Orthorexia – Warning Signs, Symptoms, and Treatment

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It’s important to be aware of what we eat, as good nutrition has many benefits. However, what happens when a focus on healthy eating becomes obsessive?

What Is Orthorexia?

Orthorexia comes from the Greek words’ ortho’, meaning ‘correct’, and ‘orexi’, meaning ‘appetite’. It is characterised by an obsession with food quality in a person’s diet.

People who suffer from orthorexia are extremely focused on the purity and quality of what they eat. Despite the focus on eating, orthorexia nervosa can lead to malnourishment. The unhealthy obsession over food and the rigid beliefs and rules that comes with it may cause a person to create a restricted diet, leading to severe weight loss and other medical complications. It can also lead to problematic social relationships or issues at work and school.

As orthorexia nervosa is not formally recognised in the Diagnostic and Statistical Manual of Mental Disorders – but listed as an unspecified feeding and eating disorder – a person visiting the doctor with symptoms may not be officially diagnosed. Without formal diagnostic criteria, they may not receive the treatment help they need. It also makes it difficult to determine how many people suffer from orthorexia.

What Causes Orthorexia?

Although the exact causes of orthorexia are unknown, some personality and social risk factors have been identified. These include anxiety, having a history of disordered eating, and the influence of social media.

Celebrities or popular users on social media who display behaviours hold an influence in promoting orthorexia. Their claims may be considered credible due to the high following of their accounts.

Nutrition students, yoga and exercise instructors, and dietitians are commonly diagnosed with orthorexia. This could be because the onset of orthorexia is thought to be connected to increased thinking about food choice, shape, or body weight.

While some believe that orthorexia is a stand-alone eating disorder, others believe that orthorexia could be a food-centred manifestation of obsessive-compulsive disorder (OCD). Orthorexia Nervosa shares elements of perfectionism, rigid thinking, excessive devotion, hyper-morality, and a preoccupation with details and perceived rules common in OCD.

Some experts hypothesise that preoccupation with illness in a person with somatization disorder may give rise to an obsession with food and diet as a means to combat either real or perceived illness.

How Do We Differentiate Orthorexia from “Healthy Eating?”

While healthy food can bring about major improvements in our health, an obsessive focus on it can develop into an eating disorder.

How we choose to eat is a personal decision, and our eating habits have their place. However, with orthorexia Nervosa, the importance of specific patterns can harm a person’s everyday life.

Orthorexia involves obsessive thoughts and behaviours around eating ‘clean,’ minimally processed healthy foods. However, ‘clean’ eating also comes with moralising and labelling other foods as ‘dirty’ or unwanted, creating an unnecessary stigma. The fixation on ‘healthy eating’ or ‘righteous eating’ can damage a person’s physical and mental health.

Any person who follows a healthy diet plan does not necessarily suffer from orthorexia. Instead, orthorexia involves an unhealthy focus on eating healthily.

Do eating disorders need specialist treatment

Orthorexia Compared to Other Eating Disorders

Similar to other eating disorders, the eating behaviour – in this case, labelled ‘healthy’ or ‘clean’ – is used to cope with negative thoughts and feelings to feel in control. A person who uses food in this way could feel extremely guilty or anxious if they eat food they consider unhealthy.

Unlike other eating disorders, this condition is not usually driven by poor body image. While similar patterns of restriction may be seen in other disordered eating, such as anorexia, orthorexia involves possible pride in healthy eating habits over others, as opposed to body image. A person’s sense of self-worth may depend largely on how well they succeed in following their own healthy eating rules.

In eating disorders such as anorexia nervosa, people may be preoccupied with their body shape or weight and suffer from general body dissatisfaction. This leads to the restriction of food quantity to lose or manipulate weight.

In orthorexia nervosa, a person is not preoccupied with the quantity of food intake. Instead, they are focused on quality. They are fueled by the desire to consume pure foods and obsess over maintaining a perfect diet instead of an ideal weight.

Signs and Symptoms of Orthorexia Nervosa

The signs and symptoms of orthorexia can be seen in physical, psychological, and behavioural effects.

A person who is suffering from orthorexia may experience the following:

  • Have judgmental thoughts about others who do not eat ‘pure’ or ‘clean’
  • Spend hours per day thinking about what food might be served
  • Avoid social gatherings or restaurants due to the food on offer, or avoid eating food prepared by others out of the fear that any food not prepared by themselves will not meet their standards
  • Problems with relationships, as food becomes the primary source of happiness
  • Define healthy eating by a dietary theory or set of beliefs with an obsessive focus
  • Experience exaggerated emotional distress concerning food choices perceived as unhealthy
  • Feelings of guilt after eating ‘restricted’ foods, or 
  • Feeling that adhering to food restrictions determines a person’s self-worth
  • Impairment of academic, social, or vocational functioning secondary to behaviours or beliefs about a healthy diet
  • High levels of worry and concern about food quality

Orthorexia in Daily Life

All the signs and symptoms of orthorexia centre around being fixated on food quality. 

