Orthorexia: When Healthy Eating Becomes a Disorder

Distraught Woman with Plated AppleHealthy eating can lead to major improvements in health and well-being.

However, for some people, the focus on healthy eating can become obsessive and morph into an eating disorder known as orthorexia.

Like other eating disorders, orthorexia can have severe consequences.

This article explains everything you need to know about orthorexia.

What is Orthorexia?

Orthorexia, or orthorexia nervosa, is an eating disorder that involves an unhealthy obsession with healthy eating.

Unlike other eating disorders, orthorexia mostly revolves around food quality, not quantity. Unlike with anorexia or bulimia, people with orthorexia are rarely focused on losing weight (1).

Instead, they have an extreme fixation with the “purity” of their foods, as well as an obsession with the benefits of healthy eating.

A few years ago, orthorexia was in the media spotlight because of Jordan Younger, a successful blogger with more than 70,000 Instagram followers.

She shocked everyone by describing how her motivation to eat healthy became obsessive to the point of malnutrition.

Orthorexia is beginning to be recognized by the medical community, although it has not been officially defined as an eating disorder by the American Psychiatric Association or the DSM-5.

The term “orthorexia” was first coined in 1997 by the American physician Steve Bratman. The term is derived from “orthos” – which is Greek for “right.”

Bottom Line: Orthorexia nervosa is an eating disorder that involves an obsession with healthy eating and optimal nutrition.

What Causes Orthorexia?

A Pile of Spinach Leaves

Although you may begin a diet simply intending to improve your health, this focus can become more extreme.

Over time, good intentions can slowly morph into full-blown orthorexia.

Research on the precise causes of orthorexia is sparse, but obsessive-compulsive tendencies and former or current eating disorders are known risk factors (2, 3).

Other risk factors include tendencies towards perfectionism, high anxiety or a need for control (4, 5).

Several studies also report that individuals focused on health for their career may have a higher risk of developing orthorexia.

Frequent examples include healthcare workers, opera singers, ballet dancers, symphony orchestra musicians and athletes (5, 6, 7, 8, 9).

The risk may also depend on age, gender, education level and socioeconomic status, but more research is needed before conclusions can be reached (2).

Bottom Line: The exact causes of orthorexia are not well known, but certain personality and occupational risk factors have been identified.

How Common is Orthorexia?

Concerned Woman with Empty Plate

In some cases, it can be hard to differentiate between orthorexia and a normal preoccupation with healthy eating.

For this reason, it is hard to determine how common orthorexia is. The rates in studies range from 6% to 90%. Part of this is also because the diagnostic criteria are not universally agreed upon (10).

What’s more, the criteria don’t assess whether the behaviors negatively impact the person’s social, physical or mental health, which is a crucial part of orthorexia.

Enthusiasm for healthy eating only morphs into orthorexia when it turns into an obsession that negatively affects everyday life, such as extreme weight loss or a refusal to eat out with friends.

When taking these negative effects into account, orthorexia rates drop to less than 1%, which is much more in line with the rates of other eating disorders (10).

Bottom Line: Enthusiasm for a healthy diet only morphs into orthorexia when it starts to negatively affect physical, social or mental health.

How is Orthorexia Diagnosed?

Pomegranate Juice and Arils

To make the distinction between healthy eating and orthorexia clearer, Bratman and Dunn recently proposed the following 2-part diagnostic criteria (11):

1. An Obsessive Focus on Healthy Eating

The first part is an obsessive focus on healthy eating that involves exaggerated emotional distress related to food choices. This can include:

  • Behaviors or thoughts: Compulsive behaviors or mental preoccupations with dietary choices believed to promote optimal health.
  • Self-imposed anxiety: Breaking self-imposed dietary rules causes anxiety, shame, fear of disease, sense of impurity or negative physical sensations.
  • Severe restrictions: Dietary restrictions that escalate over time and can include the elimination of entire food groups and addition of cleanses, fasts or both.

