Orthorexia Nervosa

By Karin Kratina, PhD, RD, LD/N

Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.”  Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity.  They become consumed with what and how much to eat, and how to deal with “slip-ups.”  An iron-clad will is needed to maintain this rigid eating style.  Every day is a chance to eat right, be “good,” rise above others in dietary prowess, and self-punish if temptation wins (usually through stricter eating, fasts and exercise).  Self-esteem becomes wrapped up in the purity of orthorexics’ diet and they sometimes feel superior to others, especially in regard to food intake.

Eventually food choices become so restrictive, in both variety and calories, that health suffers – an ironic twist for a person so completely dedicated to healthy eating.  Eventually, the obsession with healthy eating can crowd out other activities and interests, impair relationships, and become physically dangerous.

Is Orthorexia An Eating Disorder?

Orthorexia is a term coined by Steven Bratman, MD to describe his own experience with food and eating.  It is not an officially recognized disorder in the DSM-V, but is similar to other eating disorders – those with anorexia nervosa or bulimia nervosa obsess about calories and weight while orthorexics obsess about healthy eating (not about being “thin” and losing weight).

Why Does Someone Get Orthorexia?

Orthorexia appears to be motivated by health, but there are underlying motivations, which can include safety from poor health, compulsion for complete control, escape from fears, wanting to be thin, improving self-esteem, searching for spirituality through food, and using food to create an identity.

Do I Have Orthorexia?

Consider the following questions.  The more questions you respond “yes” to, the more likely you are dealing with orthorexia.

  • Do you wish that occasionally you could just eat and not worry about food quality?
  • Do you ever wish you could spend less time on food and more time living and loving?
  • Does it seem beyond your ability to eat a meal prepared with love by someone else – one single meal – and not try to control what is served?
  • Are you constantly looking for ways foods are unhealthy for you?
  • Do love, joy, play and creativity take a back seat to following the perfect diet?
  • Do you feel guilt or self-loathing when you stray from your diet?
  • Do you feel in control when you stick to the “correct” diet?
  • Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat? 

So What’s The Big Deal?

The diet of orthorexics can actually be unhealthy, with nutritional deficits specific to the diet they have imposed upon themselves.  These nutritional issues may not always be apparent. Social problems are more obvious.  Orthorexics may be socially isolated, often because they plan their life around food.  They may have little room in life for anything other than thinking about and planning food intake.  Orthorexics lose the ability to eat intuitively – to know when they are hungry, how much they need, and when they are full.   Instead of eating naturally they are destined to keep “falling off the wagon,” resulting in a feeling of failure familiar to followers of any diet.

When Orthorexia Becomes All Consuming

Dr. Bratman, who recovered from orthorexia, states “I pursued wellness through healthy eating for years, but gradually I began to sense that something was going wrong.  The poetry of my life was disappearing.  My ability to carry on normal conversations was hindered by intrusive thoughts of food.  The need to obtain meals free of meat, fat, and artificial chemicals had put nearly all social forms of eating beyond my reach.  I was lonely and obsessed. … I found it terribly difficult to free myself.  I had been seduced by righteous eating.  The problem of my life's meaning had been transferred inexorably to food, and I could not reclaim it.”  (Source: www.orthorexia.com)

Are You Telling Me it is Unhealthy to Follow a Healthy Diet?

Following a healthy diet does not mean you are orthorexic, and nothing is wrong with eating healthfully.  Unless, however, 1) it is taking up an inordinate amount of time and attention in your life; 2) deviating from that diet is met with guilt and self-loathing; and/or 3) it is used to avoid life issues and leaves you separate and alone.

What Is The Treatment for Orthorexia?

Society pushes healthy eating and thinness, so it is easy for many to not realize how problematic this behavior can become.  Even more difficult is that the person doing the healthy eating can hide behind the thought that they are simply eating well (and that others are not).  Further complicating treatment is the fact that motivation behind orthorexia is multi-faceted.  First, the orthorexic must admit there is a problem, then identify what caused the obsession.  She or he  must also become more flexible and less dogmatic about eating.   Working through underlying emotional issues will make the transition to normal eating easier.

While orthorexia is not a condition your doctor will diagnose, recovery can require professional help.  A practitioner skilled at treating eating disorders is the best choice.  This handout can be used to help the professional understand orthorexia.

Recovery

Recovered orthorexics will still eat healthfully, but there will be a different understanding of what healthy eating is.  They will realize that food will not make them a better person and that basing their self-esteem on the quality of their diet is irrational.  Their identity will shift from “the person who eats health food” to a broader definition of who they are – a person who loves, who works, who is fun.  They will find that while food is important, it is one small aspect of life, and that often other things  are more important!