Orthorexia is an obsessive and unhealthy fixation with healthy eating. It is not listed as an official diagnosis or classified in the DSM-V. In 1998, the term “orthorexia” was coined. It is defined as “an obsession with proper or ‘healthful’ eating.” 
What is Orthorexia
An individual can become all-consumed with what to eat, how much to eat, what is in the food, and the lifestyle of “pure” eating. Orthorexia is about rigidity and the ‘right’ way of eating.
People believe the idea of rising above others in dieting behaviors and ‘self-punishing’ if they slip-up, through stricter eating, fasting, or exercising to rid the body of any non-pure foods they eat.
Frequently, those who struggle with orthorexia have their self-esteem wrapped up in the idea of purity and feeling superior to others, especially when it comes to what they eat . The restrictions on food and the types of food they can eat can soon become so restrictive that a person’s health can suffer.
When battling orthorexia, an individual’s relationships can suffer, he or she may isolate themselves, their physical health can deteriorate, and their life can become consumed by the “pure” eating lifestyle. In essence, like other eating disorders, their day and life is obsessed with food.
Self-Assessment of Orthorexia
When considering if someone has orthorexia, there are fortunately questionnaires like the one on NEDA’s (National Eating Disorders Association) website that help in determining if help is needed.
If a person answers ‘yes’ to more questions than not, then it may be wise to talk to a physician about the possibility of that person struggling with the disease. .
- Do you wish that occasionally you could just eat and not worry about food quality?
- Do you ever wish you could spend less time on food and more time living and loving?
- Does it seem beyond your ability to eat a meal prepared with love by someone else – one single meal – and not try to control what is served?
- Are you constantly looking for ways foods are unhealthy for you?
- Do love, joy, play, and creativity take a back seat to following the perfect diet?
- Do you feel guilt or self-loathing when you stray from your diet?
- Do you feel in control when you stick to the “correct” diet? Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?
Stages of Orthorexia
Orthorexia develops in two stages. The first stage is when a person develops a thought and belief system around healthy eating. Often the belief system revolves around clean eating, paleo, vegan, raw foods, and “elimination” diets .
Some of these may be unsafe or medically unstable and lead to malnutrition. More popular diets that may be associated with orthorexia can be followed safely, but regardless of the diet, all are restrictive in nature and can lead to orthorexia or an eating disorder.
The second stage is when the person begins to obsess about the foods. Like most diets, they can lead to the restriction of foods and food categories. The person becomes obsessed with food, preparing food, and planning the most perfect and pure meals.
Regularly, food rules are created, and these rules may become harder to follow, which can lead to ‘cheating.’ This “cheating” can lead to detoxes or cleanses to rid the body of ‘toxins’ from the unclean or impure foods eaten which in and of itself can be quite dangerous.
Symptoms of Orthorexia
The individual begins to have a drive for purity, both internal and external. The sufferer begins to worry about being impure. The need to eat flawlessly is never met. The person feels that they can always do better, or they have never ‘cleansed’ enough .
Foods develop a moral quality and are seen as ‘good’ or ‘bad.’ Eating the ‘right’ food is how positive self-esteem is developed for the person with orthorexia, and often, it can create a sense of virtue.
If a person eats ‘bad’ food, it is often seen as a “sin” and can lead to feelings of guilt and self-punishment. Even if loved ones eat ‘bad’ foods, they are seen as inferior and unclean .
Within orthorexia, pure food is used as a coping mechanism for stress, anxiety, and fear in daily life. It is sometimes difficult for the sufferer to connect with others who do not eat in the same way because they are ‘bad’ and do not eat as purely and cleanly as the sufferer.
Treatment for orthorexia is about stabilization. Since the disease is harder to detect, first signs may be physical issues that indicate something is wrong. Attention must first be directed to treating any medical conditions created due to the orthorexia. Next, it is important to address the cognitive and emotional issues underlying the unhealthy behavior with food.
Meeting with a psychotherapist, a nutritionist, and psychiatrist is key to recovery from orthorexia. The individual will need to address the co-occurring disorders of anxiety, depression, and any other issues underlying their eating disorder. Some find medication management by a psychiatrist or general practition is helpful in recovery.
Addressing the underlying physical and emotional needs does not necessarily mean abandoning the healthy eating lifestyle, but the person needs to understand that orthorexia is not a healthy way of living.
Therapy is about the sufferer understanding the contributing factors to orthorexia such as anxiety, self-esteem, perfectionism, and food fears. Recovery involves implementing coping strategies and learning other activities outside the disorder.
Nutritional support helps with relearning how to eat a varied and nutritious diet. The sufferer needs to learn that meals and snacks include all food groups. Setting up a meal plan and a support system consisting of loved ones will help throughout the recovery process.
Types of Therapies
Cognitive Behavioral Therapy (CBT) is often successful with sufferers of orthorexia. CBT can help in all aspects of the recovery process as it can aid in reframing a person’s thought process, emotions, and behavior response to triggers and situations around the orthorexia.
Mindfulness-based activities are also a therapeutic module to use with individuals to help with stress reduction and using coping skills for distress tolerance. These types of therapy modules can aid in the way the sufferer approaches recovery.
Levels of Care
Orthorexia is most often treated on an outpatient basis, though hospitalization for medical stabilization may be necessary initially. Due to orthorexia not being a diagnosis or classified in the DSM-V, insurance companies often do not cover higher levels of care for treatment.
Many individuals can recover at the outpatient level from orthorexia. With professional treatment including a therapist, nutritionist, physician and possibly group therapy, it is possible to recover from this form of disordered eating.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References: Orthorexia Nervosa. (n.d.). Retrieved February 06, 2018, from https://www.nationaleatingdisorders.org/orthorexia-nervosa
 Bratman, S., Ph.D. (2015). Orthorexia Nervosa . Retrieved February 06, 2018, from https://www.mirror-mirror.org/orthorexia-nervosa.htm
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer 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 on April 30, 2018.
Reviewed by Jacquelyn Ekern, MS, LPC on April 30, 2018.
Published on EatingDisorderHope.com