Orthorexia: When Healthy Eating Becomes an Eating Disorder
Eating well is supposed to be good for you. But for some people, the focus on healthy eating becomes obsessive. A person can become so fixated on living healthily that it actually harms their well-being. What starts as wanting to eat better becomes a set of rigid rules that takes over their life.
This is called orthorexia, a lesser-known eating disorder that’s characterized by restrictive diets and obsessing over food choices. Orthorexia can cause great anxiety, fears about disease, and conflict in relationships.
However, it is possible to recover from orthorexia or find effective ways to manage it so that it doesn’t overshadow your entire life. This page will explore orthorexia and its treatment by covering:
- What orthorexia is.
- Orthorexia symptoms and their impacts on daily life.
- Causes of orthorexia, both within the individual and society.
- Eating disorder treatment options.
- What orthorexia recovery looks like in practice.
Orthorexia: What Is a Clean Eating Disorder?
When thinking about eating disorders, conditions like anorexia and bulimia usually come to mind first. The idea that healthy eating can be a disorder may be surprising to some who haven’t come across the term orthorexia.
Orthorexia nervosa was first named in 1997, based on orthos and orexis (meaning correct and appetite in Greek). Though someone with orthorexia may appear to be perfectly healthy in their diet and lifestyle choices, the condition can interfere with and limit their daily life in several significant ways.[1]
Orthorexia is a condition characterized by an obsession with health. Typically, a person with the condition will abide by restrictive dietary choices and experience extreme emotional reactions if these rules are broken.[1] In many cases, the rules get progressively stricter, and more foods become forbidden. For example, a person may first cut out processed food, but then cut out entire food groups.
Common Orthorexia Symptoms
Although it’s not a problem to be concerned with healthy eating, the symptoms of orthorexia show how the condition can cause real harm. There are multiple emotional, social, and health consequences, including:[2][3]
- High levels of concern for health and food.
- Black-and-white labelling of foods as “pure” and “bad.”
- Compulsive checking of nutritional labels and ingredient lists.
- Restrictive eating habits such as cutting out all sugar, all meat, all dairy, or all carbs.
- Eating a very narrow group of foods (not due to an ethical choice or on a doctor’s recommendation).
- Being overly interested in what other people are eating and other people’s beliefs about food.
- Feeling superior about their own food beliefs or preferences.
- High levels of perfectionism.
- Spending hours each day thinking about future food choices.
- Following health blogs and social media accounts obsessively.
- Being highly distressed when “safe” foods are unavailable.
- Regularly avoiding social events because of food preferences.
- Overwhelming concerns about body image.
Impact of Orthorexia Nervosa
The most obvious impact of orthorexia is on dietary choices. Commonly, those with orthorexia omit foods that they deem “unnatural,” which significantly limits their choices.[3] Eating at a restaurant or just doing regular grocery shopping can become impossible.
Due to the inflexibility of orthorexia, many people with the condition will experience interpersonal conflict as a result of their behaviors. Their strict labeling of foods as “good” and “bad” is one example of how a healthy eating obsession can be extremely rigid. This rigidity can make it very difficult for loved ones to get through to someone with orthorexia, which results in disagreements.[3]
Another way orthorexia impacts someone’s social life is if it stops them from attending certain events. Their internal pressures to make healthy choices may stop them from going out for meals with loved ones or eating at other people’s houses.[1] Over time, this may mean they lose touch with friends and family, resulting in growing isolation and loneliness.
If someone with orthorexia somehow breaks their self-imposed rules, they’re likely to experience a strong emotional reaction. They may feel:
- Anxiety.
- Shame.
- A sense of impurity.
- An exaggerated fear of disease or contamination.
Broken dietary rules may also result in a subsequent cleanse, such as fasting for a day after eating something deemed “unhealthy.”[1]
There can also be negative physical health outcomes from orthorexia. Like anorexia, orthorexia can sometimes lead to malnutrition or nutrient deficiencies because of dietary restrictions.[2] If you’ve cut out so many foods that you’re not getting enough calories or nutrients, your body suffers. The sad irony is that trying to be healthy ends up harming your health.
The time and finances of those with orthorexia can also take a hit because of the condition. Some people spend excessive amounts of time thinking about food and acquiring the right foods, and it’s also more expensive if someone wants to eat a solely organic or whole-food diet.[3]
Causes of Orthorexia
A healthy eating obsession may have several causes that are intricately connected. Here, we’ll explore both individual and societal factors that play into the development of orthorexia.
Individual Factors
Personality types that are prone to perfectionism may be at greater risk of developing a condition like orthorexia. A tendency towards rigidity, neuroticism, and obsessive-compulsive traits may predispose you to engage in more extreme dietary behaviors.[4]
A history of dieting may also contribute to the development of orthorexia. If you’ve been dissatisfied with your body for several years and consistently tried new diets to change it, you may later develop disordered eating patterns.[4]
If you are living with another mental health condition, you may come to rely on food as something you can control. For instance, those with a lot of stress, anxiety, or depression in their lives may turn to orthorexic behaviors because they help them to cope and feel that they have power over something.[4]
Healthy eating behaviors may start with peer groups or trying to fit in with a certain community. For example, spending time with others who are health-conscious may naturally make you more concerned about food, too. Clean eating, health, and fitness can provide a sense of identity that is difficult to break out of.[4] Being “the healthy one” becomes part of who you are, and breaking the rules can mean letting go of that identity.
