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Orthorexia – When Healthy Eating is Disordered Eating

We live in a world with a lot of social pressures. There is a pressure to look thin, a pressure to remain fit, a pressure to behave in specific ways, and so much more. These pressures can lead to the development of eating disorders, which are psychological issues related to diets, eating habits, and emotional regulation, such as anorexia, bulimia, and binge eating.

But, as therapists for eating disorders, we also recognize that there are other ways that these social pressures can manifest – ways that may not be considered official “eating disorders” in the diagnostic manual, but are disruptive in ways that can impact a person’s quality of life.  

One example of this is with a condition called “orthorexia,” a unique form of disordered eating that is affecting more and more people, all over the world.

Who We Are

Flourish Psychology is a boutique private psychotherapy practice in NYC. It is led Dr. Sadi Fox in Brooklyn, a psychologist that specializes in eating disorders, including non-traditional eating disorders like orthorexia. 

Dr. Fox and her colleagues work with adult patients from all backgrounds. We create an accepting space that is open to different cultures, backgrounds, and orientations. We also see many celebrity and high profile clients that may require additional discretion. If you are in New York and looking for a therapist, learn more about our services or contact us today

Woman with OCD in NYC washing hands

What Is Orthorexia?

Orthorexia Nervosa, typically shortened to “orthorexia,” is a newly recognized type of eating disorder that has been growing in numbers over the past few decades, potentially as a result of social media.

Orthorexia is not like other eating disorders. People with orthorexia do not starve themselves, or find themselves overeating. Quite the opposite, in fact. People with orthorexia eat what we traditionally view as very healthy. They eat foods like salads and fruits. They eat all (or close to) the amount of calories their body needs to function. They prepare home cooked organic meals. 

People with orthorexia eat healthy. In fact, orthorexia loosely translates to “righteous eating.” People with orthorexia eat meals that we as a society consider very healthy – the types of meals that we are encouraged to eat by doctors and scientists.

With orthorexia, the quality of the food is not the problem, and neither is the quantity (usually). What makes orthorexia a problem is the obsession over the quality of the food. Individuals with orthorexia generally take healthy eating to an extreme degree, impacting the relationships, decision making, and quality of life.

How Can Healthy Eating Be Bad?

It is good to eat healthy. But your mental health, as it pertains to food, is about more than just what you consume. People with orthorexia allow their dedication to healthy eating to become an obsession that dominates almost every component of their lives. Some of the signs and symptoms of orthorexia include:

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Obsessively checking ingredient lists and nutrition labels.

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Cutting out entire food groups as a result of health beliefs, with no medical reason.

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Feeling extreme distress after eating anything other than their pre-defined healthy foods.

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Avoiding social events or hurting relationships because of the food served.

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Believing and repeating unproven “facts” about “clean eating.”

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Preoccupation with food, eating, and nutrition (eg, extensively following natural health influencers, thinking and worrying about food, and extensive meal planning)

Perhaps the most serious issue that makes orthorexia a problem is that “healthy eating” is often defined by the individual, and the individual may be – and is often – wrong. For example, a person that struggles with orthorexia may refrain from foods that are not necessarily unhealthy

This is the primary danger with orthorexia. Many people with orthorexia misunderstand nutrition or fall for misinformation about healthy foods, eventually cutting out foods that are necessary from their diet. This can lead sometimes to severe malnutrition, despite the person being focused on healthy eating and appearing – sometimes to others – that their diets are good for them.

Even without severe malnutrition, a person may be cutting out critical nutrients for health and wellness in both the short and long term. For example, people with orthorexia may avoid foods with salt or fats because they’re considered “unhealthy,” but some research into fats and salt show that they may be necessary for a healthy and more balanced diet. Examples include:

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Gluten (when not gluten intolerant)

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Protein-rich foods, like dairy, without a proper replacement.

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Healthy foods known for their calories.

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Rice and grains.

What defines “healthy” to the person with orthorexia may not be what their body needs, and often – also because of misinformation and health mythology – means cutting out foods and nutrients that are critical for long term health. There are those with orthorexia that have died 

It should be noted that many of these symptoms are very similar to those of obsessive compulsive disorder (OCD). The obsession (healthy and clean eating) becomes all-consuming, and the compulsion (restricting foods, eating only healthy foods, always planning what to eat) is used to decrease the severity of the distress.

