Orthorexia: When Healthy Eating Becomes a Disorder
Orthorexia nervosa or orthorexia is an obsessive fixation with consuming good food.

The current health food trends and diets, from plant-based eating to paleo, are hot topics in current media. Because of this, there has been increased mindful attention to food. However, in certain situations, this focus can become an obsession in the form of orthorexia, especially in people with obsessive-compulsive disorder (OCD).

Orthorexia nervosa is thought to have certain phenomenological characteristics with anorexia nervosa, obsessive-compulsive disorder (OCD), and other psychiatric illnesses. Early detection is crucial because the chances of recovery are higher if this issue is treated sooner.

What is orthorexia?

Orthorexia nervosa or orthorexia is an obsessive fixation with consuming good food. It is meant to match the more well-known anorexia nervosa but is not necessarily coupled with weight loss. More prevalent kinds of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. Orthorexia is not yet officially diagnosed as an eating disorder. Because there is a drastic increase in the number of people who exhibit characteristics of orthorexia, it has become a more discussed topic.

Orthorexia can start as a simple desire to improve eating habits and get healthier but can become an obsession to consume foods of the greatest quality or purity. Nutrition becomes a passion, and eating habits become quite rigorous. They get preoccupied with what and how much they should eat. Deviations from their rigorous food regimen may result in self-punishment in the form of fasting or excessive exercise. Self-esteem is linked with the perceived purity of their diet, and patients may even look down on others who they believe do not eat well.

Orthorexia results in limiting calories due to avoidance of so-called “unhealthy” food.

Orthorexia can cause nutritional deficiencies as a result of self-imposed food restrictions. Vitamin and mineral shortages may not be obvious at first, but they might have long-term implications. Furthermore, a person may lose the capacity to eat naturally and cannot recognize when they are hungry or full, as well as when to stop eating.

Orthorexia is more common in people who take things to the extreme or are more controlling. Other mental health issues that an individual suffering from orthorexia may develop include:

SLIDESHOW

Eating Disorders: Anorexia, Bulimia, Binge Eating See Slideshow

8 warning signs of orthorexia

Following a healthy diet does not indicate orthorexia; however, the warning signs of the condition include:

  1. A fixation over the quality of food: Individuals suffering from orthorexia are intensely focused and sometimes obsessed with the quality and purity of their meals. Individuals suffering from orthorexia frequently restrict their foods to organic, farm-fresh, whole, raw, and vegan options. They get overly obsessed with checking nutrition labels and ingredient lists. Food quantity is usually less significant than food quality.
  2. Inflexible eating patterns: Someone suffering from orthorexia are prone to be quite strict with their food consumption. Anything that the individual considers to be bad or unhealthy will most probably be avoided.
  3. Severe emotional turmoil if rules are broken: When someone deviates from their tight dietary patterns or strict self-prescribed exercise routine, they generally experience tremendous anxiety, distress, humiliation, guilt, and depression.
  4. Cutting out entire food groups: Cutting out whole food categories demonstrates how strict these orthorexia-fueled rule-based diets can get. Elimination of whole food categories often comprises processed foods, sweets, meat, dairy products, carbs, and gluten is widespread in this community.
  5. Constant worry about sickness or disease: Many people with orthorexia feel they will get ill if they intake meals that are not whole or clean, and they often see these foods as poison.
  6. Anxiety simply being around certain foods: Someone suffering from orthorexia may experience a strong need to isolate oneself from their banned meals. If they notice the meal, they may get extremely uncomfortable or leave the room. Isolation is a typical avoidance method for people with orthorexia. Skipping social engagements with fear foods often leads to sadness and worsened thinking disturbances and behaviors. In some instances, they bring prepackaged meals to parties because they believe other people's food will not satisfy their health standards.
  7. This disorder is not usually caused by a negative body image: While individuals with anorexia may demonstrate similar patterns of restriction, orthorexia is not always founded on the preoccupation with beauty or weight loss. The urge to eat “pure” or be healthy is at the root of orthorexia.
  8. Weight loss: Although weight loss is not often a clinical indication of orthorexia, it does occur in certain situations. An orthorexia diet is an imbalanced one and often leads to malnutrition. Though someone with orthorexia believes that eliminating specific foods will provide enormous health advantages. However, this often leads to depletion of nutrients while drastically reducing dietary diversity. This weight reduction is not usually deliberate.

What is the physical and mental impact of orthorexia?

Even though people with orthorexia feel that they are being self-aware and eating healthy, it negatively impacts their life both physically and mentally.

Physical complications

  • Dehydration
  • Constipation
  • Unable to concentrate
  • Sleeping issues
  • Malnourishment (caused by eating regulations that limit the amount of food ingested)
  • Thinning of hair
  • Drastic changes in weight

Psychological or behavioral changes

  • Constant worry about foods, such as how they are prepared
  • They increase using supplements
  • Dietary intake was reduced as a result of food laws based on health assumptions
  • Unwillingness to eat food that was not made by the individual or that was not monitored by the individual
  • They will criticize others’ eating habits
  • They put a lot of effort and time into gathering the supplies and preparing meals, which influence their daily life
  • Withdrawal from others

13 long-term complications of orthorexia

Orthorexia habits are often misinterpreted by society as healthy and good and hence, go unreported or untreated. Individuals get extremely malnourished.

