Healthy eating can lead to major improvements in health and well-being.
However, for some people, the focus on healthy eating can become obsessive and develop into an eating disorder known as orthorexia
What is orthorexia?
The term Orthorexia or “orthorexia nervosa” describes an obsession with healthy, “pure,” or “clean” eating. It was coined as an analogy to anorexia nervosa: “ortho,” meaning right; “rexia,” meaning hunger; and “nervosa” meaning fixation or obsession.
Unlike other eating disorders, orthorexia mostly revolves around food quality, not quantity. Unlike with anorexia or bulimia, people with orthorexia are rarely focused on losing weight.
Instead, they have an extreme fixation with the “purity” of their foods, as well as an obsession with the benefits of healthy eating.
The medical community is beginning to recognize orthorexia, although neither the American Psychiatric Association nor the DSM-5 has officially defined the condition as an eating disorder.
American physician Steve Bratman first coined the term “orthorexia” in 1997. The term is derived from “orthos,” which is Greek for “right.”
What causes orthorexia?
Although you may begin a diet simply intending to improve your health, this focus can become more extreme.
Over time, good intentions can slowly develop into full-blown orthorexia.
Research on the precise causes of orthorexia is sparse, but obsessive-compulsive tendencies and former or current eating disorders are known risk factors.
Other risk factors include tendencies toward perfectionism, high anxiety, or a need for control.
Several studies also report that individuals focused on health for their career may have a higher risk of developing orthorexia.
Frequent examples include healthcare workers, opera singers, ballet dancers, symphony orchestra musicians, and athletes. The risk may also depend on age, gender, education level, and socioeconomic status, but more research is needed before conclusions can be reached.
How common is orthorexia?
In some cases, it can be hard to differentiate between orthorexia and a normal preoccupation with healthy eating.
For this reason, it’s hard to determine how common orthorexia is. The rates in studies range from 6% to 90%. Part of this is also because the diagnostic criteria are not universally agreed upon.
What’s more, the criteria don’t assess whether the behaviors negatively impact the person’s social, physical, or mental health, which is a crucial part of orthorexia.
Enthusiasm for healthy eating only transforms into orthorexia when it turns into an obsession that negatively affects everyday life, such as extreme weight loss or a refusal to eat out with friends.
When taking these negative effects into account, the rates drop to less than 1%, which is much more in line with the rates of other eating disorders.
Diagnosis
In a 2016 paper in the journal Eating Behaviors, Dr. Bratman and his co-author, Thom Dunn, proposed the following diagnostic criteria:
Criteria A
All of the following:
- Compulsive behavior and/or preoccupation with a restrictive diet to promote optimum health.
- Violation of self-imposed dietary rules causes exaggerated fear of disease, a sense of personal impurity, and/or negative physical sensations, anxiety, and shame.
- Dietary restriction increases over time and may come to include the elimination of food groups and cleanses. Weight loss commonly occurs, but the desire to lose weight is not the focus.
Criteria B
Any of the following:
- Malnutrition, severe weight loss, or other medical consequences from a restricted diet.
- Intrapersonal distress or impairment of social, academic, or occupational functioning due to beliefs or behaviors about healthy diet.
- Self-worth, identity, and body image unduly dependent on compliance with one’s “healthy” diet.
Research is needed to refine the diagnosis, determine prevalence rates, identify risk factors, and develop treatments. An important first step is developing an assessment tool; a 100-question survey is in development to assess and diagnose orthorexia.
Researchers are currently proposing the use of the diagnostic tool ORTO-R, which contains six items from ORTO-15 determined to be the best markers.
Other Risks
Dr. Bratman reported that the condition of orthorexia has already shown signs of evolution since he first conceived of it.
He noted that exercise is now more commonly a part of it than it was in the 1990s. He also reported that incorporating low-calorie foods has also become a bigger part of the healthy eating associated with orthorexia.
Orthorexia may also, on occasion, be a disguise for anorexia by individuals presenting a more socially acceptable way of staying thin. Orthorexia nervosa may also cross over with bulimia nervosa and avoidant/restrictive food intake disorder (ARFID).
Because it can cause malnutrition, orthorexia nervosa may produce any of the medical problems associated with anorexia nervosa including loss of menses, osteoporosis, and heart failure.
Treatment
Although treatments have not been specifically validated for orthorexia, clinicians have reported that treatments that challenge the dietary theory and build more flexible eating have been successful in the treatment of orthorexia.
If you or a loved one shows signs of orthorexia, please seek help from an eating disorder treatment professional. As with other eating disorders, early intervention increases the chance of a complete recovery and minimizes negative consequences.
Counseling is the mainstay of treatment. Some treatment approaches that may be recommended include cognitive behavioral therapy and dialectical behavior therapy. Medications such as antidepressants and anti-anxiety medications may also be helpful.
Often, people with eating disorders cannot recognize the power the condition has over them. In fact, people still believe what they are doing is to be healthy and don’t see it as problematic. They may not even be inclined to speak with a doctor at all.
If your current thoughts and/or behaviors surrounding food is causing distress and/or impacting your daily functioning, then it is advised to seek professional help.