In fact, clinicians often debate whether or not orthorexia should be considered a form of OCD, rather than an eating disorder. But those same symptoms are also very similar to those of anorexia, but without the obsession with body weight and fat loss.

As a result, we currently consider orthorexia to be a form of disordered eating, and most studies confirm that – although the symptoms are similar to OCD – orthorexia is much more closely related to eating disorders. 

Other Problems with “Healthy Eating”

In addition to food restriction and the way their food obsession consumes their life, those with orthorexia may also engage in behaviors that sound safe on the surface but are harmful and against scientific consensus. An example is that many people with orthorexia use natural herbal and vitamin supplements “in an effort to be healthier.” 

But many of these supplements are untested, unregulated, do not have the claimed effects, and could potentially be harmful if ingested regularly. Several vitamins are healthy when part of food, but unhealthy when ingested in high doses. Many “natural health” items, like “homeopathic medicine,” do nothing at all and are potentially harmful. 

Yet many with orthorexia consume them believing them to be healthy, natural, and effective. The herbal supplement industry is a highly unregulated field, and many of the items on the market make claims that do not hold up to science and sometimes are harmful. Unregulated kava – an anti-anxiety herb – caused severe and permanent liver damage in those that used it, and many of the herbal supplements sold today are known to have none of the herbs they claim, nor do the herbs they have seem to have any medicinal effect

Sometimes, people take these as medications instead of using proven pharmaceuticals that could save their life. 

Orthorexia is considered a psychological disorder primarily because of its obsessive nature. But it is also important to recognize that even their “healthy diets” are not always as healthy as they think them to be. The science of health is filled with misinformation and constantly changing. 

Because individuals with orthorexia may be misled by “healthy” recommendations from online influencers or in books, they may be eating a diet that is not nearly as healthy as they have been led to believe. 

What Causes Orthorexia Nervosa?

The exact causes of orthorexia are varied and complex. It has been linked to health anxiety, to low self-esteem, to bullying, to a desire for control after trauma, and much more. Research into orthorexia has identified several additional possible causes, such as:

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Increased use of Instagram and other social media platforms.

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Pre-existing strict dietary restraints – for example, veganism.

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Perfectionists may be at greater risk for orthorexia.

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Family history of eating disorders or restrictive eating may be a risk factor for orthorexia.

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Fear of death.

Orthorexia may also be the result of people feeling pressured to eat healthier. With the internet, the idea of healthy has changed, and so has our awareness of the need to take better care of ourselves. Seeing others engage in healthier behaviors can be very motivating, but the end result may be more people falling into a spiral where they become more and more obsessed with reaching their healthy eating goals.

What are the Demographics of Orthorexia?

Orthorexia can affect anyone at any age. It most commonly affects middle age, middle class adults, but unlike other eating disorders, there are very few differences in gender demographics. Both men and women appear to be similarly capable of developing orthorexia.

Woman with OCD in NYC washing hands

Orthorexia Treatments and Support – Therapy, and More

Psychologists and therapists may use a manual known as the DSM-V (5th version of the Diagnostic and Statistics Manual) to diagnose eating disorders. But orthorexia is currently not listed within the DSM-V, and does not have diagnostic criteria.

Most eating disorder therapists recognize that this is a real condition, and some diagnostic criteria have been proposed, but nothing has been adopted by any psychological organization.

Your therapist needs to talk to you to determine if you likely have orthorexia nervosa, and listen to your stories in order to determine if this may be a condition that affects you.

    Once you and your therapist have determined that you have orthorexia, there are many treatment options available. Some of the most common approaches include:

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      Acceptance and Commitment Therapy (ACT)

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      Family Based Therapy (FBT)

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      Exposure Therapy

      Patients may also need nutrition counseling in order to maintain a healthy diet after overcoming orthorexia. The treatment timeline can vary depending on the symptoms and how long someone has been struggling with it. It is typically a good idea to visit an eating disorder specialist.

      Looking for More Information?

      If you are in Brooklyn or New York and are interested in pursuing treatment for orthorexia, or any eating disorder, please contact Flourish Psychology, today. We also encourage you to visit our blog, sign up for our newsletter, follow our Facebook page, or bookmark our resources page, as we will continually adding more eating disorder resources over time.