Orthorexia is an eating disorder that fixates on “healthy” food. A person with orthorexia will spend excessive amounts of time obsessing over what food they can eat based on its supposed health benefits. While healthy eating may seem like a good thing, for a person with orthorexia, it is all-consuming and can lead to diet imbalances, relationship problems and a decreased quality of life.
Orthorexia is not officially recognized as a mental health disorder, but it has been recognized by eating disorder specialists. It is beneficial to learn some common myths and the facts about orthorexia to help spread awareness about the condition.
Myth 1: Orthorexia is all about body image.
Fact: Orthorexia is all about “healthy” eating.
The focus of attention with orthorexia is on proper nutrition. Instead of body image concerns, a person with orthorexia obsesses over nutritious food. The diet is unusually restrictive, with particular preparation rules and rituals associated with eating. Eating patterns can include rules that decide what combination of foods can be eaten together, at what time of day and in what order they can be eaten.
The source of the food is a priority when it comes to deciding whether or not to include a certain food item. For example, are the vegetables organic or are the dairy products from hormone-free cows? Are preservatives or food coloring used? How was the food packaged? Does it contain plastic compounds that could be carcinogenic? The checklist for the inclusion of foods into an orthorexic diet is often long and detailed.
While the reasons for not eating certain foods may coincide with popular movements like sustainable agriculture, saving the environment, the welfare of animals or religious beliefs, the orthorexic person is not motivated by these factors. An orthorexic person chooses their foods with the desire to improve their physical health and will spend extensive amounts of time researching, measuring and planning future meals.
Myth 2: Orthorexia and anorexia are the same.
Fact: Orthorexia is focused on food quality while anorexia is focused on quantity.
Orthorexia sets itself apart from anorexia and other disorders based on the motivation for eating or not eating certain foods. Orthorexic individuals are not so much concerned with body image or the fear of obesity. Their eating habits are fixated on healthy, quality food that is considered pure. Their thoughts on food and their habits are often unrealistic. Unlike anorexic individuals who often hide their food behavior, individuals with orthorexia like to talk about their diets and can even make showy displays of their eating behavior.
While orthorexia and anorexia are distinct from each other, they do share some similar characteristics:
- Rigidity in thought
- Impaired functioning
- Limited insight into own condition
- Guilt over eating unacceptable foods
- Increased anxiety over perceived risks
- Weight loss
- Being controlling
Orthorexia also shares similarities with obsessive-compulsive disorder due to obsessional thoughts and compulsive behavior related to food. For these and other reasons, there has been debate as to whether orthorexia should be considered a disorder, an extreme dietary habit or a behavioral addiction.
Myth 3: Orthorexia is an officially recognized eating disorder.
Fact: Orthorexia is not formally recognized as an eating disorder.
The Diagnostic and Statistical Manual of Mental Health Disorders 5th edition (DSM-5) is used by US clinicians, researchers and public health officials to communicate about and classify mental health disorders. It includes the latest clinical and scientific evidence concerning psychiatric disorders. The most recent edition, the DSM-5, was published in May 2013. There is not currently any recognition of orthorexia in the DSM-5 as an eating disorder or any other classification.
There are features of orthorexia that can be seen in other classified disorders such as:
- Anorexia nervosa
- Obsessive-compulsive disorder
- Obsessive-compulsive disorder personality
- Somatoform disorders
Despite not having been formally identified as a disorder in the US, some have proposed possible diagnostic criteria for orthorexia. Symptoms (at least two) should be based on the obsessive preoccupation with food quality. Other criteria dictates that the obsessive preoccupation causes impairments to physical, social, academic or work-related functions, that the behavior is not connected to or exacerbation of another disorder, and that the food behavior is not related to or better explained by food allergies, medical conditions or religious food observances. Orthorexia could be classified as its own distinct disorder in the future.
Myth 4: Outside influence doesn’t impact orthorexia.
Fact: Social media platforms and blogs have a huge impact on orthorexia.
Social media has given free reign to fitness and health bloggers who are often promoting their own views of healthful eating. It acts as a platform for one-sided and often erroneous and unsupported health ideas. Some influencers have large followings of people which further seems to legitimize their point of view.