If no intervention is provided, it can lead to major medical complications, such as:

  1. Malnourishment
  2. Cognitive function impairment
  3. Immune system dysfunction
  4. Heightened emotional dysregulation, such as:
  5. Increased suicidal thoughts and self-harming actions
  6. Failure of an organ
  7. Kidney problems
  8. Menstrual cycle and function changes
  9. Fertility problems
  10. Cardiovascular and cardiac problems or diseases
  11. Isolation
  12. Reduced job performance
  13. Osteoporosis or reduced bone density

QUESTION

Binge eating disorder is best described as… See Answer

What are the causes of orthorexia?

Just as with other eating disorders, there are biological, psychological, and social factors that influence the development of orthorexia. Orthorexia usually begins with support from others based on societal attitudes about food and the body, and it is sustained for the same reasons.

Biological factors

In other respects, orthorexia nervosa is neurologically similar to obsessive-compulsive disorder, including obsessive fixations. The following biological factors lead to orthorexia:

  • Eating habit problems run in the family
  • Personality qualities, such as perfectionism
  • Obsessive personality characteristics
  • Diet or digestive problems are linked to a childhood sickness
  • The belief that certain medical conditions could be treated by a pure diet

Psychological factors

A big portion of what leads to orthorexia nervosa is psychological because the condition is caused by a cognitive focus on the concepts of purity, cleanliness, and healthy eating.

Other psychological variables that contribute to the development of orthorexia include:

  • Self-esteem or self-worth issues
  • Past trauma 
  • Co-occurring mental health diagnoses, most notably obsessive-compulsive disorder or generalized anxiety disorder
  • Dieting history
  • There are fundamental ideas about purity, cleanliness, and health, as well as core views about food and self-worth, value, and morality
  • Disorganized familial attitudes about food purity and wellness
  • Extremism and obsessiveness

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What is orthorexia diagnosed?

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) does not formally acknowledge orthorexia as a condition, and acceptable diagnostic criteria are still debatable.

  • Orthorexia and obsessive-compulsive disorder (OCD) share many characteristics, such as obsessional anxiety, that lead to repetitive habits with food planning and preparation.
  • Individuals with higher OCD tendencies have higher impulses to develop orthorexia. 
  • Orthorexia is classed as OCD rather than an eating disorder because it does not feature low self-esteem, poor body image, concern with weight reduction, or the quantity of food ingested like other eating disorders, such as anorexia.

The available diagnostic criteria for orthorexia include:

Criteria A

Any of the following:

  • Obsessive behavior and mental concern with aggressive and restricted eating behaviors that the individual believes would improve health.
  • Excessive fear of sickness, a sense of personal impurity, and feeling anxious and guilty when they break self-imposed dietary guidelines.
  • Dietary restrictions may eventually lead to the elimination of whole food categories, as well as partial fasts are seen as purifying or detoxing. This ideation of eating healthy results in weight loss even though weight loss is not their intention.

Criteria B

Any of the following:

  • A limited diet can cause malnutrition, significant weight loss, and other medical issues.
  • Intrapersonal suffering or impairment in social, intellectual, or occupational performance as a result of healthy diet ideas or behaviors.
  • Positive body image, self-worth, identity, and happiness are overly dependent on adhering to self-defined healthy eating habits.

What are the treatment options for orthorexia?

Orthorexia is often treated with a multidisciplinary strategy that includes medical care, counseling, and mental medicine. Psychotherapy or medication are commonly used to treat orthorexia.

Psychotherapy

Cognitive behavior therapy, a type of psychotherapy, can help with orthorexia. It teaches a person new ways of thinking, acting, and reacting to events that allow them to feel less anxious or afraid without having obsessive thoughts or acting compulsively. Perfectionism and impaired judgment may benefit from cognitive behavioral therapy.

Relaxation therapy can help with anxiety that occurs at mealtime. Psychoeducation can address incorrect attitudes about food types, cleanliness, and preparation, but it can also cause emotional stress in orthorexia patients.

Dialectical behavioral therapy (DBT)

Dialectical behavioral therapy (DBT) is widely used to treat anxiety problems. DBT helps to heal by combining behavioral, cognitive, and meditative therapy.

Medications

The symptoms of orthorexia are similar to those of anxiety and depression, so doctors may prescribe medications used to treat those disorders to help with orthorexia. Antidepressants and antianxiety drugs are the most used treatments for orthorexia.

Many varieties of antianxiety drugs start functioning quickly. However, they should not be used for lengthy periods. Some individuals may refuse medications because they are unnatural substances.

Caring for someone with orthorexia

Caring for someone who has an eating issue may be emotionally draining. However, patience and support are crucial for their recovery.

Orthorexia can negatively impact physical and psychological health. People could be reluctant to acknowledge that they have an eating disorder because they believe they have been eating healthily.

  • Be patient and gently urge them to seek assistance.
  • Avoid discussions on food and weight issues, food quality difficulties, etc.
  • Try to enroll in family or group psychotherapy sessions so that the caregiver and the person can both fight orthorexia.

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Medically Reviewed on 6/23/2022
References
Image Source: iStock image

GoodTherapy. Orthorexia: An Obsessive Relationship with Healthy Eating. https://www.goodtherapy.org/blog/orthorexia-an-obsessive-relationship-with-healthy-eating-1223157

Psycom. Orthorexia Nervosa. https://www.psycom.net/eating-disorders/orthorexia/

Edward-Elmhurst Health. When healthy eating becomes unhealthy: orthorexia. https://www.eehealth.org/blog/2020/06/when-healthy-eating-becomes-unhealthy-orthorexia/