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Orthorexia nervosa (ON) is a serious mental health condition involving a fixation on "eating clean," "eating healthy," or living a "clean" lifestyle. Despite its focus on health, however, this condition can lead to a number of complications with mental, physical, and emotional well-being.
In a society that pushes concepts like wellness and fitness, it can be difficult to detect this problem and even more difficult to seek treatment. However, orthorexia nervosa can be dangerous if left untreated, so finding appropriate care is important.
Thankfully, a number of treatment options have been developed to help people overcome orthorexia nervosa. If you or a loved one are struggling with ON, it's important to seek out this type of professional care.
Orthorexia nervosa is not explicitly defined in the Diagnostic and Statistical Manual (DSM-5), the official catalog of medically-recognized mental health disorders. However, physicians have acknowledged some form of the disorder for many years.4
In general, ON is characterized by an extreme preoccupation with maintaining a "clean" or "healthy" diet. That usually means eating foods that are organic or otherwise considered "pure" and staying away from processed or pre-prepared foods or those otherwise considered "toxic" or "contaminated."4 This obsession can eventually extend out to eliminating entire food groups or other types of disordered eating behavior.
What separates ON from less-problematic attempts to eat a healthier diet is the intensity of this preoccupation. In response to these disordered thoughts, eating often becomes restrictive, with a number of rigid or inflexible self-imposed rules. The amount of time spent thinking about, obtaining, and/or preparing "appropriate" food becomes disruptive to daily life. When someone with ON is not able to eat the food of their choosing or follow their rules, they become markedly distressed or anxious.4
Eating disorders often have drastic physical impacts, but these conditions are mental health disorders. It's essential for someone struggling with orthorexia nervosa or any eating disorder to treat the underlying causes of their condition, which is often done through psychotherapy.
There are many different types of psychotherapy or talk therapy, and individuals may participate in multiple types of therapy throughout their healing process.
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy (CBT) is the leading therapeutic approach for many eating disorders.3 This structured form of therapy helps patients recognize unhelpful thought and behavioral patterns, gives them tools to break those patterns, and introduces them to newer, healthier coping mechanisms.
CBT for orthorexia nervosa treatment can help patients understand that no food is inherently "good" or "bad" but that anxiety around the choices we make about food can be unhealthy. Once they understand the thoughts driving their behaviors, patients can work on changing them.
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy (ACT) focuses on helping people develop more mental flexibility by teaching them mindfulness, meditation practices, and other techniques that encourage engagement in the present moment. Instead of fixating on something, like eating healthy, with ON, patients are asked to spend their energy on activities that make them feel good and align with their morals.
Acceptance and commitment therapy can also help people change thoughts and behaviors by expanding mental flexibility and diffusing fixations. The fixation on eating healthy food and related behavior in ON has been linked to obsessive-compulsive disorder (OCD), and ACT has also been found to help reduce OCD symptoms.4,5
Dialectical behavior therapy (DBT)
Dialectical behavior therapy (DBT) is similar to CBT in many ways and has many similar goals, including helping patients recognize and change disordered thoughts and behaviors. Like ACT, it also helps patients become more mentally flexible. With DBT, this is done by focusing on the idea that two opposing things can be true at once, specifically that someone must simultaneously change their behaviors and learn to accept themselves.2
DBT is a comprehensive treatment approach that often involves individual therapy, group therapy, and other consultations with a therapist. Patients are also given "homework" and asked to report on their progress at individual sessions. When used as a treatment for orthorexia, DBT could help patients regulate the emotions that may be informing disordered behaviors.
Exposure therapy
Exposure therapy generally involves experiencing or interacting with things or situations that set off disordered behaviors or irrational fears. This method should always be administered by a licensed practitioner trained to introduce these scenarios slowly and help the patient manage their reactions in a healthy way.
As an orthorexia treatment, patients may be asked to look at, touch, smell, or taste foods they deem unhealthy. If they are concerned about eating food not personally prepared by them, they may be taken to a restaurant. In any case, the goal is to help patients understand that eating “unhealthy” foods will not result in getting sick, being a "bad person," or whatever their specific fear is.
Group therapy
As the name suggests, group therapy involves meeting with a group of people and working on issues with the help of one or several therapists. These forums can be excellent opportunities to develop new coping skills and reflect on one another's challenges and triumphs.
On a personal level, these kinds of groups can also help people with orthorexia nervosa meet individuals going through similar struggles. This can help create the foundation of a support network and help them gain more perspective on what they're going through.
In addition to the more common and traditional forms of therapy used to treat orthorexia, there are other types of treatment methods used.
