Researchers at York University’s Faculty of Health say those who have a history of an eating disorder, obsessive-compulsive traits, dieting, poor body image, and a drive for thinness are more likely to develop a pathological obsession with healthy eating or consuming only healthy food, known as orthorexia nervosa (ON).
Although eating healthy is an important part of a healthy lifestyle, for some people this preoccupation with healthy eating can become physically and socially impairing.
In the first exhaustive review of the psychosocial risk factors associated with orthorexia nervosa, York University psychology researchers examined all studies published up until the end of 2018 in two popular databases.
They looked at studies that examined how orthorexia nervosa is related to psychosocial risk factors that predisposed or made an individual vulnerable to or more likely to develop the condition.
They then amalgamated all available findings for each risk factor to reach conclusions about which psychosocial factors were most reliably associated with the condition.
“The long-term impact of these findings is that they will lead to better recognition among healthcare providers as well as members of the public that so-called healthy eating can, in fact, be unhealthy.
It can lead to malnourishment or make it very difficult to socialize with people in settings that involve eating.
It can also be expensive and time-consuming,” says Jennifer Mills, associate professor in the Department of Psychology and senior author on the study.
“When taken to the extreme, an obsession with clean eating can be a sign that the person is struggling to manage their mental health.”
Orthorexia Nervosa, one of the least mentioned eating disorders has been gaining more and more attention in a world so focused on healthy diets and clean eating.
Obesity has been considered a national emergency for Americans, so you might be thinking why would healthy eating be such a problem?
Well, it’s not healthy eating itself that is the problem.
It’s an obsession with healthy eating that turns a seemingly beneficial lifestyle change into a dangerous road of obsession and fixation on “pure” food consumption.
The term Orthorexia Nervosa is not officially recognized in the Diagnostic and Statistical Manual of Mental Disorders or by the American Psychiatric Association as a classified eating disorder; however, it was coined by American physician, Steven Bratman, M.D. in 1997. From the Greek, the term Orthorexia Nervosa literally means “correct diet.”
Physicians and mental health professionals classify individuals living with Orthorexia Nervosa as possessing an unhealthy obsession with the quality of foods being consumed.
This differs from the more widely known eating disorders of Bulimia Nervosa and Anorexia Nervosa that are focused on an unhealthy obsession with the quantity of foods consumed.
Research has shown a co-occurrence of multiple patterns of disordered eating in individuals suffering from Orthorexia Nervosa.
In fact, those individuals living with Orthorexia Nervosa are also more likely to suffer from Anorexia Nervosa as well.
While not universally accepted, two proposed criteria have been suggested for Orthorexia Nervosa.
Criterion one suggests individuals suffering from Orthorexia Nervosa have an obsessive focus on healthy eating with noticeable exaggerated emotional distress toward foods considered unhealthy or impure.
Criterion two suggests a clinical impairment of some form in direct relation to the compulsive behavior and mental preoccupation with healthy eating.
Orthorexia Nervosa oftentimes goes unnoticed because it does not seem unusual in this day and age to be “obsessed” if you will, with healthy eating.
We are constantly bombarded with new diets and exercise regiments, that it seems everyone is on a diet or has the desire to eat healthier food options.
Anything in excess can impose a problem on everyday life though. We’ll explore the symptoms, diagnosis, and treatment options of Orthorexia Nervosa in the next sections.
What are the Symptoms?
As previously mentioned, the overarching distinction between Orthorexia Nervosa and other, more common, eating disorders is the focus of the preoccupation.
While possibly a part of it, Orthorexia Nervosa sufferers are fueled by the desire to consume pure, healthy foods, obsessing over maintaining a perfect diet rather than an ideal weight.
To a person suffering from Orthorexia Nervosa, they may cut out any food that is considered unhealthy or impure.
These include foods containing:
- Artificial flavors, colors, or preservatives
- Fat, sugar, or salt
- Pesticides or genetically modified foods
- Animal or dairy products
- Any other ingredient considered to be unhealthy
If you are suffering from Orthorexia Nervosa, you might demonstrate a number of obsessive behaviors over food consumption. These behaviors may include:
- Obsessive concerns over food choices on health. That is, obsessive thoughts over the food put in your body on medical conditions, such as asthma, anxiety, allergies, or digestive problems.
- Severe restriction of types of food consumed. This is due to excessive reductions in the number of foods deemed acceptable to your diet. Many times, individuals suffering from Orthorexia Nervosa limit their food consumption to 10 or less different types of foods.
- Avoiding foods due to food allergies that have not been medically diagnosed.
- Significant increase in the consumption of probiotics, herbal remedies, and other supplements thought to have healthy effects on the body.
- Irrational concern over preparation of foods – relating to food washing techniques and sterilization of utensils.
In addition to obsessive behaviors, you are likely experiencing a number of emotional reactions to food if you are suffering from Orthorexia Nervosa. These emotional symptoms may include:
- Feelings of satisfaction and happiness from clean, healthy, pure eating
- Feelings of guilt when consuming foods that are not considered healthy and pure
- Excessive time spent thinking about food and the consumption of food
- Regular advanced meal planning; feelings of guilt and displeasure when meals are not planned in advance
- Having critical, judgmental thoughts of others who do not following healthy, pure eating plans
- Avoidance of eating food away from home or not prepared in your home kitchen, because you will not be able to comply easily with your healthy eating plan
- Avoiding food bought or prepared by others
- Creating distance between friends and family who do not share the same beliefs you have about food
- Mood swings
- Feelings of shame
- Social isolation
Wanting to eat a healthy, pure diet can be a great thing.
