health

Orthorexia: Signs, Symptoms, and Solutions

Nahida

April 16, 2024

Knowing how different foods affect your body can be good for your health. But when this interest becomes an obsession with only eating “healthy” or “clean” foods and feeling intense fear about eating anything labelled “junk” or “bad,” it is called orthorexia nervosa. Orthorexia is a pathological fixation on eating only “pure” or “clean” foods. So, with this condition, you might eat three meals a day, but you are too focused on healthy food and miss out on essential nutrients.

The rise of social media influencers and trendy diets frequently spotlighting “superfoods” and demonising entire food categories like fats or carbs fuel this obsession. Those with orthorexia may receive accolades for their seemingly disciplined health choices, yet behind the scenes, they face malnutrition risks inadvertently induced by their restrictive eating patterns.

Orthorexia Meaning: Decoding The Disorder

Orthorexia nervosa is an intense preoccupation with healthy eating to the extent that it begins to disrupt daily life. Individuals with this disorder might limit their diet to a narrow range of foods deemed ‘pure’, like organic vegetables, excluding other vital food groups. This rigorous approach disrupts social meals and prevents the body from getting comprehensive nutrition, potentially leading to serious health repercussions.

Though not officially classified in the Diagnostic and Statistical Manual for Mental Disorders (DSM), orthorexia shares traits with recognised eating disorders. It can be a gateway to conditions like anorexia nervosa. Like other eating disorders, orthorexia nervosa is not a choice but develops from an unhealthy relationship with food. Many people feel pressured to fit into societal body image and health status, leading to strict diets and obsessions with healthy eating.

Summary

Orthorexia nervosa is the extreme preoccupation with consuming only ‘pure’ or ‘clean’ foods, often leading to the exclusion of essential nutrients, negatively impacting overall health. Not officially recognised as an eating disorder in the DSM, it still presents significant risks, potentially evolving into more severe eating disorders if not addressed.

Orthorexia vs. Anorexia

While orthorexia nervosa and anorexia nervosa both stem from the Greek word “rexia,” meaning “hunger,” their paths diverge drastically. “Ana” signifies “without,” reflecting anorexia’s hallmark of avoiding food intake, whereas “ortho” translates to “right,” portraying orthorexia’s pursuit of consuming what is deemed ‘correct’ or ‘pure’ food.

Similarities and Differences

The two disorders share common ground in their restrictive nature and the intense focus on diet, yet they manifest differently:

Common Traits

  • Stringent food and drink limitations.
  • Adherence to inflexible eating routines is common.
  • Perfectionist attitudes are often prevalent.
  • Food-related thoughts can dominate daily life, leading to social withdrawal and nutritional deficiencies.

Key Differences

  • Anorexia nervosa primarily concerns caloric restriction driven by weight gain fears, often resulting in significant weight loss.
  • Orthorexia nervosa centres around food purity and health, with individuals not necessarily aiming for or achieving extreme thinness.
  • Unlike anorexia, which is clinically recognised, orthorexia lacks official status in the DSM-5, though its impact is no less severe.

Summary

Orthorexia and anorexia, both characterised by the term “rexia,” hunger, display divergent motivations and manifestations. Anorexia focuses on weight control through food avoidance, while orthorexia obsesses over the healthfulness of food. Despite their differences, both disorders can lead to severe health and social consequences, underlining the importance of recognising and addressing these conditions.

Stages of Orthorexia Development

Orthorexia typically unfolds in two distinct stages:

Belief Formation

Initially, individuals adopt a belief system valuing certain dietary practices as superior, often influenced by trends like clean eating, paleo, or vegan diets. While aiming for health, these rigid food philosophies can inadvertently lead to the exclusion of essential nutrients.

Obsessive Behaviour

The second stage is marked by an intense preoccupation with food choices, meal planning, and food preparation, striving for an ideal of purity and perfection in the diet. This obsession can result in self-imposed food rules, with deviations leading to feelings of guilt and subsequent detoxes or cleanses, which pose their own health risks.

Understanding these stages helps in recognising the progression of orthorexia and the importance of addressing its underlying issues before they escalate.

Summary

Orthorexia evolves in two stages: the adoption of rigid dietary beliefs and the escalation into obsessive, rule-bound eating behaviour. Recognising these patterns is crucial for seeking timely intervention and fostering a healthier relationship with food.

Orthorexia Symptoms

While orthorexia nervosa lacks formal diagnostic criteria, its hallmark signs are hard to ignore. Central to this disorder is a stringent pursuit of dietary perfectionism, often leading to a compulsive need for control over food quality and purity. Additional signs and symptoms, according to the National Eating Disorders Association (NEDA), may include:

Obsession with Food Quality

Those with orthorexia fixate on consuming only what they consider ‘pure’ foods—organic, unprocessed, farm-fresh, and often raw or vegan. Their concern is less about quantity and more about the perceived cleanliness of their diet.