Nutrition counseling and meal support
It may sound counterintuitive to seek nutritional counseling for someone focused on healthy eating. However, those with ON may be getting their information from less-than-reputable sources, and often, their diets become restrictive to the point of becoming unhealthy.
Through nutrition counseling and education, those with orthorexia nervosa can learn the facts behind proper nutrition and help build a healthy meal plan that promotes an adequate and balanced diet. This can also help people step away from disordered thoughts about foods being inherently "good" or "bad" and learn to eat more mindfully and intuitively.
Meal support may also benefit someone with orthorexia nervosa. This involves eating with another person, either in person or virtually. The other person can serve as a coach or a supporter, helping the person get through meals they may be uncomfortable with, especially early on in treatment.
Experiential treatments for orthorexia nervosa
Various forms of relaxation training have been explored as orthorexia nervosa treatment.1 This includes (but is not limited to):
Breathing exercises
Meditation or mindfulness
Yoga
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.
When thinking about treatment for orthorexia, it's important to consider not just the methods of treatment but the level of care that may be required. As with other eating disorders, orthorexia nervosa can range in severity, and these various needs are addressed with various levels of care.
Someone with orthorexia nervosa may go through all treatment levels, or they may participate in a few, depending on their recovery journey.
Inpatient hospitalization is the most intensive level of care, generally reserved for cases when someone's life is in immediate danger.
When someone is hospitalized for an eating disorder, they may be experiencing abnormal vital signs, expressing suicidal ideation, or otherwise be in danger of extreme physical harm.
Inpatient hospitalization stays are usually short because they are generally meant to address these immediate problems and help someone become medically stable. However, patients stay full-time at the hospital, where they can receive 24-hour care and be observed by medical staff until they are cleared to leave.
Residential treatment is also an intensive form of care, though patients generally must be considered medically stable to join a program. This level of care also involves patients staying full-time at a facility but is more focused on long-term recovery goals, so stays are often much longer, lasting several weeks or sometimes months at a time.
While in a residential program, patients follow strict daily schedules that often involve several treatment approaches. For orthorexia treatment, individual and group therapy, nutritional counseling and education, meal monitoring, and regular medical check-ins are common. Some patients may also be prescribed medication as part of their recovery plan and check in regularly with a doctor or psychiatrist for medication monitoring.
Partial hospitalization programs (PHP) are for people with ON who want daily support but may not need round-the-clock care. These programs involve rigorous treatment schedules, which occur most days of the week and often last for many hours. Patients commute to these sessions and live and sleep at home.
Often, an individual will start PHP after discharge from residential care. However, some patients who qualify for residential treatment may prefer a PHP, especially if they have concerns about program costs or at-home responsibilities.
When used as orthorexia nervosa treatment, partial hospitalization programs involve most or all of the same treatment options as residential programs. However, PHPs are generally more flexible than residential care, and as patients progress toward their recovery goals, schedules can be adjusted to reflect where they are in their journey.
Intensive outpatient programs (IOPs) are essentially the middle-ground of orthorexia treatment. Individuals live at home but attend treatment sessions several times a week. These sessions are generally longer or more intensive than standard outpatient treatment, and a patient may still participate in several therapy types at once.
IOPs are best for someone ready to return to their home life or start incorporating more social obligations into their daily routine. With orthorexia nervosa, this may be when someone isn't as focused on healthy eating or preparing nutritious meals and can allocate more of their time toward other activities and responsibilities. Intensive outpatient treatment is also an appropriate step up from standard outpatient care if a patient feels they need more support.
Outpatient care is the least intensive form of treatment for orthorexia or other mental health conditions. It usually involves regular meetings with a therapist but can also include occasional check-ins with psychiatrists or other specialists.
At this point, patients must be mostly in control of their disordered thoughts and behaviors. Therapy sessions are generally focused on staying recovery-focused and troubleshooting potential triggers or relapses.
Patients may start their treatment experience with outpatient care. Many also return to outpatient care after transitioning out of more intensive therapy and decide to continue at this level of care to help maintain long-term recovery.
Orthorexia nervosa treatment at Within Health
The experts at Within 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 individually personalized 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.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Donini, L. M., Barrada, J. R., Barthels, F., Dunn, T. M., Babeau, C., Brytek-Matera, A., Cena, H., Cerolini, S., Cho, H. H., Coimbra, M., Cuzzolaro, M., Ferreira, C., Galfano, V., Grammatikopoulou, M. G., Hallit, S., Håman, L., Hay, P., Jimbo, M., Lasson, C., Lindgren, E. C., … Lombardo, C. (2022). A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eating and Weight Disorders, 27(8), 3695–3711.
