Many people focus on maintaining healthy diets, but some people focus on healthy eating so much that every food choice can cause distress.
If you’re experiencing recurring concerns about the types of foods you’re eating and find yourself frequently preoccupied with eating only the healthiest possible foods, you might be experiencing a condition referred to as orthorexia nervosa, most commonly referred to as orthorexia.
What is orthorexia nervosa?
Orthorexia refers to a persistent pattern of restricting one’s diet to only include foods with the greatest possible health benefits. In other words, people struggling with orthorexia are fixated on eating only what they deem to be “right.”
Although it is relatively common for people to have some degree of concern over the healthiness of their eating habits, the level of concern can interfere with the lives of those who struggle with orthorexia. Below are some signs and symptoms of the condition.
Signs and symptoms of orthorexia may include:
- Creating and compulsively following food “rules” such as not eating entire food groups (meat, dairy, sugar, carbs, etc), only eating at certain times, and/or only eating home-cooked food
- Obsessively monitoring caloric intake, constantly viewing nutritional labels, and/or over-consuming health media
- Feeling afraid around foods deemed unhealthy
- Experiencing anxiety when self-inflicted food “rules” cannot be followed
- Worrying about whether eating certain foods deemed to be “unhealthy” will result in unwanted health-related consequences, such as high blood pressure, diabetes, or elevated cholesterol levels
- Spending large swaths of time planning out meals, grocery shopping, and preparing food that meets their criteria
- Spending more money than expected on specialty health foods that meet highly specific criteria
- Going to multiple grocery stores to select the “best” food option
- Putting extreme emphasis on maintaining a healthy diet to prevent diseases
- Comparing food consumption to other peoples’
- Seeking reassurance from family members, friends, and other trusted individuals about the nature and content of the food being prepared and served
This condition can even contribute to the very health-related challenges that the sufferer is so desperate to prevent. By limiting one’s diet to include only a very narrow range of acceptable foods or very small portions, a person can inadvertently expose themselves to significant medical risks.
Negative health effects of orthorexia include:
- Unintentional weight loss
- Malnutrition
- Impact on relationships
Understanding orthorexia in the context of OCD and other eating disorders
Research has shown that orthorexia is linked to both eating disorders and OCD.
While other eating disorders such as anorexia and bulimia may be focused on losing weight or being thin, and people struggling with orthorexia focus on maintaining an optimal diet, there is often a lot of overlap among these disorders. Orthorexia is sometimes misunderstood as a subtype of OCD; however, it is a distinct condition from OCD. Orthorexia is typically classified as an eating disorder, rather than an obsessive-compulsive spectrum disorder, though it has yet to be officially classified within the DSM.
Brittany Trimble, a social worker who specializes in eating disorders and OCD, says that orthorexia comes up in her work often, though it’s generally comorbid with another disorder or condition. One way to tell if OCD may be at work in someone’s orthorexia is if someone’s dietary “rules” are escalating in severity. For example, one of Trimble’s past therapy members made a rule about consuming a certain number of calories per day. As a result, they researched the type of yogurt with the lowest calories and only allowed themselves to eat that specific kind of yogurt. At first, the patient had a rule about calorie counting, which led to a new, more restrictive rule to never eat another type of yogurt again.
People with orthorexia may seem to experience obsessions: they often describe anxiety-provoking worries about whether eating certain foods deemed to be “unhealthy.” Orthorexia may also appear to be marked by compulsions, as people with the condition often repetitively check the nutritional content/facts of foods they’re considering eating and also engage in extensive food-related research. However, despite the apparent presence of obsessional thoughts/worries and compulsive “safety behaviors” in orthorexia, the condition is most often considered distinct from OCD.
How orthorexia is treated
If you’re experiencing orthorexia, there is hope for getting better.
One promising treatment for orthorexia is exposure and response (ERP) therapy. ERP involves confronting feared situations/stimuli and resisting the urge to rely on “safety behaviors” aimed at reducing anxiety or preventing a feared consequence. NOCD has over 300 therapists who specialize in treating OCD and related conditions, and you can find additional support in dozens of support groups. If you’re looking for other sources of support or other treatment options, the International OCD Foundation is an excellent resource, and the National Eating Disorders Association may also provide helpful information.
When used to treat orthorexia, ERP might involve gradually incorporating feared and avoided foods into one’s diet without extensively monitoring or researching their nutritional information.
Potential exposures that may be used to treat orthorexia include:
Incorporating avoided foods into one’s diet
ERP patients facing orthorexia may try foods like burgers, desserts, pizza, or other types of food they typically avoid.
Challenging food rules
“We figure out what the rules of their eating disorder is and then design exposures that break the rules. For example, for someone following a strict intermittent fasting schedule where they stop eating at 6 every night, I might try to get them to eat dinner at 7 instead,” Trimble describes.
Changing relationship with exercise
An exercise-related exposure might involve only exercising for 15 minutes one day if the patient is vigilant about exercising for two hours daily.
It is through gradual processes like these that an individual learns that they can tolerate uncertainty, doubt, and “imperfection” in their diet and manage anxiety about potential health-related consequences.