Food Groups and Physical Health

The obsessive focus on healthy eating may mean a person becomes distressed over food choices. They may choose only organically grown fruits and vegetables or refuse to eat any food that contains anything considered to be impure or unhealthy. This could be anything from fat, salt, sugar, artificial flavours, or preservatives, to animal or dairy products. Food considered ‘pure’ or ‘impure’ varies from person to person.

While a person suffering from orthorexia may believe that cutting out certain foods will bring them immense benefits in health, it often has the opposite effect. They could deplete their nutrition by limiting their food variety.

While there is nothing wrong with food choice, orthorexia involves an obsession with a ‘correct diet’ or ‘clean’ eating that can be all-consuming for a person and affect their daily lives.

Dietary Practices

Apart from inflexible eating or consuming, a person may also have an obsessive fixation on planning, purchasing, and preparing food.

For a person suffering from orthorexia, a ‘healthy diet’ involves self-imposed dietary practices, such as restrictive eating behaviours, believed to promote optimum health. A person may take an existing theory about healthy eating and adapt it with different beliefs of their own, and make a moral judgment of others based on dietary choices. There can also be periodic shifts in their nutritional beliefs.

Dietary restrictions escalate over time and may result in a person cutting out entire food groups. People may feel distressed or disgusted when they are in proximity to prohibited foods and therefore eliminate them. Eliminating certain foods such as sugar, meat, carbohydrates, gluten, or processed food also comes with progressively more severe ‘cleanses’ or partial fasting. These fastings are considered detoxifying or purifying and are often practised when a person has violated a dietary restriction.

As the restrictions and cleansing escalate, weight loss typically occurs, but the desire to lose weight is hidden or subordinated to the imagination of healthy foods. The elimination of nutrients or vitamins may also cause a person to feel weak, tired, or experience low energy levels. They may also take a long time to recover from illness.

Emotional and Psychological Effects

With orthorexia, a person’s emotional state is overly dependent on eating the ‘right’ food, meaning their sense of self-worth, identity, and satisfaction is excessively dependent on compliance with their self-defined eating behaviours. A violation of self-imposed dietary rules often makes those suffering from orthorexia feel an exaggerated sense of personal impurity and negative physical sensations. People who break their dietary regimen or deviate from their rigid eating patterns may experience depression, anxiety, guilt, and shame.

Violating their rules may also cause an exaggerated fear of disease. A constant worry about illness or sickness may relate to a belief in ‘good’ versus ‘bad’ foods; a person may have an exaggerated faith that including or excluding specific foods can prevent or cure disease. Any physical or mental illnesses may be attributed to what they consider ‘unhealthful’ eating.

Avoidance and Isolation

People suffering from orthorexia may experience anxiety simply by being around specific foods, so they may feel an intense need to separate themselves. Unfortunately, this means that a person suffering from orthorexia may use isolation as an avoidance technique. Specific foods can make them feel so uncomfortable – and often lead to intensified thought disturbances – that they may leave a room if the food can be seen, or entirely skip social events that may have ‘fear foods.’

Are There Treatment Options for Orthorexia Nervosa?

Living with orthorexia can be challenging, but there are ways of finding support and treatment available for it.

Mental health professionals can provide psychotherapy, including gradual exposure to anxiety-provoking or feared foods. It can also involve cognitive behavioural therapy, which can help a person change obsessive thought patterns about food while treating any co-existing mental health conditions such as anxiety disorders, stress, or depression. Medication may also be prescribed in the case of an untreated underlying mental health disorder.

Practices involving weight restoration are also part of treatment, and a dietician may help with this part of a treatment plan. Those who suffer from orthorexia may be deficient in vitamins and minerals, such as vitamins B and D, calcium, and folate. An essential part of treatment is a replacement of these nutrients.

Contact The Wave

Here at The Wave, we understand how difficult it can be to break through a thought process and develop a healthy relationship with food. But we also know that recovery is possible with a supportive, caring environment and a solid treatment programme.

We know that every person has different triggers and individual experiences, which is why we make sure each treatment plan is personalised. We provide a nutritional program tailored to your specific needs to ensure you get all the vitamins and minerals you need to stay strong and recover. We also offer a wide range of education on nutrition and how it affects the body, as well as alternative therapies to enhance wellness and promote healing from the inside out.

From dance and art therapy to reiki and mindfulness, The Wave can help you better cope with negative emotions and relieve stress. Creative therapies offer the chance to express feelings and let go of negative associations with food. These therapies may also help you develop new skills and hobbies that can help you channel your energy into something creative after you’ve left our clinic.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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