Cutting Out Entire Food Groups

People with orthorexia tend to be extremely strict about what they eat. They avoid anything they see as “bad” or “unhealthy.” For instance, they often cut out entire food groups, such as processed foods, sugar, meat, dairy products, carbohydrates, and gluten.

Emotional Turmoil When Breaking Dietary Rules

Deviating from their strict dietary rules triggers intense emotional responses such as anxiety, shame, and guilt. It highlights the deep psychological impact of the disorder.

Anxiety Around Specific Foods

Individuals with orthorexia often feel a strong urge to distance themselves from foods they consider forbidden. They might feel very uneasy or even leave a room if they see that food. A common behaviour pattern is skipping social gatherings to avoid encountering their “fear foods,” which can intensify the obsessive thoughts.

Weight Loss

An orthorexic diet is often unbalanced, leading to malnutrition. By believing that avoiding certain foods will improve health, people with orthorexia may unintentionally lower their nutrition levels by severely limiting food variety. This weight loss is typically not intentional. 

As we delve deeper into understanding orthorexia, it becomes clear that recognising these symptoms is the first step toward addressing the disorder. Let us not take you through a self-assessment to help identify if you or someone you know may be experiencing these signs.

Summary

Orthorexia, characterised by an excessive focus on eating ‘pure’ foods, leads to significant nutritional and emotional consequences. Key indicators include an obsession with food quality, strict avoidance of certain food groups, emotional distress over dietary deviations, fear of specific foods, and unintentional weight loss. Recognising these symptoms is crucial for addressing the disorder and fostering healthier eating habits.

Self-Assessment for Orthorexia

Recognising the early signs of orthorexia can be challenging, as it often starts with seemingly positive intentions towards healthy eating. To better understand your relationship with food, consider the following questions inspired by resources like the National Eating Disorders Association (NEDA):

  • Do you find yourself constantly worried about the quality of your food?
  • Is your day dominated by thoughts of what you will eat next and how it fits into your diet?
  • Have you found that your eating habits are isolating you from social events and interactions?
  • Are you rigidly adhering to dietary rules, feeling distressed when you deviate even slightly?
  • Does your pursuit of a ‘perfect’ diet overshadow other joys and activities in your life?

Answering ‘yes’ to several of these questions might indicate an unhealthy focus on food that could benefit from professional insight. Consulting with a healthcare provider can offer guidance and support tailored to your needs.

Summary

Self-assessment for orthorexia involves introspection into one’s eating habits and attitudes towards food, with a focus on identifying obsessive tendencies and social isolation caused by dietary restrictions.

What Causes Orthorexia? 

While the exact causes of orthorexia remain uncertain, it appears to be associated with other eating disorders and mental health conditions such as anxiety and obsessive-compulsive tendencies. Some jobs that focus a lot on health, fitness, and performance, like healthcare workers (such as medical students, doctors, and dietitians), athletes, dancers, and performers, may have a higher chance of developing orthorexia.

Vegans and vegetarians tend to have higher rates of orthorexia. However, it seems that in these groups, opting for a vegan or vegetarian diet may be a sign of orthorexia rather than the root cause. 

None of this suggests that veganism or any specific diet causes orthorexia, nor does it imply that individuals following these diets have an eating disorder. The issue lies in the motivation behind adopting these diets. Some vegan individuals with orthorexia may use the diet as a way to mask their disorder through socially acceptable means.

Summary

Orthorexia’s exact causes remain uncertain, but it is linked to eating disorders, anxiety, and obsessive-compulsive tendencies. Certain professions focusing on health, fitness, and performance, like healthcare workers, athletes, and performers, may heighten the risk. Vegans and vegetarians show higher orthorexia rates, though choosing these diets may signal orthorexia rather than causing it. 

Negative Effects of Orthorexia 

Extreme dietary restrictions, such as those seen in orthorexia nervosa, can have harmful effects on health. Common physical effects include fatigue, significant weight loss, malnourishment, anaemia, bone mass loss, low sodium levels, and decreased blood cell counts. Orthorexia can also lead to negative psychological and social behaviours. Such as:

Psychological Effects

People with orthorexia get very upset when their food habits change. Breaking their own food rules makes them feel guilty or like they need to cleanse or fast dangerously. They spend a lot of time worrying if foods are pure enough, like if vegetables have pesticides or if dairy has hormones. They also spend extra time planning and checking their food.

Social Effects

Orthorexia can make people feel very isolated socially. People with orthorexia spend a lot of time managing their food, researching, shopping, and preparing meals. It can affect their social relationships. They might give unwanted advice about eating, bringing their food to social events, or avoiding them altogether. 

