Orthorexia

When Healthy Eating Starts to Take Over

Orthorexia is a term coined by Dr. Steven Bratman in 1997 to describe a preoccupation with eating "healthily" or "purely" that starts to cause distress and take over life. Although not officially recognised as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), orthorexia is a growing concern among mental health professionals.

Orthorexia is characterised by an intense focus on the quality and purity of food, often leading to rigid food rules, social isolation, and significant distress. The prevalence of orthorexia is difficult to determine due to the lack of standardised diagnostic criteria. Estimates vary widely depending on how orthorexia is measured, and higher rates have been reported among people with a history of eating disorders.

In line with the transdiagnostic approach to eating disorders, at Exhale Psychology Centre we do not see orthorexia as a distinct diagnosis but instead as a different expression of restrictive eating (anorexia). In our clinical experience, people who come to us with orthorexia are highly preoccupied with food ‘purity’ but this purity is arbitrary, often related to calories, and ultimately unrelated to actual health guidelines.

It is worth noting that in popular culture (Instagram influencers, TikTok, YouTube vloggers, celebrities etc.), orthorexia or clean eating is presented as a status symbol, with its lead influencers being thin, wealthy, and white (caucasian). This shows that the associations with orthorexia are not about health and wellness but about being wealthy, white, and on trend - having a body that is on trend, eating on-trend orthorexic foods, wearing on-trend clothes, living an on-trend lifestyle etc.

What Orthorexia Can Look Like

People with orthorexia may experience:

• Rigid adherence to a specific diet, often involving the elimination of entire food groups
• Preoccupation with the quality and purity of food, including organic, non-GMO, and pesticide-free products
• Excessive time spent researching, planning, and preparing meals
• Feelings of guilt or shame when going outside their food rules
• Social isolation due to the avoidance of situations involving food
• Significant weight loss or nutritional deficiencies
• Day-to-day life becoming harder because of the preoccupation with healthy eating

Orthorexia Causes and Contributing Factors

While the exact causes of orthorexia are not fully understood, there are several contributing factors that may play a role in its development. One potential cause is societal pressure to conform to a certain standard of beauty and health. In a culture that idolises thinness and equates it with success and self-worth, people may become preoccupied with eating "clean" as a way to achieve a desired body image. Additionally, people with perfectionistic tendencies may be more prone to developing orthorexia. The need to control and achieve perfection in all aspects of life, including diet, can lead to a preoccupation with food that causes distress. Anxiety, OCD, and low self-esteem have also been associated with orthorexia. It is important to note that orthorexia can occur in both men and women of any age, and it often coexists with other eating disorders and mental health difficulties.

• Societal pressure to maintain a healthy lifestyle and ideal body image
• Exposure to social media and other sources promoting extreme dietary practices
• A history of eating disorders or body image concerns
• Perfectionistic personality traits
• Anxiety or obsessive-compulsive tendencies

To learn more about the causes of eating disorders and the support available, go to Eating Disorders.

Support for Orthorexia

If orthorexia is affecting you or someone you know, consider the following tips:

• Seek support from a mental health professional experienced in working with eating disorders
• Develop a support network of friends and family who understand, are anti-diet culture, and support you as you make changes
• Practise self-compassion and challenge perfectionistic tendencies
• Limit exposure to social media and other sources that promote extreme dietary practices
• Focus on the enjoyment and social aspects of eating, rather than solely on the nutritional value of food as mental health is part of health too

Frequently Asked Questions

Q: What is Orthorexia?

A: Orthorexia is an eating disorder characterised by an intense preoccupation with eating healthy or "clean" foods. People with orthorexia often have rigid, inflexible eating patterns and exclude entire food groups or specific ingredients they deem as unhealthy.

Q: What are the risk factors for orthorexia?

A: The exact causes of orthorexia are still unknown, but there are several factors that may contribute to its development. These include having a history of anorexia or other eating disorders, personality traits like perfectionism and obsessive-compulsive tendencies, societal pressure to eat a certain way, and a strong desire for control.

Q: What can orthorexia look like?

A: Orthorexia may include an intense focus on healthy eating, strict and inflexible eating patterns, severe distress or anxiety when going outside these patterns, avoiding social situations involving food, malnutrition or nutrient deficiencies, and day-to-day life becoming harder.

Q: Can orthorexia lead to other eating disorders?

A: Although orthorexia itself is not officially recognised as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it shares similarities with anorexia nervosa, bulimia nervosa, and binge eating disorder. Some people with orthorexia may develop other eating disorders if their rigid eating patterns become more extreme.

Q: What might suggest someone is developing orthorexia?

A: Things to look out for include a preoccupation with food choices and ingredients, a preoccupation with health and nutritional information, avoiding social events that involve food, a sense of superiority over others when it comes to food choices, and a decline in overall well-being due to restrictive eating habits.

Q: Can orthorexia be harmful?

A: Yes, orthorexia can be harmful both physically and mentally. The preoccupation with eating healthily can lead to malnutrition, nutrient deficiencies, and social isolation. It can also create a constant state of anxiety and distress around food, impacting a person's quality of life.

Q: Is orthorexia the same as "clean eating"?

A: They are not the same, but they are closely connected. "Clean eating" is a diet culture trend rather than a health guideline, and for some people it becomes a pathway into orthorexia. Orthorexia involves an intense, rigid focus on eating only "pure" or "clean" foods that causes distress and starts to take over life.

Q: Can orthorexia be identified as being "health conscious"?

A: It is important to differentiate between being health conscious and having orthorexia. While being health conscious involves a balanced and informed approach to food choices, orthorexia is characterised by an intense and rigid preoccupation with eating only specific foods that are perceived as healthy.

Q: Can orthorexia be easily identified as "healthy eating"?

A: While orthorexia may initially appear as healthy eating, it goes beyond making nutritious food choices. Orthorexia involves rigid, distressing eating patterns that can lead to nutrient deficiencies, social isolation, and a decline in overall well-being.

Q: Can orthorexia be linked to other mental health conditions?

A: There is evidence suggesting that orthorexia may be related to conditions such as obsessive-compulsive disorder (OCD) and generalised anxiety disorder. However, more research is needed to fully understand the connection between orthorexia and other mental health conditions.

Q: How can one develop a better understanding of orthorexia and eating disorders?

A: To develop a better understanding of orthorexia and eating disorders in general, it is helpful to educate oneself about the subject. Resources such as books, articles, and reputable websites, including the National Eating Disorders Association, can provide valuable information and insights.