8 Important Facts to Know About Orthorexia Nervosa

Many young people are attempting to improve their eating habits by cutting out junk food and excessive amounts of sugar and carbs. Much of the food today is laden with chemicals, additives, hormones, and a variety of artificial colors. Understandably, there would be an increase in people striving to eat more natural foods. However, like many other positive goals, such as exercise, it can be taken to extremes. Eating the right kind of foods ultimately becomes an obsession with some people.

Orthorexia is a condition in which individuals reject specific foods because they’re not clean enough or pure enough. They often become fixated on maintaining a very specific eating routine. Orthorexia nervosa is currently not recognized as an official diagnosis. It is, however, a real condition that can cause serious problems in a person’s life. According to the National Eating Disorders Association (NEDA), the term orthorexia was first used in 1998. The term has come to mean an obsession with healthful or proper eating. The following are several important facts to know about orthorexia and how it affects the individuals experiencing this condition.

1. Orthorexia Often Begins with Positive Eating Goals

Most types of eating disorders involve negative behaviors such as eating large amounts of food in a short amount of time or consuming too few calories. Orthorexia is a disorder in which individuals want to develop good eating habits. Their eating patterns and choices, however, develop into a routine that is no longer beneficial. There are several distinct differences between positive eating and orthorexia. A person might start out eating a vegetarian diet and progress over time to a vegan eating plan. Then the person may decide to only eat raw vegan foods. Eventually, the individual may come up with more rules and food exemptions, severely limiting their food choices. Ultimately the person becomes obsessed with sticking to an extreme eating plan and unwilling to eat other items if those few food choices aren’t available.

Because someone’s intended goals are generally to be in the best health possible by eating high-quality foods, it can be difficult for others to recognize that the person has an eating disorder. What started as a choice to only eat certain types of food has, over time, become an obsession that the person has now lost control over. It can be difficult to pinpoint when the person crossed the line from a positive eating routine to one that has become detrimental. When individuals go to dietary extremes it will eventually become unrealistic for most of them to stick to the highly regimented routine. This can lead to emotional distress and social isolation. 

2. Orthorexia is More About Quality than Quantity

An individual with orthorexia puts more focus on the nutritional value of the food that is eaten than how much is eaten. Some people with this condition may even limit their food choices to the point that there are only a dozen or even fewer foods they are willing to eat. The caloric intake or the actual amount of food consumed is usually not nearly as important as how pure or high-quality the food is perceived to be by the individual who has orthorexia. Low caloric intake, however, will become an inadvertent effect for most people experiencing orthorexia.

Some individuals may spend hours in the grocery store selecting food or asking lots of questions about how an item is prepared in a restaurant before placing an order. This is because the person has so many stipulations that must be met regarding the foods they eat. Is it organic? Is it gluten-free? Is there added salt or is it prepared in oil? The pursuit of a high-quality life may also be connected to the prevalence of orthorexia. Individuals pursuing higher education as well as many types of athletes appear to be more susceptible to developing this condition. According to Plos One, studies have concluded that individuals participating in endurance sports seem to have a connection to orthorexia.

3. Entire Food Groups are Often Eliminated

A person with orthorexia may become convinced that certain food groups, such as carbohydrates, should always be off-limits. Each person individual experiencing this condition may have specific types of foods or ingredients that are unacceptable to eat. The following is a list of items that those with orthorexia will often limit or totally exclude:

• Animal and Dairy Products
  

  An individual with orthorexia will often avoid animal and dairy products because of high fat content or added hormones.

• Sugar and Salt
  

  They may exclude anything with added sugar and salt. They might eventually eliminate items with natural sugar such as fruit.

• Artificial Preservatives, Colors, and Flavors
  

  While this would include junk food and many snacks, it might also include cereal, oatmeal, cheese, pickles, and fish.

• Genetically Modified Foods
  

  Soy, which is used in a variety of food, is often genetically modified. Many types of fruits and vegetables are often modified as well.

• Gluten

  Gluten is the name of different proteins that are in wheat. Gluten can be found in everything from pasta, cereal, and baked goods to soups and salad dressings.

4. Orthorexia Isn’t Usually Driven by Poor Body Image

Unlike several other types of eating disorders, individuals normally aren’t obsessed with the size or shape of their bodies. Their appearance isn’t usually the primary factor driving the need to eat a certain way. This disorder is about the quality of the food and the specific ingredients in everything that is eaten. Maintaining a strict eating routine is more about the inside of the body, the state of overall health, and staying away from any type of food that is regarded as harmful.

What causes orthorexia isn’t entirely understood. Just as with other eating disorders, genetics and psychological factors likely play a role. Disorders.org states that there may be a correlation between recent changes in culture and the development of certain eating disorders. Just as social media and the proliferation of extremely thin celebrities may have contributed to anorexia nervosa, a rise in the popularity of organic and clean living in recent years may be contributing to individuals developing orthorexia. While culture is not the sole cause of eating disorders it may be a contributing factor when a person develops these conditions. 

