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What Causes Orthorexia Nervosa?

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Orthorexia nervosa (ON) is an eating disorder that is characterized by an obsession with “healthy” eating. People with orthorexia may restrict themselves to only eating what they consider “pure” or “clean” foods, cutting out all processed foods or entire food groups. Eating a variety of food–both nutritious and not-so-nutritious–food is a good thing. But when the need to micromanage everything that goes into your body is taken to the extreme, it can lead to immense psychological distress, as well as serious medical complications, including malnutrition, blood disorders, and chronic fatigue. As with all eating disorders, orthorexia nervosa doesn’t have a single cause. Instead, several biological, behavioral, and social factors contribute to its development.

What Causes Orthorexia Nervosa?

Biological Factors of Orthorexia Nervosa

Childhood Digestive Illnesses

There may be a link between childhood digestive issues and the development of orthorexia nervosa in later life. If a child suffers recurrent abdominal pain or another form of digestive symptoms, they may start to avoid certain foods they associate with the pain and distress. This could set them on a path to disordered eating behaviors, like restricting foods considered not to be ‘pure.’ (1)

Scientific literature has also found a link between non-specific gastrointestinal symptoms and the symptoms of orthorexia nervosa. (2) This link could indicate the role of health anxiety in the development of orthorexia. Individuals cut out foods they fear may be contaminated or impure, and, therefore, may contribute to their gastrointestinal symptoms.

History of Eating Disorders

Generally speaking, a person is more likely to develop an eating disorder, such as orthorexia nervosa, if there is a family history of eating disorders or issues surrounding food restriction. This link can be attributed to both observed behaviors and genetics.

An Australian study recently discovers that a history of eating disorders is one of the strongest predictors of developing orthorexia nervosa. (3)

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Environmental Factors of Orthorexia Nervosa

Psychological/Emotional/Identity

Health Anxiety

One of the key factors contributing to orthorexia nervosa is the fear of falling ill, due to unhealthy or “unclean” foods. (4) Health anxiety is known to be linked to an obsession with food, which may lead to problematic changes in eating behaviors. (5)

In some cases, people with orthorexia believe they can heal present symptoms with an extremely healthy diet. These individuals tend to be preoccupied or anxious about these symptoms, prompting them to devote excessive amounts of time and energy focusing on their food and diet to combat the real or perceived illness. (5)

The disordered eating behaviors of orthorexia nervosa may develop as a response to hypochondriacal fears, in an attempt to cure somatic (unexplained) symptoms. (4)

Personality & Cognitive Traits

Certain cognitive traits are associated with orthorexia nervosa. Studies have shown that participants with orthorexia perform poorly in the areas of working memory, cognitive rigidity, external focus, and set-shifting (the ability to shift attention between one task and another). (5)

Several personality traits are also positively associated with the likelihood of developing orthorexia nervosa, including perfectionism, the need for control, a drive to be thin, and obsessive-compulsive traits. (6)

Studies have shown that 10% of individuals diagnosed with OCD may develop disordered eating behaviors at some point in their lives. (5) Additionally, studies in healthy populations have revealed that obsessive-compulsive symptoms are linked with orthorexia tendencies. This leads to feelings of guilt in those with orthorexia if they don’t follow their strict healthy eating rituals. (7) 

History of Anxiety and Depression

It’s common for individuals with orthorexia nervosa to have issues with other mental health conditions, including anxiety and depression. (8) Those with orthorexia need control. To regain control over their negative emotions, they develop maladaptive eating behaviors, including focusing on their diet, cutting out all foods considered to be unhealthy.

Past History of Trauma

The association between a history of trauma and the development of eating disorders has been comprehensively described in the literature. The rates of eating disorders, like orthorexia nervosa,are significantly higher in people who have experienced past trauma or suffered from post-traumatic stress disorder. (9)

The types of trauma linked to eating disorders, include, but are not limited to:

  • Unhealthy relationships
  • Bullying
  • Sexual assault and sexual harassment
  • Emotional and physical abuse
  • Neglect
  • Conflict and/or alcohol or drug use within the home
  • Death of a loved one
  • Divorce
  • Financial instability

Poor Body Image

Recent studies suggest that those identifying as female who demonstrate orthorexia eating behaviors have a worse body image and are less accepting of their body than females with low orthorexia tendencies. (4)

Social/Peer Pressure and Competition

Having A Health-Related Career

Research has estimated the prevalence rate for orthorexia is between 1-7% for the general population. The prevalence is much greater for those in high-risk groups, which include dieticians and health care professionals, at 35-57.8%. (10)

High-risk groups may not be limited to healthcare professionals. Evidence suggests those with careers in the entertainment industry (such as actors and artists) are at greater risk of developing orthorexia than the general population, thanks to the career’s focus on image and the pressure to model “healthy” behaviors for others. (11)

Social Media Obsession

Social media has been linked to the development of orthorexia. A 2017 study found that higher Instagram use was associated with a greater risk of developing orthorexia nervosa. (12) 

Study results indicated that almost 50% of Instagram users who regularly follow health food accounts showed symptoms of orthorexia nervosa. The more often an individual used Instagram, the more orthorexia symptoms they had. This was not limited to just health professionals, but also to non-professionals and influencers, who regularly post about their diets. (12)

This study demonstrates that an obsession with social media may play a key role in the development and maintenance of disordered eating behaviors. 