Summary

Extreme dietary restrictions, like those in orthorexia nervosa, harm health by causing fatigue, weight loss, malnourishment, anaemia, bone loss, low sodium, and low blood cells. Orthorexia causes psychological distress when food habits change, leading to guilt and dangerous fasting. It also prompts excessive concern about food purity and consumes extra time planning meals. Socially, it isolates individuals, impacting relationships due to obsessive food management and avoidance of social gatherings.

Preventing Orthorexia: Strategies for Sustainable Eating Habits

Preventing orthorexia centres on cultivating a balanced approach to nutrition and wellness, where food is neither the enemy nor the sole focus of life. It is about learning to enjoy eating healthily without falling into the trap of obsession. Here’s how to foster a mindset that promotes nutritional well-being:

Promote Nutritional Literacy: Knowledge is power. Understanding nutritional basics demystifies eating patterns and underscores the importance of variety in your diet. A well-rounded diet ensures that you consume all the necessary nutrients. It prevents the nutritional deficiencies that restrictive eating can cause.

Encourage Mindful Eating: Mindfulness at mealtimes encourages a deep connection with food, fostering an appreciation for flavours and satisfaction cues. This practice helps identify true hunger and fullness signals. Additionally, it reduces the risk of overeating or obsessing over food choices.

Diversify Diet: A varied diet introduces a wide range of nutrients, reducing the risk of imbalances and deficiencies. Exploring different foods also makes eating a more enjoyable and less restrictive experience, helping to avoid orthorexia.

Supportive Community: Connection with others who value balanced eating can reinforce positive habits and offer perspective. Sharing meals and experiences with a community encourages a healthy relationship with food, away from isolating and obsessive behaviours.

Professional Guidance: Sometimes, the path to balanced eating requires expert navigation. Consulting with healthcare professionals ensures any dietary changes support overall health without compromising nutritional needs.

After establishing these foundational steps, incorporating HealthifyMe’s services can further reinforce prevention efforts. The app’s resources and tools, including access to expert nutritionists, personalised meal planning, and community forums, provide a supportive framework for sustaining healthy eating practices without veering into orthorexia.

HealthifyMe offers personalised dietary planning guided by expert nutritionists. It ensures a balanced intake of all food groups, countering the restrictive tendencies of orthorexia. Furthermore, HealthifyMe’s technology, such as the HealthifySnap feature, can simplify the tracking of dietary intake, making the process less stressful and more intuitive. This tool aids in maintaining a realistic perspective on food quality and quantity, which is integral to overcoming orthorexia.

Summary

Preventing orthorexia is about creating an environment that encourages balanced and mindful eating habits. HealthifyMe supports this through educational content, mindfulness practices, diverse meal planning, community engagement, and professional guidance. It helps individuals maintain a healthy relationship with food and prevents the descent into obsessive eating behaviours.

Orthorexia Nervosa Treatment

Orthorexia nervosa, with its unique blend of dietary fixation and mental health challenges, requires a thoughtful treatment approach. Recognising its overlap with obsessive-compulsive behaviours, treatment aims to recalibrate the individual’s relationship with food and self-care. Fortunately, many with orthorexia are receptive to therapy, leveraging their health-oriented mindset towards healing.

Cognitive-Behavioural Therapy (CBT) and Beyond

A holistic treatment plan may include cognitive-behavioural therapy (CBT), possibly supplemented by medications like SSRIs if deemed necessary. CBT helps individuals identify and modify distorted thought patterns around food and body image, easing the anxiety linked to dietary decisions.

Psychoeducation and Nutritional Counseling

Educating individuals about orthorexia’s impact on health and its psychological underpinnings is crucial. Psychoeducation broadens understanding, helping dismantle the disorder’s hold. Coupled with nutritional counselling, which HealthifyMe provides, individuals can rediscover the joy of eating diversely and healthily, stepping away from rigid dietary confines towards a more balanced and fulfilling lifestyle.

Summary

In treating orthorexia, a combination of cognitive-behavioural therapy, psycho-education, and nutritional counselling forms the cornerstone of effective management, with HealthifyMe serving as a key ally in navigating the journey to recovery and sustained health.

HealthifyMe Suggestion

Using socialisation as a way to prevent or manage orthorexia is a smart strategy. Engaging with others can help shift the focus away from rigid eating habits and create a more balanced approach to food. Here are some ways to leverage socialising:

  1. Regularly schedule meals with family and friends: This can help diversify your eating habits as you’re likely to encounter foods that aren’t part of your typical diet, encouraging flexibility. 
  2. Engage in cooking activities with friends or family: It’s a fun way to explore new foods and recipes without the pressure of sticking strictly to clean ingredients. Consider joining a cooking club which can expand your culinary horizons and help reduce anxiety about eating a variety of foods. 
  3. When eating socially, try to focus on the experience and enjoyment of being with others, rather than the food itself. This shift in focus can alleviate the stress of having to eat perfectly. 