5. There Is an Obsession with Labels and Ingredients

A person experiencing orthorexia will constantly be reading and examining food labels. This may include reading entire cans, packages, etc., of food to make sure that every ingredient or the preparation methods are known before eating the food. There are several types of foods that those with orthorexia will look for when planning to prepare meals. Some terms they’ll look for include raw, vegan, organic, whole, and farm-fresh.

According to Eat Right, someone with orthorexia might also obsessively follow lifestyle and nutrition blogs and websites. Besides just reading labels and ingredients on specific foods they are purchasing, individuals with this condition will continually seek out all the information they can find on pure eating. The constant change in eating advice and new information that is always coming out concerning what is good and not good to eat may completely consume a person with orthorexia.

6. Severe Emotional Distress Can Occur

If individuals believe they have eaten something that doesn’t have clean ingredients it can cause them to experience extreme emotional distress. The person may have inadvertently eaten something unacceptable and after learning that it has been consumed this person might experience anxiety, depression, shame, or extreme guilt. Since social interactions so often revolve around food, adhering to a strict eating routine may also be a cause of social isolation. While many individuals adhere to a special diet, most are flexible enough to occasionally eat different items at holidays and other social gatherings. A person with orthorexia will face great emotional distress when deciding between participating in social events with family and friends or maintaining their eating routine.

Sometimes anxiety may occur simply being around specific kinds of foods. A person might leave a room or an area if a particular food or type of food is there. People with this disorder may also become unusually preoccupied with what others are eating as well. They may become distressed if they see others they care about eating foods they deem unsafe or inappropriate. Some people with orthorexia may also start taking natural supplements to make up for the nutrients and calories they’re no longer receiving.

7. Symptoms and Consequences May Mimic Anorexia Nervosa

While orthorexia and anorexia nervosa are two distinct conditions, they do share several of the same symptoms and consequences. For this reason, orthorexia in adolescence may often be confused with anorexia nervosa. The following are several symptoms and health consequences that occur in people with orthorexia that are often seen in individuals with anorexia nervosa.  

• Extremely Rigid Eating Patterns
  

  Any food deemed unacceptable by the person will be avoided. If individuals with this condition are in a situation in which only something “inappropriate” is available to eat, they will go without eating instead of eating this particular food.

• Abnormal Weight Loss
  

  While not everyone experiencing orthorexia will exhibit extreme weight loss, many will. They are most likely not trying to lose weight, but it’s a natural consequence of extremely limiting their food choices.

• Medical Problems
  

  A person with either orthorexia or anorexia nervosa may have electrolyte imbalances. This specifically includes low blood potassium, chloride, and sodium. They might experience gastrointestinal and kidney problems. There may also be malnutrition due to limited food intake. 

• Cognitive Impairment
  

  Most individuals who become malnourished, whether due to an eating disorder, chronic dieting, or a medical condition, will experience some degree of cognitive impairment. Their ability to think clearly and rationally will be greatly reduced. This, unfortunately, may decrease their ability to see any problems with their current eating patterns.

8. Orthorexia Is Often Associated with Anxiety Disorders

The National Institutes of Health describes orthorexia as a pathological obsession. There is often a connection between orthorexia and anxiety disorders or traumatic events. 

• Anxiety Disorders
  

  There are several anxiety disorders including generalized anxiety, Obsessive-Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), Panic Disorder, and Social Phobia. It is not unusual for an individual to have any of these disorders along with orthorexia. 

• Trauma
  

  A person who has lost a loved one due to obesity or heart disease may feel compelled to eat a certain way to avoid experiencing the same thing. Instead of dealing with the underlying issues, the person will attempt to “take control” over their life by controlling their diet.

Orthorexia treatment will need to include treating any of these co-occurring disorders. Treatment for orthorexia as well as anxiety often will include types of psychotherapy. Treatment may also include methods to help reintroduce certain foods to an individual that may have previously been avoided. 

Clementine Residential and Outpatient Treatment

Clementine provides both residential and outpatient treatment for a variety of eating disorders, including orthorexia treatment. A team of highly trained professionals would evaluate a person upon admission and create an individualized treatment plan to meet each person’s specific needs. Clementine provides a variety of extensive psychotherapy, relationship groups, and nutritional counseling. Their team of experts can offer nutritional guidance based on mindful eating.

Clementine also offers academic support for adolescents, family programs, parent education, and coached family meals. They can provide a high level of psychiatric care, including orthorexia counseling, in a homelike setting. They help adolescents navigate through the challenges of learning how to make positive eating choices. Contact Clementine for more information.

Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.