Orthorexia refers to obsessive thoughts and behaviors regarding eating healthful or “clean” food.
While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not classify orthorexia as a separate eating disorder, such as anorexia nervosa, some argue that it is a subtype of avoidant/restrictive food intake disorder (ARFID).
A person with orthorexia may follow a strict diet comprising only “clean” or “pure” foods, such as organically grown fruits and vegetables. The obsession with clean eating can be all-consuming for the individual.
These strict rules for eating can lead to social isolation, malnutrition, and mental distress.
Continue reading to learn more about orthorexia, including the warning signs, treatment options, and how to cope.
Orthorexia nervosa, which people may refer to as righteous eating, is a harmful obsession with proper nutrition. Its hallmark is a strict avoidance of foods that a person believes to be impure or unhealthful.
However, although orthorexia may lead to anorexia, there are subtle differences between the two.
A person with anorexia typically focuses on the number of calories in foods, while someone with orthorexia focuses on the quality or purity of foods.
Orthorexia can result in people severely restricting the foods that they allow themselves to eat.
Examples of restricted foods and ingredients may include:
- nonorganic foods
- foods containing artificial colors, flavors, or preservatives
- all refined sugar
- any processed or packaged foods
- high carb foods
- meat and other animal products
- food that anyone other than themselves has prepared
Research on orthorexia is limited, and, as the condition is not a standalone diagnosis, it is difficult for researchers to determine how many people it affects.
Data from a small 2017 study of college students suggest that the prevalence of orthorexia is less than 1% overall, although it may be higher in healthcare professionals and performance artists. However, other research in students in Europe has found that 17% of people may be at risk of orthorexia.
It is important to note that many people avoid certain food groups for other reasons.
For example, vegetarians and vegans may avoid animal products for ethical reasons, and people with celiac disease or a gluten intolerance avoid foods that contain gluten to prevent health issues. People with certain religious beliefs may also abstain from particular foods, such as pork or beef.
The difference between regular dietary restrictions and orthorexia is that the latter has a mental health impact because a person may have intrusive thoughts about their eating habits.
Orthorexia tends to start with a person cutting down on foods such as red meat or processed products to make their diet more healthful.
The individual may continue to restrict their diet by cutting out major food groups.
Eventually, they end up eating a limited number of foods that they consider pure. The healthful eating practice soon becomes the center of a person’s life.
Signs and symptoms of orthorexia include:
- spending more than 3 hours a day researching, acquiring, and preparing specific types of foods (not in relation to a job)
- avoiding restaurants or social gatherings because of the food on offer
- having judgmental thoughts about others who do not eat “clean”
- blaming unhealthful eating for physical or mental illnesses
- experiencing feelings of guilt after eating restricted foods
- feeling that adherence to food restrictions determines self-worth
- having obsessive thoughts about food that interfere with sleep, work, or school
- having problems with relationships, as food becomes the primary source of happiness and meaning
- using frequent cleanses or fasts to “detox”
- experiencing malnutrition and weight loss
Many other factors increase a person’s chances of developing orthorexia or an eating disorder.
Experts do not recognize orthorexia nervosa as an official psychiatric diagnosis, although some consider it to fall under the ARFID classification.
A doctor, therapist, or dietitian can diagnose an eating disorder by interviewing a person and reviewing their symptoms and eating habits.
A doctor may follow up with a routine physical exam and blood work to check for nutritional deficiencies and other complications.
The treatment for orthorexia is similar to the treatment for other eating disorders.
It involves some form of therapy to address both the eating disorder and any underlying mental health conditions, such as depression and anxiety disorders.
Types of therapy that a doctor may recommend include:
Cognitive behavioral therapy (CBT)
CBT helps a person recognize that their thoughts and beliefs directly affect their emotions and behaviors.
By challenging and changing their negative thinking about food and self-esteem, CBT can help people with orthorexia.
Dialectical behavioral therapy (DBT)
The idea behind DBT is to help individuals come to terms with their uncomfortable thoughts, feelings, and behaviors instead of avoiding them.
Treatment for orthorexia should include education on the different nutrients that a person needs in their diet to maintain good health. A registered dietitian can help with this part of a person’s treatment plan.
A doctor may prescribe an anti-anxiety or antidepressant medication if the individual has an untreated underlying mental health disorder.
Correcting nutritional deficiencies
Individuals with orthorexia may be deficient in multiple vitamins and minerals, such as vitamin D, calcium, folate, and B vitamins. Replacement of these and other nutrients is an important part of treatment.
Hospitalization may be necessary if a person is significantly underweight or malnourished.
Living with orthorexia can be challenging, but there are several things that a person can do to cope and find support. The first step is to talk with a medical or mental health professional.
Additional suggestions include:
- confiding in a trusted friend or family member
- practicing self-acceptance and stress management techniques
- avoiding fad diet trends, celebrity influencers, and dietary advice from less than credible sources
Online support networks are also available:
- National Eating Disorders Association
- National Association of Anorexia Nervosa and Associated Disorders
With proper treatment and support, a person with orthorexia can foster a state of emotional and physical well-being.
Orthorexia is an obsession with eating only foods that the person considers pure or clean. It may start when a person’s desire to eat healthfully leads to a severely restrictive and potentially dangerous eating disorder.
Treatment for orthorexia involves nutritional counseling, psychotherapy, and addressing any underlying psychiatric disorders.