What is orthorexia nervosa?
The term "orthorexia" was first coined in 1997 to describe a fixation on "proper" or "healthful" eating.2 That can mean focusing on things like calorie counts, macro-nutrient fulfillment, different types of diets, organic foods, or other ways of eating purportedly for health reasons.
It's crucial to understand that simply eating a healthy, well-balanced diet isn't an indication of orthorexia nervosa. Instead, ON describes the fixation on "healthy eating," or the compulsive need to micromanage the kinds of foods one is consuming. This way of thinking is unhealthy, regardless of what someone eats, which is why orthorexia nervosa is defined, ultimately, as a mental health disorder.1,4
Still, there is no proper definition of orthorexia in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which means there are no universally agreed-upon diagnostic criteria.2 This can make it difficult for doctors to know what orthorexia means or to diagnose it, but generally, thoughts or behaviors are considered part of a disorder once they reach the point of disrupting someone's day-to-day life.
Diagnosing orthorexia nervosa
Without an official definition of orthorexia, it can be tricky to diagnose. Usually, when assessing someone for an eating disorder, doctors check the person's symptoms against a set of formal diagnostic criteria.
Without these types of guidelines about what defines orthorexia or what symptoms should be present, medical professionals may look for a number of different symptoms, including:1
- Compulsive behavior and/or mental preoccupation on the subject of eating to achieve optimal health
- Fear, anxiety, shame, or other negative experiences when self-imposed dietary rules are not followed
- Escalating dietary restrictions over time
The above issues may be considered part of orthorexia nervosa when they:
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- Lead to malnutrition or severe weight loss
- Interfere with social responsibilities, such as work, school, and family commitments
- Disrupt someone's body image or sense of self-worth, or when someone's sense of self-worth comes to be defined by their food choices
Patients are also frequently interviewed by a physician as part of the diagnosis, with doctors sometimes also reaching out to close friends or relatives for additional information.1
Again, the main issue with ON doesn’t start with the food someone's eating but the way they think about food. The obsession with so-called “healthy eating habits” is problematic, along with the distress that's generally caused when someone can't follow their own strict rules about what they eat.
Signs and symptoms of orthorexia nervosa
It can be challenging to spot orthorexia nervosa compared to other eating disorders, which generally have a more dramatic physical impact. Frequently, people with ON show no physical symptoms, so there is no immediate outward cause for concern.4
Paying attention to how someone thinks, speaks about, and acts around food may be a better indication that something more concerning is going on. Some of the most common signs of orthorexia include:2
- Eating a restricted variety of foods, including restricting entire food groups
- Compulsively checking ingredient lists or nutrition labels
- Fixating on the consumption of food considered "pure" or free from chemicals, additives, and preservatives
- Fearing eating out or attending functions that include meals
- An unusual interest in what others are eating
- Showing physical and psychological signs of distress when they have no control over what food is available
Some studies have also shown that people who struggle with orthorexia nervosa are more likely to use nutritional supplements and seek out alternative forms of medicine to improve their psychological health.3
Related disorders
As with most eating disorders, orthorexia nervosa often co-occurs with other conditions.
Much more research on the condition is needed in general, but some studies have connected ON to obsessive compulsive disorder (OCD). The two mental illnesses share many of the same reactions in the brain that lead to unhealthy fixations with certain behaviors.1
Orthorexia nervosa has also been linked to anorexia nervosa (AN), as it's thought that ON can lead to AN in some cases.1 The two disorders function similarly, through a fixation on food and eating, though people with AN focus on the quantity of food, while people with ON focus on food quality.1
Orthorexia nervosa also shares many related characteristics with both AN and OCD, including:
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- Anxiety
- Perfectionism
- A need to exert control
When seeking treatment for orthorexia, it’s vital to also receive treatment for any underlying or co-occurring mental health or behavioral disorders to ensure the best chances at a complete recovery.
Effects of orthorexia nervosa
It may seem counterintuitive that focusing on “healthy eating” could negatively affect health. But orthorexia nervosa is a serious eating disorder, and it can bring on many mental, emotional, and physical health concerns.
Mainly, ON has been tied to mental and emotional health effects, including:4
Still, other research has indicated that orthorexia nervosa could eventually lead to malnutrition, especially in cases when the disorder starts developing into anorexia nervosa.1
On a social level, the fixation with healthy eating and restrictive dietary practices experienced by people with ON can create strain among friends and family or fundamentally interrupt the ability to work, which can have significant consequences.
Treatment of orthorexia nervosa
While more research is needed to distinguish the types of treatment that could best help with ON specifically, there are a number of therapies and other forms of care that can help people with many different types of eating disorders.
Family-based therapy
For those whose ON progresses to AN,
family-based therapy may be another helpful approach. The treatment modality has been successful at helping patients with anorexia nervosa, especially those who are younger, by teaching key members of their household how to create a healing environment at home and how to temporarily take over food-based decisions for the patient.
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Nutritional counseling
People struggling with orthorexia nervosa may also benefit from
nutritional counseling or certain types of medication to help ease symptoms of anxiety or depression. Treatment plans should be determined by doctors on a case-by-case basis, depending on a patient's particular needs and medical history.
How to help someone with orthorexia nervosa
People who have this disorder find themselves in a difficult position as they struggle to balance their fears and desires to be healthy with the realities of modern living. For those who struggle to let go of their obsession with healthy eating, there are some ways to help:
- Avoid making comments about food.
- Educate yourself on which foods are more nutritious than others so you can help your loved one make smart choices.
- Speak to your doctor, nutritionist, or psychotherapist skilled in treating eating disorders about how to gain insight into how you can support your loved one experiencing an eating disorder.
- Get professional advice from a nutritionist or other professional who knows about orthorexia nervosa to give you tips for helping your loved one.
Finding help for orthorexia nervosa
It may be hard to define orthorexia nervosa, but finding help doesn’t need to be.
If you or a loved one are struggling with ON or any type of eating disorder, your primary care physician, therapist, or a trusted medical professional may be a good place to start. These experts can help recommend the best course of action, including ways to get an official diagnosis or suggest treatment programs that may be effective.
Virtual treatment is available
At Within Health, we also strive to help. Our unique program brings together a multidisciplinary group of experts to craft tailored treatment plans for each patient, taking into account their specific physical, emotional, and mental needs and medical history.
If you or a loved one need help with an eating disorder, like orthorexia nervosa, our care partners are available to start your healing journey. Call our admissions team today.
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