In This article

• Symptoms
• Differences between Orthorexia Nervosa and other Disorders
• Risk Factors
• Treatment Options

Daphne was a 24 year old graduate student who would say she has always been concerned about her health.  She started noticing and being vigilant about the types of food she was consuming when she was a junior in high school.  Daphne wanted to improve her long distance times in track, and she sought “healthy” foods to help boost her energy level and muscle tone.  For her, it started with checking food labels and making sure all foods were organic with no artificial ingredients.   When Daphne moved to college and made the track team, her fascination with health foods began to increase.  She began spending hours shopping and preparing food to make sure all the foods she consumed were “pure.”  While she did follow a few health bloggers in high school, in college she was a diligent follower of health bloggers.  Often, Daphne noticed she spent more time researching foods and watching health bloggers than doing her school work.  Daphne decided to cut out all meat when she graduated from college because she did not need as much protein when she was not in track.

Daphne did not think there were any issues with her healthy life style.  When she went home to visit her parents for Christmas her first year of graduate school, she insisted on going to the grocery store herself to purchase ingredients to make her own meals.  Also, she brought premade meals to her grandmother’s house for Christmas.  Daphne stated that she did not like how her body felt when eating artificial ingredients.   While Daphne noticed increased anxiety with food options at home, she told herself it was nothing to worry about. Daphne’s mom spoke with her about concern over Daphne’s obsession with healthy foods.  Daphne told her mom she had nothing to worry about.  When Daphne returned to school, she thought more about her mom’s concern.  Obsessive thoughts had been something she was struggling with lately.  She noticed obsessive thoughts relating to food options and preparing meals were getting in the way of concentrating on school.  Daphne sought help from a mental health professional for anxiety instead she was diagnosed with orthorexia nervosa.

Dr. Stephen Bratman was the first person to develop the term orthorexia in 1997 to describe an unhealthy obsession with healthy eating (Bratman & Knight, 1997).  Orthorexia is derived from the Greek words “orthos” meaning right and “orexis” meaning diet.  This disorder involves the unhealthy focus on “dietary purity” which leads to disordered eating (Cena et. al, 2018).

Symptoms

While orthorexia nervosa is not an official diagnosis in the diagnostic manual for behavioral health issues (DSM-5), Dr. Bratman created proposed diagnostic criteria (Dunn & Bratman, 2016).  The following are symptoms he suggested as well as symptoms observed by mental health professionals for over 20 years that characterize the disorder (NEDA, 2022) (Davidson & Petre, 2022).

• Concern over the health of ingredients
• Inability to eat foods or food groups that are not deemed as “healthy” or “pure”
• Cutting out an increased number of food groups (all carbs, all sugar, all meat, all meat products)
• Being unable to deviate from a specific dietary regime without extreme anxiety
• Compulsive checking of ingredient lists and nutrition labels
• Unusual interest in the health of what others are eating
• Spending many hours per day thinking about, purchasing, and preparing meals that fit in their “pure” or “healthy” diet
• Spending hours a day thinking about what foods will be served at social events
• Missing social events due to not having the foods deemed “healthy” or “pure”
• Bringing their own meals to social events due to others not preparing the food in a “healthy” way
• High level of destress when “healthy” or “good” foods are unavailable.
• Spending hours a day looking at and following health bloggers on Twitter, Instagram, or social media
• Body image issues may or may not be present
• Possible weight loss or malnutrition due to severe limitations in diet
• Fixation on preventing or healing disease with clean eating

After reading this long list of symptoms, you may find that you fit one or two of these symptoms.  The important symptoms of this disorder to remember are the obsession with healthy and purity with foods, experiencing anxiety or inability to change behaviors, and the great impact it has on daily life and functioning.

Differences between Orthorexia Nervosa and other Disorders

Orthorexia Nervosa vs. Anorexia Nervosa  Anorexia nervosa involves the refusal to maintain a healthy weight for the person’s age and height, distorted view of one’s body, and fear of gaining weight or becoming fat.  Those who have orthorexia nervosa may have normal or below normal body weight.  Also, body image issues may or may not be present.  People who are diagnosed with anorexia nervosa focus on avoiding all foods; those with orthorexia nervosa avoid “bad” foods or “unhealthy” foods (Scraff, 2017).   Anorexia nervosa focuses on quantity of food where as orthorexia nervosa focuses on quality of food (Scraff, 2017).  Individuals who experience orthorexia nervosa are not ashamed of their “heathy” or “pure” food habits; they are very vocal about their dietary choices.  On the other hand, those with anorexia nervosa hide their disorder and experience shame.  Often the behaviors of orthorexia nervosa are socially accepted and promoted as healthy diet choices.

Orthorexia Nervosa vs. OCD  While those with orthorexia nervosa may not see their behaviors as disordered, those with obsessive compulsive disorder (OCD) report experiencing the inability to adequately cope with compulsions.  Similarities between orthorexia nervosa and obsessive compulsive disorder include anxiety, perfectionist, and needing to feel in control (Scarff, 2017).   Those with OCD indicate more insight into their disordered behaviors than those with orthorexia nervosa.   Due to some of the behaviors of orthorexia nervosa being socially acceptable, those with orthorexia nervosa may not realize they are suffering from an eating disorder.

Risk Factors

History of an eating disorder and obsessive compulsive tendencies are known risk factors for orthorexia nervosa (Davidson & Petre, 2022).  Other risk factors include perfectionism, need for control, and history of high anxiety (Davidson & Petre, 2022).  One study showed that preoccupation with appearance and weight as well as fearful and dismissive attachment styles are associated behaviors with orthorexia nervosa (Barnes & Caltabiano, 2017),  It has been thought that orthorexia nervosa is seen as a socially acceptable form of restricted eating.  The promotion and popularity of “clean eating” on social media moralizes food as “clean” and “dirty” which can put one at higher risk of developing orthorexia nervosa (Davidson & Petre, 2022).

Treatment Options

A multidisciplinary approach is best in treating orthorexia nervosa.  One’s treatment team should include a psychiatrist, dietician, and psychotherapist.  An individual with orthorexia nervosa may struggle to realize she has an issue due to believing her diet choices are helping her body (Davidson & Petre, 2022).  On the other hand, those with orthorexia nervosa may be more willing to see treatment due to wanting to pursue a healthy life style (Scarff, 2017).  At this time, there are not studies on the effectiveness of psychotherapy for orthorexia nervosa (Scarff, 2017).  It is recommended that cognitive behavioral therapy be used for cognitive distortions within the disorder.  Exposure therapy is often prescribed for obsessive compulsive tendencies.  Relaxation and mindfulness training have been used to reduce anxiety with food and meal times.  Therefore, research is needed to find the most effective treatments for this new disorder.

If you believe you may be suffering from orthorexia nervosa or another eating disorder, contact us at MyCounselor.  We can help with diagnosis and treatment.