What is orthorexia nervosa?
While not specifically defined in the DSM-5, the record of all officially recognized mental health disorders, orthorexia nervosa is considered a form of pathological disordered eating.
The condition centers around an obsession with "healthy eating," including "clean eating" or otherwise "superior" diets. To cater to this fixation, someone with ON may eliminate entire food groups considered unhealthy or practice otherwise rigid, restrictive, or ritualized forms of eating.3
Orthorexia nervosa can be difficult to detect from the outside. Generally, people look to bodies that are thinner or larger than average for signs of eating disorders. Still, the symptoms of orthorexia are more subtle and easily hidden in a society that upholds many standards of toxic diet culture.
Many people who are struggling with ON present as health-conscious, albeit excessively so. While the intentions behind these actions are often good, what marks the disorder is the intensity of fixation on this lifestyle and the extreme distress caused by its disruption.
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Signs of orthorexia nervosa
Medically, “signs” of a disorder are the effects that can be outwardly measured, whether through test results or the observations of doctors or close friends and family. There are a number of known signs of orthorexia nervosa.
Physical signs of orthorexia nervosa
It may sound counterintuitive that an obsession with "healthy" foods could lead to physical issues. However, people with ON frequently have an extremely restricted diet, which can lead to a number of nutritional deficiencies and other health complications.2,3
Amenorrhea
A frequent issue for women struggling with nutritional deficiencies and eating disorders in general, amenorrhea describes the irregularity or overall loss of a period.
For those struggling with orthorexia, the difficulty could be related to issues like low body weight or a disrupted endocrine system, two common results of a restricted diet. These changes can throw off the hormonal rhythms that keep menstrual cycles regular.7
Thyroid problems
The thyroid dispatches appropriate hormones and maintains the body’s metabolic rate. The nutritional deficiencies and highly regimented eating habits a person with orthorexia nervosa may have can severely impair both of these primary thyroid functions.3,4
Heart disease
An extremely restricted diet and nutritional deficiencies can also negatively impact the cardiovascular system, eventually leading to several imbalances resulting in blood pressure changes and other cardiovascular issues, including heart disease.3,4
Emotional and behavioral signs of orthorexia nervosa
Along with physical signs, orthorexia nervosa can have some emotional or behavioral manifestations.
Extremely restricted diet
A severely restricted diet is perhaps the chief sign of ON, lying at the heart of the disorder.
The person often starts with good intentions. But, when taken to extremes, their concern with eating healthy can become unhealthy in and of itself, eventually consuming enough psychological space to disrupt the person’s lifestyle and relationships.3
Restricted diets can be a slippery slope, starting with small cuts here or there but eventually leading to the dismissal of entire categories of food, such as all sugar, all carbs, all dairy, all meat, or all animal products.5
Sometimes, a person may have allergies, religious beliefs, or other legitimate reasons for such dietary exclusions. However, when the choices are driven by a fixation on maintaining a “pure,” "clean," or "healthy" diet, it may be a symptom of orthorexia nervosa.3
Excessive scrutiny
People who struggle with orthorexia nervosa are often at the behest of self-imposed "healthy eating" rules, and the actions needed to uphold these rules can be another sign.
Excessive scrutiny can present as a compulsive checking of ingredients on a food label, a deluge of recipe-related questions at a restaurant, or a fixation on details, including whether vegetables have been exposed to pesticides, whether dairy products came from hormone-supplemented cows, or whether preservatives were added.3
This scrutiny can also be pointed outward. A common sign of orthorexia nervosa is an overly judgmental attitude toward individuals who do not practice such strict diets, which can present as scrutiny or criticism of the eating habits of others.6
Obsessive following of “healthy lifestyle” social media
Some studies have suggested that people struggling with orthorexia nervosa exhibit feelings of superiority about their diet, with limited tolerance for interacting with others who aren’t similarly-minded.
3
In the digital age, people with ON may follow certain “wellness” brands and pages, seeking reinforcement and advice about their lifestyle choices.
5 And following an excessive amount of these brands or pages is one of the bigger
risk factors for ON.
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Orthorexia symptoms
In the medical world, "symptoms" are effects that aren’t always outwardly measured or even detected by another person. They can only be experienced and gauged in severity by the person enduring them.
Due to the complex physical, psychological, and social mechanics behind ON, orthorexia symptoms may manifest in many ways.