Overwhelming Society Pressures

Our society is fixated on fitness and obsessed with “healthy” everything, especially eating. The recent increase in a societal trend known as “clean eating” has contributed to these pressures. (13) This trend’s gain in popularity-characterized by highly monitored eating patterns and avoidance of “impure” foods--has seen an increase in orthorexia nervosa symptoms in people. (13)

In addition, the “healthy” eating movement (sometimes known as “healthism”) has spread through every aspect of popular culture. Images of “healthy” food fill social media feeds and the promotion of “healthy” eating has been adopted by governments and marketing campaigns everywhere. Healthy foods are lauded as a way of improving our overall health and wellness, preventing disease, and improving our appearance. 

But all this has resulted in a not so healthy effect on people. This broadening interest in “clean eating” has facilitated the growth in orthorexia, as an interest in healthy food is a prerequisite for developing the condition. (14)

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Treatment of Orthorexia Nervosa

While treatments for orthorexia have not been specifically validated, therapeutic interventions for this condition are similar to those for other eating disorders. The goal of treatment is creating a healthy relationship with food, not concentrating on the perceived health value of food.

Challenging the flawed dietary theory of those with orthorexia can help them adopt a more flexible eating plan, as well as challenge their misconceptions that certain foods are not “pure” or “clean.”

 A multidisciplinary team, including dieticians, physicians, and psychotherapists, will devise a treatment plan based on a person’s individual needs. Therapies can include:

  • Nutritional counseling
  • Cognitive behavior therapy 
  • Dialectical behavior therapy
  • Family therapy
  • Support groups

Partners and family members of those with orthorexia nervosa can also benefit from attending support groups, where they, too, can discuss their concerns and better understand the condition.

While there are no medications designed specifically to treat orthorexia nervosa, selective serotonin reuptake inhibitors, such as fluoxetine or paroxetine, can be a very effective treatment to manage accompanying mood disorders. Plus, nutritional supplements may be recommended to combat any deficiencies.

Seeking help for an eating disorder can be daunting. Each individual will need support, compassion, and empathy.

Within Health offers virtual care programs for anyone dealing with an eating disorder, like orthorexia nervosa. Call our team today to learn about our clinically-superior care.

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Frequently asked questions

Resources

  1. Childhood abdominal pain may be linked to disordered eating in teenagers. University of Oxford. (n.d.). 
  2. Gajdos, P., Román, N., Tóth-Király, I., et al. Functional gastrointestinal symptoms and increased risk for orthorexia nervosa. Eat Weight Disord (2021).
  3. Barnes, M. A., & Caltabiano, M. L. (2017). The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eating and Weight Disorders : EWD, 22(1), 177–184.
  4. Barthels, F., Meyer, F., & Pietrowsky, R. (2015). Orthorexic eating behavior. A new type of disordered eating. Ernahrungs Umschau, 62(10), 156-161.
  5. Koven N, Abry A. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015;11:385-394
  6. Petre, A. (2020, April 2). What to know about orthorexia. Healthline. 
  7. Yılmaz H, Karakuş G, Tamam L, Demirkol ME, Namlı Z, Yeşiloğlu C. Association of Orthorexic Tendencies with Obsessive-Compulsive Symptoms, Eating Attitudes and Exercise. Neuropsychiatr Dis Treat. 2020;16:3035-3044
  8. McComb, S. E., & Mills, J. S. (2019). Orthorexia nervosa: A review of psychosocial risk factors. Appetite, 140, 50–75.
  9. Eating disorders, trauma, and PTSD. National Eating Disorders Association. (2018, February 20). 
  10. Varga, M., Dukay-Szabó, S., Túry, F., & van Furth, E. F. (2013). Evidence and gaps in the literature on orthorexia nervosa. Eating and Weight Disorders : EWD, 18(2), 103–11.
  11. Whitcomb, I. (2020, October 7). Orthorexia: Causes, symptoms and treatment. LiveScience. 
  12. Turner, P. G., & Lefevre, C. E. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders : EWD, 22(2), 277–284.
  13. Newman V. (2020) Co-Occurring Eating Disorders and Orthorexia Nervosa. In: Evans Y.N., Dixon Docter A. (eds) Adolescent Nutrition. Springer, Cham.
  14. Bratman, S. Orthorexia vs. theories of healthy eating. Eat Weight Disord (2017) 22, 381–385.
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