8. Obsessing over healthy lifestyle influencers on social media
As previously mentioned, orthorexia nervosa can help inform someone's sense of self-worth and even identity, as well as work to keep them socially isolated from real-life friends and loved ones. This can lead them to seek out like-minded others, especially online.
"Wellness culture" and related communities thrive online, particularly on social media. Someone with ON may have a
social media timeline filled with clips on clean eating, food preparation, trendy diets, such as the ketogenic diet, and recipes that adhere to their strict food rules, which can serve to reinforce their disordered ideas.
3
One study found that frequent Instagram use was associated with higher rates of orthorexia nervosa. Orthorexia nervosa symptoms were also highly represented among healthy eating influencers themselves, which can have a further impact on the mental health of users consuming their content.
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Common physical symptoms of orthorexia
While many orthorexia nervosa signs and symptoms are emotional and behavioral in nature, the disordered eating patterns that can result from the condition can also lead to a number of physical issues.
The most common physical sign of orthorexia is a severe restriction of diet, which can cause malnutrition and nutritional deficiencies.4 Although more long-term research is needed, anecdotal evidence indicates that orthorexia nervosa may also lead to:1,4,5
- Severe weight loss
- Weak bones and loss of bone mass
- Fatigue, weakness, lethargy
- Fainting or dizziness
- Vomiting and rapid breathing (due to metabolic acidosis)
- Stomach bloating
- Constipation
- Stomach pain, nausea, and vomiting (due to pancreatitis)
- Abnormally slow heart rate
- Difficulties falling or staying asleep
- Numbness or tingling in extremities
- Muscle cramps
- Feeling cold due to a drop in body temperature
- Brittle hair and dry skin
- Fine hair growth all over the body (lanugo)
What causes orthorexia nervosa?
As with other eating disorders and mental health conditions, there is no single cause of orthorexia nervosa. Rather, a mix of psychological, biological, and environmental factors influence the potential development of ON, including:1,7
- A history of trauma
- Exposure to extreme views growing up
- Rigid thinking
- Preoccupation with details or rules
- Hypermorality
Psychologically, the condition has been strongly linked to obsessive-compulsive disorder (OCD), with some experts arguing that ON should actually be classified as a subset of OCD.4 Orthorexia is marked by intrusive thoughts (obsessions) around food purity and health and attempts to quiet these thoughts through compulsive behaviors involving diet and food preparation.4
The condition also shares a number of traits with anorexia nervosa (AN), including:4
- Perfectionism
- Anxiety
- A need for control
- Achievement-oriented mindset
Still, AN is widely frowned upon in society, so orthorexia nervosa may develop as a more "socially acceptable" way to restrict food.1 This feeling may be bolstered by excessive use of Instagram and other social media, where "clean eating" is largely celebrated, normalized, or held up as the "morally superior" way to live.6
Other orthorexia nervosa risk factors
Eating disorders can impact anyone at any point in their life, but research suggests some people may be especially at risk for developing orthorexia nervosa, including:1,8
- Athletes
- Healthcare workers
- Performance artists
Those who follow restrictive diets, such as the paleo, ketogenic, or raw food diet, may also have an increased risk of developing orthorexia. This can be due to the relationship between rigid thinking, a preoccupation with rules, and prevailing beliefs around "clean eating" and morality. People who engage in this type of rigid eating also tend to engage in compensatory behaviors, such as increased restriction or fasting, if they violate their diet.9
Isn’t healthy eating a good thing?
Eating nutritious and balanced meals has countless benefits. But when a person's eating pattern becomes pathological and obsessive, restricting entire food groups, engaging in ritualized eating, or deeming certain foods "good," "bad," "pure," or "impure," the consequences can be significant.
Over time, this fixation on healthy eating rules can lead to:
3
- Food restrictions
- Mental and physical imbalance
- Malnutrition
- Medical complications
- Nutritional deficiencies
- A poor sense of well-being
One study called orthorexia nervosa “a disease disguised as a virtue.”10 Indeed, this eating disorder may go underdiagnosed because it presents differently than other eating disorders and some of the behaviors are glorified, especially on social media.
How to treat orthorexia symptoms
As ON is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), there is no way to officially clinically diagnose the condition and no established treatment protocol for orthorexia nervosa. However, professionals have suggested best practices, such as:1,4
- Individualized treatment based on one’s unique needs
- A multidisciplinary team comprised of dietitians, doctors, and therapists
- Cognitive behavioral therapy
- Psychoeducation
- Selective serotonin reuptake inhibitors (SSRIs)
- Antipsychotics, such as olanzapine
- Exposure and response prevention
- Habit reversal training
- Cognitive restructuring
- Relaxation methods
- Psychoeducation related to dietetic science
- Physical exam and lab studies
Individuals with orthorexia may reject medications since they are not natural or pure, so pharmaceutical intervention may not be possible, at least not until they are committed to recovery.
Treatment for orthorexia may occur on an inpatient or outpatient basis. Inpatient programs involve living at the facility for the duration of the eating disorder treatment program. Outpatient care is more flexible and involves living at home and attending scheduled treatment sessions. Still, many treatment barriers exist. Virtual care may be viable if you lack treatment access due to geography, transportation, or scheduling.
If you think you or a loved one have experienced any symptoms of orthorexia nervosa, it’s important to seek eating disorder treatment right away.
Help is available
If you think you or a loved one have experienced any symptoms of orthorexia nervosa, it’s important to seek eating disorder treatment right away.
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