Social media also allows individuals to connect with people they view as similar. This, in turn, can further promote unhealthy food habits and behaviors.
The similarity or orthorexia to obsessive-compulsive disorder means that individuals with orthorexia tend to have obsessive thoughts that are intrusive. These thoughts can come up at inappropriate times. Ever-present social media platforms contribute to this intrusion with the constant flow of new posts and stories.
Myth 5: People with orthorexia are aware they have a problem.
Fact: People with orthorexia are often unaware that they have a problem.
Often times people with mental health disorders are unaware that they have a problem. It is no different with orthorexic individuals. While their knowledge of perceived food quality is high, their insight into their own condition is limited. Even when there are noted impairments due to their condition, they will deny any problems.
Orthorexic individuals can develop very rigid, or stubborn, thinking concerning their behavior related to food. Their own perception of their diet choices is in harmony with what they view as high quality and pure. It can be very difficult to change their minds on what they view as healthy or unhealthy.
Another feature of orthorexia is a sense of hypermorality, viewing their way of eating as the best and they are often not open to others viewpoints if they conflict with their own. In addition to flaunting their food habits and choices, they can act superior about such habits and avoid interaction with others who are not like them or who do not eat like them.
Myth 6: Orthorexia isn’t harmful.
Fact: Orthorexia can cause malnutrition and other health complications.
The food restrictions seen in orthorexia are based on what the individual considers healthy or unhealthy. Foods commonly restricted in an orthorexic diet can include genetically modified ingredients and foods that have undesirable amounts of fat, sugar or salt. The manner in which an orthorexic person prepares food originates from the same motivation for pure, healthful food. Care is given to how vegetables are sliced, what serving tools are used, etc. An inordinate amount of time and money can be spent choosing, buying, preparing and consuming food. This form of compulsive behavior and obsessive thoughts can lead to malnutrition and an unbalanced diet.
When an entire food group is eliminated from a person’s diet, there can be nutritional deficiencies. Extreme forms of orthorexia can have effects similar health complications as anorexia:
- Electrolyte imbalances
- Metabolic acidosis
- Weakened bone health
- Digestion problems
- Hormonal imbalances
- Slowed heart rate
Treatment for orthorexia ideally involves a team of physicians, therapists, and dieticians. Cognitive behavioral therapy and psychotherapy can help to restructure negative and rigid thought patterns concerning food. Medication such as selective serotonin reuptake inhibitors may also be helpful in orthorexia treatment.
Treatment for the condition will take time, as it can cause emotional upheaval for the orthorexic individual. Their food beliefs are deeply emotional and have provided structure to a person’s life.
If you or someone you know is struggling to balance obsessive thoughts concerning food and are using substances to cope, contact The Recovery Village. One of our representatives can discuss a treatment plan appropriate for you.
Koven, Nancy S.; Abry, Alexandra W. “The clinical basis of orthorexia nervosa: emerging perspectives.” Neuropsychiatric Disease and Treatment, February 18, 2015. Accessed May 30, 2019. Haman, Linn; Barker-Ruchti, Natalie; Patriksson, Goran; Lindgren, Eva-Carin. “Orthorexia nervosa: An integrative literature review of a lifestyle syndrome.” International Journal of Qualitative Studies in Health and Well-being, August 14, 2015. Accessed May 30, 2019. Mayoclinic.org. “Anorexia nervosa.” February 20, 2018. Accessed May 30, 2019.
Koven, Nancy S.; Abry, Alexandra W. “The clinical basis of orthorexia nervosa: emerging perspectives.” Neuropsychiatric Disease and Treatment, February 18, 2015. Accessed May 30, 2019.
Haman, Linn; Barker-Ruchti, Natalie; Patriksson, Goran; Lindgren, Eva-Carin. “Orthorexia nervosa: An integrative literature review of a lifestyle syndrome.” International Journal of Qualitative Studies in Health and Well-being, August 14, 2015. Accessed May 30, 2019.
Mayoclinic.org. “Anorexia nervosa.” February 20, 2018. Accessed May 30, 2019.
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