However, when these compulsive behaviors and mental preoccupations with healthy eating start to impair your quality of life, you may end up suffering from severe weight loss, malnutrition, or some other type of medical condition based on severe diet restrictions.
In addition, Orthorexia Nervosa may cause an impairment to your social, academic, or work life.
If you are suffering from Orthorexia Nervosa, you may also suffer from negative self-worth, negative body image, and become obsessively dependent on your healthy eating lifestyle to the point of social isolation.
How Orthorexia Nervosa is Diagnosed
You may be wondering if it is not officially recognized by the American Psychiatry Association or given a set of criterion in the Diagnostic and Statistical Manual of Mental Disorders that diagnosis is uncommon.
In fact, because of Americans’ obsession with healthy eating, Orthorexia Nervosa is becoming more and more common and individuals are more readily being diagnosed and treated for this condition.
If you are wondering if you are suffering from Orthorexia Nervosa, consider the following questions:
- Do you ever wish you could stop thinking so much about food and spend more time thinking about your loved ones?
- Are you constantly questioning food and considering how foods are unhealthy for you?
- Do you feel guilt or shame when you stray from your perfect diet?
- Does it seem physically impossible to eat a meal prepared by someone other than yourself?
- Do you feel “in control” when you stick to your planned, healthy, pure diet?
- Do you look down on others who eat less healthy than you?
If you answered yes to some or all of these questions, it is possible that you might be suffering from Orthorexia Nervosa.
Orthorexia Nervosa is a serious condition and could cause major disruptions to your well-being and social life.
It is best to seek medical help if you or a loved one is suffering from the effects of this condition.
Malnutrition can result – and sometimes, associated with malnutrition, cardiac problems may also arise.
Social isolation and interference with interpersonal relationships may also occur due to individuals with this condition putting themselves on a “nutritional pedestal” – looking down on those who don’t follow the same lifestyle as them.
Your physician and mental health provider will assess you physically and mentally – through medical tests and diagnostic assessment tools – to confirm suspicion of Orthorexia Nervosa.
Though a lesser known disease, Orthorexia Nervosa sufferers can benefit from treatments to change their obsessive thought patterns about food.
Many times, Orthorexia Nervosa co-occurs with other mental health disorders – so treatment is essential. Common disorders that co-occur with Orthorexia Nervosa include:
- Obsessive Compulsive Disorder
- Bipolar Disorder
- Panic and Anxiety Disorders
- Substance Abuse Disorders
- Post-traumatic Stress Disorder
- Obsessive Compulsive Personality Disorder
If you are suffering from Orthorexia Nervosa, you may benefit from a number of treatment options.
Most commonly, these include talk therapy sessions, meal support and nutritional counseling, medications, and neurofeedback.
Psychotherapy and Dialectical Behavioral Therapy (DBT) are two of the most common types of talk therapy.
Anti-anxiety and anti-depressants are often times prescribed to individuals coping with Orthorexia Nervosa to ease symptoms. Lastly, neurofeedback may be performed to alter brain waves that affect behavior, mood, and thinking patterns.
If you are suffering from Orthorexia Nervosa, it is important to stick with your treatment plan, even if you start feeling “better.”
Treatments for this condition and other types of eating disorders, can be considered “ever-changing” and organic.
Therefore, regular check-ins with your physician and therapist will allow for reassessments and treatment plan changes, as needed.
Think of your treatment plan as your roadmap to recovery – there might be twists and turns, but eventually, if you follow course, you’ll get to your destination.
Previous research has shown that unlike individuals with anorexia nervosa who restrict calories to maintain very low body weight, people who have the condition have a fixation with the quality of food eaten and its preparation rather than the number of calories.
Over time, they spend increasing amounts of time and effort purchasing, planning, and preparing pure and healthy meals, which eventually becomes an all-consuming obsession that interferes with other areas of life and results in weight loss.
One of the main reasons for conducting this study was that current research on the condition is limited. Unlike other eating disorders, such as anorexia, bulimia, orthorexia is not recognized in standard psychiatric manuals for healthcare providers.
“It was surprising to me that the overwhelming majority of the articles in this field were of neutral-poor quality, indicating that the results of these studies must be interpreted with caution,” says Sarah McComb, a Master’s student in Mills’ lab and first author of the study.
“It really suggests a call for more valid measurement tools of orthorexia, so that more reliable conclusions can be drawn about the true prevalence of orthorexia in the population and which psychosocial factors really put a person at risk for developing orthorexia nervosa.”
Researchers found the literature consistently showed that those who have obsessive-compulsive traits, depression and a previous eating disorder, and/or are preoccupied with their appearance and body image, are more likely to be at risk for developing the condition.
Other eating habits such as being a vegetarian or vegan also put individuals at higher risk for developing orthorexia nervosa.
Lacto-vegetarians were at highest risk for the condition and people who are on a strict eating schedule, spending large amounts of time preparing meals, were also at greater risk.
Previous research has shown that unlike individuals with anorexia nervosa who restrict calories to maintain very low body weight, people who have the condition have a fixation with the quality of food eaten and its preparation rather than the number of calories. The image is in the public domain.
“In our research, we found equal rates of men and women who struggle with symptoms of orthorexia nervosa,” said Mills.
“We still think of eating disorders as being a problem that affects mostly young women. Because of that assumption, the symptoms and negative consequences of orthorexia nervosa can fly under the radar and not be noticed or taken seriously.”
Researchers say developing a consistent definition of orthorexia nervosa will make it easier for health researchers to develop reliable measures and provide better diagnosis and treatment of the condition.
Anjum Nayyar – York University
The image is in the public domain.
Original Research: Closed access
“Orthorexia nervosa: A review of psychosocial risk factors”. Sarah E.McComb and Jennifer S.Mills.