2. Behavior that Disrupts Daily Life

The second part is compulsive behavior that prevents normal daily functioning. This can happen through any of the following ways:

  • Medical issues: Malnutrition, severe weight loss or other medical complications.
  • Lifestyle disruption: Personal distress or difficult social or academic functioning due to beliefs or behaviors related to healthy eating.
  • Emotional dependence: Body image, self-worth, identity or satisfaction is excessively dependent on complying with self-imposed dietary rules.

Bottom Line: One diagnostic framework for orthorexia looks for an obsessive focus on healthy eating and behaviors that disrupt daily life.

Negative Health Effects of Orthorexia

Distressed Woman with Eating Disorder

The negative health effects linked to orthorexia generally fall under one of the following three categories:

1. Physical Effects

Although studies on orthorexia are limited, this condition is likely to lead to the many of the same medical complications as other eating disorders.

For instance, a shortage in essential nutrients caused by restrictive eating can result in malnutrition, anemia or an abnormally slow heart rate (4, 12).

Additional consequences include digestion problems, electrolyte and hormonal imbalances, metabolic acidosis and impaired bone health (13, 14).

These physical complications can be life-threatening, and should not be underestimated.

Bottom Line: Orthorexia is expected to result in medical complications similar to those linked to other eating disorders.

2. Psychological Effects

Individuals with orthorexia can experience intense frustration when their food-related habits are disrupted.

What’s more, breaking self-imposed dietary rules is likely to cause feelings of guilt, self-loathing or a compulsion towards “purification” through cleanses or fasts (2, 3).

In addition, a large amount of time is spent scrutinizing whether certain foods are “clean” or “pure” enough. This can include concerns about vegetables’ exposure to pesticides, hormone-supplemented dairy and artificial flavors or preservatives (4).

Outside of meals, extra time might be spent researching, cataloging, weighing and measuring food or planning future meals.

Recent research reports that this ongoing preoccupation with food and health is linked to a weaker working memory (4, 15).

Furthermore, orthorexic individuals are less likely to perform well on tasks requiring flexible problem-solving skills. They also are less able to maintain focus on their surrounding environment, including people (4, 15).

Bottom Line: An constant preoccupation with healthy eating can have negative psychological effects, and is linked to impaired brain function.

3. Social Effects

Individuals with orthorexia don’t like to give up control when it comes to food (2).

The also often follow strict, self-imposed rules dictating which foods can be combined in a sitting or eaten at particular moments during the day (2).

Such rigid eating patterns can make it challenging to take part in normal social activities revolving around food, such as dinner parties or eating out.

Additionally, intrusive food-related thoughts and the tendency to feel their food habits are superior may further complicate social interactions (4).

This can lead to social isolation, which seems to be common among people suffering from orthorexia (2, 3).

Bottom Line: The rigid eating patterns, intrusive food-related thoughts and feelings of moral superiority can have negative social effects.

How to Overcome Orthorexia

Fruits and Vegetables

The consequences of orthorexia can be just as severe as those from other eating disorders.

If left untreated, they can result in irreversible damage to health.

The first step towards overcoming orthorexia is identifying its presence.

This can be challenging, because individuals who have this disorder often fail to recognize any of its negative effects on health, well-being or social function.

Once the problem has been recognized, help should be sought from a multidisciplinary team that includes a doctor, psychologist and dietitian.

Common treatments include exposure and response prevention, behavior modification, cognitive restructuring and various forms of relaxation training.

However, the effectiveness of these treatments for orthorexia has not been scientifically confirmed (4).

Finally, education about scientifically valid nutrition information may also help orthorexic patients get rid of false food beliefs (16).

Bottom Line: There are several ways to treat orthorexia. Seeking help from a health professional is strongly recommended.

Take Home Message

Being mindful of the foods you eat and how they affect your health is generally regarded as a good thing.

However, for some people, there’s a fine line between healthy eating and an eating disorder.

If your current healthy diet negatively affects your health, psychological well-being or social life, it is possible that your focus on health has morphed into orthorexia.

This disorder can have life-threatening consequences, and should not be taken lightly. Consulting with your doctor, psychologist or dietitian is strongly recommended.