Physical symptoms of orthorexia
Once again, the driving factor behind so many orthorexia nervosa symptoms is the restrictive diet that marks the disorder. Nutritional imbalances caused by such diets can lead to many discomforts and difficulties for the person dealing with ON.
Gastrointestinal issues
Gastrointestinal issues are often a symptom of orthorexia or any serious eating disorder.
Strictly inhibited food choices, especially those based more on pop science than medical advice, can lead to digestive troubles, including constipation, bloating, acid reflux, gassiness, nausea, and other gastrointestinal issues.4
Chronic fatigue
Chronic fatigue can manifest as an orthorexia nervosa symptom for several reasons.
Certainly, the nutritional deficiencies caused by a severely restricted diet can contribute to this issue.4 But people struggling with ON may also not consume enough calories or be more susceptible to extreme exercise routines, though more evidence is needed to fully support these connections.3
Comorbid conditions
A majority of orthorexia symptoms are emotional or behavioral, but they could also be driven by several comorbid—or concurrent—medical or mental health conditions.
While much more research into the subject is needed to draw conclusive connections, some studies have identified several mental disorders considered to be strong indicators or drivers of orthorexia nervosa.
Obsessive-compulsive disorder is frequently found in people struggling with ON, which could also inform the rigid rules and diet associated with the disorder and the distress caused by any variation on those rituals. Perfectionism—typically considered a trait of OCD—is also common in people with orthorexia nervosa.3
People presenting with orthorexia nervosa have also been found to struggle with anxiety disorders at a higher rate, and some studies suggest they may also be more prone to depression.3
Emotional and behavioral orthorexia nervosa symptoms
Many of the most serious symptoms of orthorexia manifest in a person’s emotional and behavioral reactions. As the disorder progresses, a person may find it more difficult to integrate into society due to their increasing concern over the purity of their food.3
Preoccupation with food
Indeed, a preoccupation with food is one of the cardinal orthorexia symptoms. The issue can lead to undo stress, especially when the food in question is out of the person’s control, such as when going to a restaurant or catered event.
In these cases, a preoccupation with food may present as someone fixating on the types of food that will or will not be at an event and worrying obsessively over what they will or won’t be “able” to eat.
2
This symptom of orthorexia can also manifest as:
3
- Excessive research into food production or certain food products
- The following of many food-related social media outlets
- Days that are planned specifically around certain food-based needs or eating rituals
Extreme distress when preferred foods are not available
Coupled with the food preoccupation is the distress many people with ON feel when their dietary requirements cannot be met.
This orthorexia nervosa symptom is typically closely tied to other complex psychological factors, especially any comorbid mental health conditions that may be in play.
The person could become upset at the eating establishment or dinner host for not accounting for their needs. Alternatively, the distress may transmute into feelings of guilt or self-loathing, and an individual may follow up a so-called transgression by doubling down with an even stricter routine, a desire for “self-punishment,” or other rituals, such as a cleanse or fast.3
Social isolation
Sadly, the fixation with food may put those struggling with ON at a higher risk for experiencing social isolation.
This symptom of orthorexia can stem from an increasingly strict diet, which the person may feel can only be met when they exhibit total control over their environment. A tendency toward moral superiority when following their routine may also inform this predisposition.3
And eventually, this orthorexia symptom may turn into a positive feedback loop, where a person limits their exposure to outside activities to tend to their increasing food-based needs, which only reinforces the importance of those rules and makes it more difficult for the person to get along in a more relaxed environment.3
When to get help for orthorexia nervosa
As with most other eating disorders, it may be challenging to get someone struggling with ON to understand the power the condition has over them. And because the disorder centers around the concept of being “healthy,” it may be even more difficult to get someone to think anything is amiss at all.
But despite the type of food consumed, all forms of disordered eating can be dangerous and detrimental. Once orthorexia symptoms begin to disrupt someone’s daily functioning or cause them undue amounts of harm or distress, it’s time to seek help.
The good news is many different types of therapies are available that can help someone make a full recovery from the condition.
Get help for orthorexia nervosa
At Within Health, our multidisciplinary team can help you or your loved one understand the various physical and psychological factors that may be powering your eating behaviors and help you work on making positive and lasting changes.
If you or a loved one are struggling with ON or any other type of disordered eating, you can contact us today for more information on how to seek help.
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