veganism is another extreme diet that can carry a high risk for developing orthorexia, due to the fact that it is often a difficult diet to maintain safely.
Orthorexia nervosa is presently not formally recognized in the DSM-5 as being a diagnosable mental health condition. The lack of formal diagnostic criterion for orthorexia nervosa leads to several issues, including making it difficult to accurately assess. Additionally, because there is a not an official diagnostic criterion, it isn’t entirely possible to gauge just how many individuals are suffering from the condition.
It has also difficult to determine whether orthorexia nervosa is a stand-alone eating disorder, or if the condition is a subtype of a preexisting disorder such as anorexia nervosa or obsessive-compulsive disorder. Studies have shown a link between orthorexia nervosa and obsessive-compulsive disorder in that the majority of individuals with orthorexia also have OCD.
The author who coined the term orthorexia, Dr. Steven Bratman, also created an orthorexia test. If you feel that you may be suffering from the condition, we encourage you to look into the self-test here.
Because the DSM-5 doesn’t formally list orthorexia as a mental illness, there is no exact treatment for orthorexia. However, many eating disorder experts treat the condition as a subtype of anorexia nervosa or obsessive-compulsive disorder.
Orthorexia nervosa treatment is still a new area of study. However, it is imperative that individuals suffering from the condition do not let it go unacknowledged. The disorder has the potential to cause serious, irreversible damage if left without attention.
Orthorexia: Final Thoughts
Comparable to anorexia, bulimia, and binge eating disorder, there is certainly hope for individuals suffering from orthorexia nervosa. Those who suffer are not alone. If you feel that you may have orthorexia, we urge you to talk to your mental health professional. The road to recovery may seem like a daunting one, but with support, you can begin today.