Orthorexia treatment plan

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Orthorexia nervosa (ON) is a serious eating disorder that can be very tricky to detect, as we live in a health-conscious culture. ON is characterized by obsessive thoughts and behaviors around foods that an individual may view as “healthy.” This eating disorder causes an individual to restrict many foods that provide the body with the nutrition the body needs to function properly. There are treatments available for those with orthorexia nervosa, and understanding treatment options is a significant first step on the road to healing.

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Levels of care for orthorexia nervosa

Orthorexia nervosa can range in severity and may require different levels of treatment. Someone with orthorexia nervosa may go through all treatment levels, or they may participate in a few, depending on their recovery journey. 

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Inpatient

Inpatient care means an individual receives care at a hospital or treatment facility and spends at least one night under supervision. Inpatient care is primarily for those who need medical attention due to their eating disorder. For those with orthorexia nervosa, some individuals experience malnutrition due to food restrictions and may require immediate medical attention. The length of an inpatient care program depends on the individual’s case. Some inpatient treatments are one night. Others may last a few weeks, or months. 

Residential

Residential treatment is similar to inpatient treatment. It provides 24-hour care to those with orthorexia nervosa in a more home-like environment, instead of a hospital. But An individual may transition to residential treatment from inpatient treatment or start with residential treatment, depending on their needs. 

Partial hospitalization program (PHP)

Partial hospitalization programs (PHP) are for people with orthorexia nervosa who want daily support but may not need round-the-clock care. In many cases, an individual may start PHP after making progress during inpatient care. The individual feels ready to start putting into practice what they’ve learned through treatment but still craves a controlled treatment environment. 

Intensive outpatient (IOP)

With intensive outpatient (IOP) treatment, the individual is living at home but advised to participate in intensive treatment. IOP differs from PHP in that the individual does not receive daily support. A person may receive IOP once they progress in an inpatient or residential care program and want to transition back to their home life. Those with orthorexia nervosa may start to feel comfortable eating food they previously restricted but want continued reassurance that their food choices are right for their body.

Outpatient

Outpatient care for individuals with orthorexia nervosa means they can live at home and participate in their regular activities, but they receive some treatment, usually a reoccurring therapy session. There is no set length of time a person with orthorexia nervosa may receive outpatient care. Individuals may participate in outpatient care for a few months up to a few years. Others choose to continue outpatient care indefinitely.

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Psychotherapy for orthorexia nervosa

Psychotherapy, or talk therapy, is an evidence-based treatment option for many eating disorders, including orthorexia nervosa. There are many different types of psychotherapy, and individuals may participate in multiple types of therapy throughout their healing process. 

Acceptance and commitment therapy (ACT)

Acceptance and commitment therapy (ACT) is commonly used to treat obsessive-compulsive behaviors in orthorexia nervosa. ACT focuses on helping people with orthorexia nervosa understand their underlying desire to eat healthily is an appropriate feeling. They learn it is okay to eat healthily, but they may need to adopt new behaviors, so they don’t have compulsive thoughts and actions intruding on their daily activities to the point where their behavior impairs functioning or interferes with routines. 

Cognitive-behavioral therapy (CBT)

People living with orthorexia nervosa have developed a way of thinking that puts foods in either a “healthy” or “unhealthy” bucket. Cognitive-behavioral therapy (CBT) helps individuals with orthorexia nervosa understand why they view foods a certain way and how their thoughts about “healthy” and “unhealthy” foods affect their eating behaviors. Once they know why they think a certain way, they can change their behaviors.

Cognitive remediation therapy (CRT)

One outcome of cognitive remediation therapy (CRT) is to change how someone processes information. Generally, someone with orthorexia nervosa has criteria for making food “healthy” or “unhealthy.” CRT works to help those with orthorexia nervosa rethink how they assess the “healthiness” of a food. With a new perimeter for “healthy” food, the individual can restrict fewer options. 

