Many often ask “what’s the problem with attempting healthful eating or clean eating?” and the National Eating Disorders Association provided the perfect response, stating that “although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in-and-of-itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being .”
While not a formal mental health diagnosis in the Diagnostic and Statistical Manual of Mental Illness (now in its 5th edition), between 21% to 58% of the population have eating behaviors that are characteristic of orthorexia .
This disorder is problematic on its own and becomes more concerning when one considers that these “clean eating” behaviors often give way to more severe and problematic disordered eating behaviors.
A recent study reviewed much of the existing literature on orthorexia in order to learn more about the underlying psychopathology, risk factors, and relationship to other eating disorders.
Based on these results, the study’s researchers proposed a psychosocial model of orthorexia nervosa. It points out that most research on orthorexia indicates a combination of social factors, such as stigmatization of obesity or value placed on “healthy” eating habits, as well as psychological factors .
Social factors connected to orthorexia include stigmatization of obesity, availability of organic/“clean” food, access to food/research knowledge, positive reinforcement from others, and time for food planning or preparation .
Psychological factors associated with orthorexia include perfectionism, dieting, restrictive eating, drive for thinness, thin-ideal internalization, neuroticism, obsessive-compulsive tendencies, past history of an eating disorder, fear of losing control, and perceived vulnerability to disease .
If you have read articles regarding risk factors for anorexia, bulimia, and binge eating disorder, you may find many of those listed above familiar.
There are differences, however, as individuals with bulimia or anorexia often report body dissatisfaction or disturbance, fear of fatness, and low self-esteem. The study notes that most women with orthorexia are proud of their bodies and are more likely to show them off.
Despite this, individuals with anorexia, bulimia, and orthorexia all report thin-ideal internalization and a drive for thinness.
Researchers often debate whether orthorexia is a distinct and separate eating disorder or a prelude or way to maintain other eating disorders due to the often restrictive rules and behaviors involved.
The study found that the eating disorder orthorexia is most like is actually none of those listed above and is, instead, ARFID, avoidant and restrictive food intake disorder, noting that both are “maintained by persistent failure to meet appropriate nutritional or energy needs, through virtue of eliminating certain foods or food groups, or restricting intake. This feeding disturbance may be caused by concern about the aversive consequences of eating, such as fear of contamination or consumption of toxins, as is common in ON .”
Regardless of which disorder orthorexia most closely resembles, research makes it clear that “clean eating” behaviors overlap greatly with symptoms and risk factors for anorexia, bulimia, binge eating, and ARFID, making any of these behaviors concerning.
References Unknown (2019). Orthorexia. National Eating Disorders Association, retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia.  Unknown (2019). Orthorexia: Statistics, signs, causes, and symptoms. The Refuge, retrieved from https://www.therefuge-ahealingplace.com/eating-disorders/orthorexia/effects-symptoms-signs/.  McComb, S. E., Mills, J. S. (2019). Orthorexia: A review of psychosocial factors. Appetite, 140:1.
About the Author:
Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published December 17, 2019, on EatingDisorderHope.com
Reviewed & Approved on December 17, 2019, by Jacquelyn Ekern MS, LPC