Striving for a healthy pattern of eating is generally a good goal unless it is taken to extreme. About two decades ago, the term orthorexia was coined. It had been noted that some individuals were becoming more obsessive in their attempt towards healthier eating. This then resulted in an exaggerated preoccupation with only allowing themselves to eat what they deemed as healthy foods and a progression towards excessive food limitations.
Although orthorexia is not officially categorized as an eating disorder, based on the Diagnostic and Statistical Manual that defines specific eating disorders, the negative impacts can be similar. Since there is not an exact definition of the term, diagnosis can be difficult. Instead of a concrete cut off between a healthy and unhealthy relationship with food, think of it as a continuum or pendulum moving from healthy eating on one side towards unhealthy eating on the other. It is the point at which a healthy diet no longer serves the purpose of improved health.
Many people have adopted popular diets that involve food restriction and food rules. Although these can sometimes lead to negative health outcomes, this does not mean these individuals have orthorexia. Orthorexia has a more psychological connection with food intake.
An individual with orthorexia has specific self-imposed food rules to which they feel they need to adhere. Eating is often ritualistic. It generally involves food thoughts that are obsessive, compulsive, and self-punishing if they deviate from their food rules. They may experience a high level of distress when foods they deem as safe are not available.
A person with orthorexia may start with a goal of eating cleaner and avoiding certain types of foods and food additives, but then adds more restrictions as time goes on. Their food restriction can be related to how foods are grown and/or prepared. They may spend a lot of time learning about what might constitute a healthy food, securing allowed foods, obsessively reading food labels to determine the health of the ingredients, and preparing foods in a way they deem acceptable.
Their extensive food rules make it difficult to eat out, to travel, or to allow others to prepare foods for them which can negatively impact interactions with others. They may also become more judgmental about the way other people eat. These tendencies can lead to social isolation over time.
Conscious or subconscious reasons for the restrictive eating can be due to a drive towards perfectionism, the desire for a greater sense of control in their life, a need to feel superior to others in some way, or other emotional needs.
Unfortunately, as the list of allowed foods becomes shorter, there is a risk for malnutrition, unhealthy weight loss, low energy levels, feeling overwhelmed about eating options, spending an excessive amount of time thinking about food, health concerns, increased emotional stress, depression, and greater anxiety. These can all impact mental, emotional, and physical function. What starts out as a healthy eating goal can then lead to unhealthy consequences which can actually damage well-being.
To make matters worse, if the individual does not strictly adhere to their own food rules, they often feel guilt, a sense of failure, and self-hatred. This can negatively affect body image, self-worth, identity, and personal satisfaction. They can become constantly fearful of food and of making food mistakes.
As compared to anorexia nervosa, orthorexia is usually not related to a weight loss goal, although the resulting restrictions can lead to weight loss. With orthorexia, it is the quality not the quantity of food that is the main focus. Orthorexia, however, can lead to anorexia nervosa.
In addressing orthorexia, the recommendation for treatment is similar to what would be suggested for an eating disorder working with a professional team consisting of a therapist, registered dietitian, psychiatrist, and a health care provider.
Since it has a psychological base, the team would help the individual explore the root causes of the progression to orthorexia and then assist them with ways to move towards a healthier relationship with food. Examples of possible topics might be addressing black and white thinking, easing obsessive thoughts, and moderating perfectionism. Discussions could also involve healthier ways to feel more in control of their lives and coping skills for anxiety.
It can be helpful to for the individual to consider their self-imposed food rules and the concerns of food restriction. Discussions with the treatment team may involve topics related to the importance of food for nourishment, brain and body fueling, and emotional stability. The treatment team can help the individual develop a more positive self-image and learn to feel pleasure/satisfaction from eating.
Recovery can also involve reframing the definition of healthy eating to mean making health choices most of the time but allowing some less healthy foods in moderation some of the time without guilt or self-blame. This could potentially ease the stress and obsessive thinking of orthorexia.
Pam Stuppy, MS, RD, CSSD, LD is a registered, licensed dietitian with nutrition counseling offices in York, ME and Portsmouth, NH. She has also been the nutritionist for Phillips Exeter Academy, presents workshops nationally, and is Board Certified as a Specialist in Sports Dietetics. (See www.pamstuppynutrition.com for more nutrition information, some healthy cooking tips, and recipe ideas).