If comfortable, open up about your eating concerns with trusted friends or family members. Sometimes, just talking about these issues can lessen their power and support you.

The Final Word

In the journey towards optimal health in a world saturated with social media’s filtered views on diet and fitness, the line between healthy eating and orthorexia can blur. The allure of ‘eating clean’ and following the perfect diet, often amplified by influencers and wellness gurus, can lead to a dangerous obsession with food purity. While orthorexia is not yet recognised officially in medical diagnostics, its impact is real and parallels other eating disorders, risking severe health and emotional well-being.

The good news? Recovery is within reach. Integrating cognitive-behavioural therapy, enriched with HealthifyMe’s personalised nutrition plans, offers a pathway to healing. The HealthifyMe app educates and also provides practical tools for maintaining a balanced diet free from the constraints of orthorexia. HealthifyMe’s ecosystem, with its blend of technology and expert guidance, helps you navigate the complex terrain of eating habits. The support of expert nutritionists enables you to steer away from the extremes and towards sustainable health practices.

In conclusion, while the digital age brings health and wellness information to your fingertips, it is crucial to approach this wealth of data with discernment. So, strive for a balanced lifestyle where nourishment and pleasure coexist on your plates and where apps like HealthifyMe empower you to make informed, healthy choices without falling prey to the perfection trap of orthorexia.

Disclaimer: The purpose of this article is just to disperse knowledge and raise awareness. It does not intend to replace medical advice from professionals. For further information, please contact our certified nutritionists Here.

Research Sources

1. Overall proportion of orthorexia nervosa symptoms: A systematic review and meta-analysis including 30 476 individuals from 18 countries

2. Orthorexia Nervosa: An Obsession With Healthy Eating

3. Orthorexia nervosa – An eating disorder, obsessive-compulsive disorder or disturbed eating habit?

Frequently Asked Questions (FAQs)

Q: What is orthorexia disorder?

A: Orthorexia nervosa arises when someone becomes overly fixated on eating healthy, pure foods, disrupting their daily life. This obsession can lead them to eat only certain types of foods or insist on consuming only organic food, causing them to miss out on essential nutrients and vitamins, which can harm overall health.

Q: How to treat orthorexia?

A: Counselling from trained professionals is crucial for treating an eating disorder. Counselling often involves dialectical behaviour therapy (DBT) and cognitive behavioural therapy (CBT), where you learn to manage your emotions and behaviours related to food. You may also benefit from personalised food-based interventions and psychoeducation to unpack myths about food.

Q: What are orthorexia symptoms?

A: Symptoms of orthorexia include extreme stress or anxiety about eating “unhealthy” foods, worrying about meals, and avoiding meals with people who do not share the same food philosophies. Some may often resort to spending hours following social media accounts that promote clean eating. While weight is not always a significant sign of orthorexia, in some cases, weight loss can occur.

Q: What is the cause of orthorexia?

A: Orthorexia nervosa is a disorder that develops gradually, influenced by various negative behaviours and unhealthy relationships with food. These risk factors may include past trauma, a perfectionist personality, a history of dieting, societal pressures, childhood trauma, social media fixation, an intense need to “fit in,” and a craving for extreme control.

Q: What is the difference between orthorexia and anorexia?

A: Orthorexia and anorexia both involve severely limiting food, but they differ in certain ways. While both disorders revolve around obsessing over food, people with anorexia nervosa use food to control their weight and maintain a specific body image. However, those with orthorexia nervosa are not focused on weight control but on how healthy, pure foods can benefit their well-being. Anorexia is known for causing severe low-weight or concerning weight loss. People with orthorexia do not always become underweight or aim to be extremely thin.

Q: What is the treatment for orthorexia?

A: Treatment for orthorexia may resemble that for obsessive-compulsive disorder or other eating disorders. It typically involves psychotherapy with a counsellor and nutrition counselling. A therapist or counsellor will assess your thoughts on food groups, outlook on diets, and current coping skills to decide if DBT or CBT will work best for you.

About the Author

Nahida is a registered dietician with 9 years of experience, working extensively with individuals dealing with obesity, diabetes, thyroid and PCOD. In addition, she has worked with NGOs supporting cancer patients by providing them with nutritional counseling. After completing her post-graduation in Dietetics & Applied Nutrition from Mumbai University, she went on to finish her MBA in Healthcare Services. Nahida is also a certified diabetes educator from International Diabetes Center. Currently a Sr. Nutritionist with HealthifyMe, Nahida is looking forward to let people take their weight off their mind and body by enjoying the journey.


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