What is Orthorexia?

Eating a well-balanced diet can be an important part of one’s mental and physical health. However, orthorexia, which is the obsessive pursuit of health through food, can paradoxically lead to significant medical problems. Orthorexia is a term used to describe an excessive preoccupation with eating “healthy” or “clean” foods. The condition involves rigid dietary rules, ritualized eating patterns, and complete avoidance of foods perceived as unhealthy.

The term orthorexia was first introduced by Steven Bratman in 1997 to describe people who followed extreme diets for health reasons, but the diets ended up causing malnutrition and impairment of functioning. Although orthorexia is not yet formally recognized as a psychiatric diagnosis, it is a serious mental health condition that causes harm.

Symptoms of Orthorexia

• Intense fixation on “clean eating”
• Fear of eating foods perceived as “bad” or “unhealthy”
• Compulsive checking of nutritional labels and ingredients for “healthy” foods
• Cutting out entire groups of foods, such as carbohydrates or sugar
• Putting an extreme emphasis on a healthy diet to prevent diseases
• Refusal to eat out or eat food made by others because it might be “unhealthy”
• Spending a lot of time thinking about what food might be served at an upcoming event
• Obsessively following food and “healthy lifestyle” blogs on social media
• Holding critical opinions of others’ eating habits
• Extreme weight loss or malnutrition caused by the restrictive eating patterns

What are the Health Consequences of Orthorexia?

Perhaps counterintuitively, the obsessive pursuit of health through food can lead to significant health problems. Eliminating entire food groups such as dairy, meat or grains can result in fatigue, nutritional deficiencies, electrolyte abnormalities and psychological distress. Excessive dietary restriction causes weight loss and medical complications similar to those seen in Anorexia Nervosa, including low heart rate, anemia, gastrointestinal concerns, sleep disorders, difficulty concentrating, and low bone mineral density.

When food-related thoughts and rituals dominate most of the day, daily functioning becomes impaired and leads to reduced quality of life. In orthorexia, meals are a source of stress rather than connection. Individuals withdraw from activities and from people who do not align with their strict dietary regimen. They experience social isolation and relationships suffer.

Causes of Orthorexia

As in other eating disorders, there is no single cause for orthorexia. Risk factors for orthorexia include significant “health anxiety,” a strong belief that “food is medicine,” and a history of dieting or an eating disorder. Individuals who demonstrate perfectionism, rigid thinking or a need for control are susceptible to developing orthorexia.

Exposure to “wellness influencers” and “clean eating” groups can reinforce rigid dietary beliefs. The moral framing of food choices as “good” or “bad,” or an emphasis on an individual’s ability to control their health through diet, can predispose susceptible individuals to pathological eating.

How Does Orthorexia Differ From Other Disorders?

Orthorexia differs from other eating disorders because the obsessive eating is driven by the perceived health benefit of food rather than by concerns about weight or body size. In Anorexia Nervosa and Bulimia Nervosa, a fear of being overweight or gaining weight leads to disordered eating. In contrast, body dissatisfaction is less consistently linked to orthorexia than other eating disorders.

Anorexia Nervosa and Bulimia Nervosa are more widely reported in women than in men, but gender does not seem to be a consistent risk factor for orthorexia. Both orthorexia and Anorexia Nervosa involve restrictive eating patterns but for different reasons. In orthorexia, the restriction is driven by rigid food rules around food categories (such as processed foods); in anorexia, the restriction is caused by the goal of decreasing calories for weight loss.

Both orthorexia and obsessive-compulsive disorder (OCD) involve intrusive, repetitive thoughts and behavior patterns but they differ in content and focus. In orthorexia, the preoccupation is on the quality or health benefits of a particular food. OCD obsessions are typically more diverse and can involve themes such as contamination, harm or symmetry. Individuals with orthorexia see their dietary rigidity as good and helping them achieve optimal health, whereas in OCD, obsessions may be perceived as unwanted and distressing.

Treatment and Recovery

Orthorexia is not yet formally recognized as a distinct diagnosis, and more research is needed to determine the efficacy of different approaches to treatment. However, the level of disordered eating and potential for serious health consequences warrant the need to address symptoms using a multidisciplinary approach.

1. Psychotherapy

• Cognitive-behavior therapy (CBT) can target cognitive rigidity and reduce ritualized eating behaviors.
• Exposure and Response Prevention (ERP) is a type of CBT which involves eating feared foods without performing rituals, and is useful when orthorexia overlaps with OCD.
• Dialectical behavior therapy (DBT) and mindfulness-based strategies may be useful to target emotion regulation or anxiety around food.
• Psychoeducation is a useful adjunct to help patients identify the pathological preoccupation with food and understand the medical consequences of dietary restriction.
• Family-based therapy (FBT), where parents are empowered as the primary agents of change to feed their child, may be useful for adolescents.

2. Nutrition support – Working with a registered dietitian can help to correct misinformation about nutrition, normalize eating patterns, address nutritional deficiencies and gradually re-introduce feared foods.

3. Medical treatment – There is no FDA-approved medication for orthorexia, but pharmacotherapy (medication management) may be useful in treating symptoms of orthorexia and related conditions. Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine, may be a useful adjunct to psychotherapy. SSRIs are indicated if Generalized Anxiety Disorder, Major Depressive Disorder or OCD are also present. If the restrictive intake causes electrolyte imbalances, severely low weight, or medical instability (such as low heart rate or blood pressure), then more support and medical monitoring through inpatient treatment may be needed.

With early recognition and support, many people improve significantly with treatment. Recovery involves eating a wider range of foods, focusing on overall health instead of purity, and tolerating uncertainty about “perfect” eating. Recovered individuals learn to stop compulsive checking and researching about food, resume eating socially, and enjoy food again. Although progress may be gradual, recovery from orthorexia is entirely possible.