Societal Factors
The use of Instagram is also associated with orthorexic behaviors more than other social media sites. Experts speculate this is because the image-based nature of Instagram normalizes “health” behaviors that are not actually normal.[3] Scroll through Instagram, and you’ll see hundreds of “clean eating” posts and perfect influencer bodies without any context beyond what is carefully being shown to you.
Because eating disorders have increased at an alarming rate, some experts believe the media is responsible. The way in which the media portrays unrealistic beauty standards and popularizes “clean eating” may be to blame for increased rates of disordered eating.[4] Diet culture is everywhere, often marketed as wellness and sold as self-improvement.
Being a nutritionist or dietitian may also be a risk factor for developing orthorexia. Research finds that eating disorders are more common in nutrition professionals, perhaps because they commonly have to think about food choices.[3]
Mission Connection is here to help you or your loved one take the next steps towards an improved mental well-being.
Orthorexia Recovery and Treatment
Typically, orthorexia requires professional support in order for recovery to be effective. Cognitive behavioral therapy (CBT) and nutritional counseling have been the predominant approaches, but mindfulness and acceptance-based therapies are also proving effective.
Orthorexia recovery may also require adopting new personal philosophies about what constitutes progress, balance, and health.
Psychoeducation and Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is a prominent treatment for people with orthorexia, and it commonly features something called psychoeducation. This is when people are given information about how orthorexia perpetuates itself so that they are better able to understand their condition.[4] You learn the patterns happening in your brain because this is the first step to breaking them.
From there, CBT practitioners help people with orthorexia to recognize and challenge their distorted beliefs around health and food. This may be done by reframing rigid beliefs and using exposure techniques to disprove them.[4]
A goal of CBT treatment may be to overcome food anxiety and help people gradually reintegrate feared foods. In this way, CBT can help people move away from disordered eating and towards lifestyle choices that are more balanced and not driven by anxiety.[4]
Nutritional Counseling
Like other eating disorder treatments, orthorexia treatment may involve nutritional and intuitive eating counseling. This kind of work takes place with a dietitian or nutritionist who specializes in treating people with eating disorders by providing personalized guidance. The aim of this work is to restore a balanced relationship with food and health behaviors.[4]
The first step of nutritional counseling for orthorexia may be to address any nutritional deficiencies caused by restrictive eating patterns. They may work with you to develop a structured meal plan that meets your dietary needs, often encouraging variety and moderation.[4] If you’ve been eating the same ten foods for months, you might be missing nutrients you don’t even know about.
Another approach is intuitive eating, which emphasizes being attuned to your body’s internal hunger cues. This stands in contrast to the rigidity of orthorexia, which may take someone away from their intuitive sense of what will be nourishing for them.[4]
Mindfulness and Acceptance-Based Therapies
Another approach to treating orthorexia involves concepts from mindfulness and acceptance-based treatments, which cultivate present-moment awareness and self-acceptance. They encourage you to simply observe your obsessive thoughts about food.[4] You notice the thought “I shouldn’t eat that” without immediately obeying it.
Mindfulness and acceptance may also be integrated into other therapies, such as CBT. The combination of challenging beliefs (CBT) and observing them without reacting (mindfulness) can be particularly effective.
Accepting a Continuous Process
Many of those who recover from orthorexia talk about how the journey to recovery is a turbulent process with inevitable setbacks. Understanding this will be important for people experiencing active orthorexia because they may be discouraged by slow progress at the beginning.[5]
Therefore, it will be important to celebrate small steps in recovery and to challenge thoughts that frame recovery as a “finish line” one must cross.[5]
Moving Towards Food Freedom
Another way people with orthorexia can further their recovery is by embracing the philosophy of food freedom, which encompasses intuitive eating along with other ideas. Food freedom is a concept popularized in orthorexia recovery circles online that rejects ideas rooted in diet culture.[5]
Food freedom is about unlearning principles from diet culture and learning new ways of relating to food and health. For example, you allow yourself to eat whatever you like and reject the idea that food choices need to be justified. Central to the food freedom sphere is that all foods fit within a balanced diet.[5]
Get Personalized Therapy for Orthorexia With Mission Connection
If you seek therapeutic support for orthorexia, Mission Connection is here to help you. We offer personalized outpatient treatment tailored to your unique needs. Our expert clinical team provides a range of mental health treatment approaches.
In addition to standard outpatient care at our locations in California, Virginia, and Washington, we also offer more intensive levels of care, such as a partial hospitalization program (PHP) or an intensive outpatient program (IOP). We treat a variety of mental health conditions and are in-network with most major insurance providers.
To find out more about our in-person, virtual telehealth, or hybrid program that combines in-person and virtual care, call us at 866-833-1822. You can also get started online.