Dialectical behavior therapy (DBT)

Dialectical behavior therapy (DBT) is primarily for those who struggle with an interpersonal conflict and want to improve their relationships with others. (2) Some people with orthorexia nervosa find themselves criticizing the food choices of others, which can put a strain on relationships. They also tend to stress about eating healthily, making it challenging to enjoy different culinary experiences. DBT helps individuals practice mindfulness. Through mindfulness, an individual can learn how their comments about another’s diet can affect that person. They also gain awareness on how to live in the moment and enjoy eating all types of food. 

Exposure therapy

Exposure therapy for orthorexia nervosa is about exposing individuals to foods they’ve deemed as unhealthy. The goal of exposure is to help them understand that eating “unhealthy” foods will not result in whatever their fear is. Many people with orthorexia nervosa believe eating certain foods will make them sick. In exposure therapy, they taste foods that trigger them to see that they won’t get ill and the food is okay to eat. 

Family therapy 

Family therapy involves a person with orthorexia nervosa doing a group therapy session with their family members. One of the primary goals is to help family members understand what their loved one is going through and help the person with orthorexia nervosa feel seen and heard by their relatives. 

Sometimes those with orthorexia nervosa develop the condition because of family trauma. The individual with orthorexia may have had a family member who got sick because they were not eating the right foods for their body. The person with orthorexia nervosa may interpret the sickness as a result of eating “unhealthy” foods and, therefore, build a fear toward anything that is not “healthy.” Family therapy is a place for the individual, the family, and a therapist to unpack those family dynamics and history to help everyone understand the root of the eating disorder. 

Group therapy

Group therapy is an opportunity for those living with orthorexia nervosa to connect with others with similar eating disorders. A licensed therapist leads individuals in group therapy sessions through activities and discussions to share challenges and successes concerning their eating disorders. Sessions tend to occur weekly, but some people may choose to attend more or less, depending on their situation and doctors’ recommendations. 

Interpersonal psychotherapy (IPT)

Interpersonal psychotherapy (IPT) focuses on the difficulties individuals may experience in building relationships. (3) People who develop orthorexia nervosa in adolescence or young adulthood may have limited experience starting and maintaining intimate relationships, because they have a preoccupation with “healthy” foods. IPT teaches individuals to identify interpersonal challenges and how to overcome them.

Nutrition counseling and meal support

Nutrition counseling for those with orthorexia nervosa focuses on teaching the individual how foods they may view as unhealthy bring nutritional value to the body. It also helps the individual understand the nutritional value behind the foods they are comfortable eating. 

A person living with orthorexia nervosa learns to apply nutritional education to their meals through meal support. Meal support works with a registered dietitian to incorporate more foods into a diet. If the individual prefers eating fresh produce, they’ll find ways to bring in additional foods, such as meats and grains, through meal support.

Experiential treatments for orthorexia nervosa

Various forms of relaxation training are explored as experiential treatments for those with orthorexia nervosa. (1) Relation training includes breathing exercises, meditation, yoga, and tai chi. With orthorexia nervosa, there can be a lot of anxiety around straying away from what the individual deems “healthy” foods. If the individual starts feeling overwhelmed, they can practice a form of relaxation training to help calm themselves.

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Treating orthorexia nervosa at Within Health 

The experts at Within Health understand the complexity of orthorexia nervosa and offer a revolutionary way for people to receive clinically superior and continuous care at home. All treatment plans are personalized to the individual to strike a balance between helping clients cope with food and body challenges and exploring the deeper themes and interpersonal concerns of orthorexia nervosa.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. WebMD. (2020, September 9). Orthorexia nervosa: Signs & treatment.
  2. What is dialectical behavior therapy (DBT)? Behavioral Tech. (n.d.).
  3. Murphy, R., Straebler, S., Basden, S., Cooper, Z., & Fairburn, C. G. (2012). Interpersonal psychotherapy for eating disorders. Clinical Psychology & Psychotherapy, 19(2), 150–158.

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