Orthorexia, also known as orthorexia nervosa, is a term some doctors use to describe an unhealthy obsession with creating a diet limited only to foods that support optimum well-being. While a number of health professionals have pushed for classification of this condition as a distinct type of eating disorder, orthorexia is not officially recognized by the American Psychiatric Association, an organization that defines mental disorders in the United States. Still, the disorder has certain features in common with anorexia nervosa and obsessive-compulsive disorder, and can have a significant harmful impact on your health and well-being.
Orthorexia nervosa was first defined in 1997 by a medical doctor named Steven Bratman, who had previously developed symptoms of the disorder in the 1970s while living on a commune. The term itself is Greek, and means proper or straight (“orthos”) appetite (“orexia”). While current nutritional thinking fully supports the adoption of healthy eating habits and avoidance of certain unhealthy foods or ingredients, people with orthorexia fixate on creating a “perfect” diet that completely eliminates any potential source of contamination or health degradation. According to the Mayo Clinic, this typically means avoiding any food that contains pesticides, artificial preservatives, artificial flavors or colors, saturated or trans fats, processed sugar or various forms of added salt. People with the disorder also typically avoid all genetically modified foods.
In addition to these basic restrictions, orthorexics sometimes develop an obsession with the physical cleanliness of their food, and therefore only eat foods that have been washed repeatedly and cooked well enough to avoid any potential exposure to bacteria or other microorganisms. Orthorexics also frequently avoid eating in any setting where they don’t personally control food preparation, including restaurants and other people’s homes.
No one knows precisely what causes orthorexia. In many cases, people with the disorder apparently start out simply wanting to improve the quality of their diets, but lose track at some point and start focusing on precise dietary details and rules instead of the nutritional big picture. Other mental or emotional motivations that can potentially trigger the disorder include a compulsive desire for control of one’s self and/or environment, a desire to stay thin, a desire to improve self-esteem or create a firm identity, a desire to control or avoid fear, and use of food to create or increase a sense of spirituality.
Orthorexia Signs and Symptoms
The effects of orthorexia commonly manifest in signs and symptoms that include spending several hours or more per day focusing on issues of dietary health, putting increasing limitations on the types of “acceptable” foods you will eat, avoiding foods that were previous dietary favorites, experiencing feelings of virtue or superiority based solely food choices, developing highly critical thinking about others who eat “bad” foods, and using this critical thinking as a justification for increasing social withdrawal and isolation. In addition, the orthorexic’s obsessive focus on dietary control commonly leads to disproportionate feelings of guilt, self-hatred or remorse when that control is not successfully maintained. In extreme cases, people with orthorexia can develop severe malnutrition or even die as a result of their quest to eliminate food “impurities.”
Links to Other Disorders
Orthorexia and anorexia are linked by their emphasis on extreme dietary control, as well as their risks for exposing you to malnutrition and death. For these reasons, some mental health professionals define orthorexia as a variant form of anorexia. Obsessive behaviors such as repeated food washing also link orthorexia with obsessive-compulsive disorder. In addition, some mental health experts lump orthorexia together with other controversial, officially unrecognized conditions like the muscle-building disorder known as muscle dysmorphia.
Regardless of the official status of orthorexia among mental health professionals, the effects of the disorder can have a serious negative impact on your health and well-being. The National Eating Disorders Association recommends that people affected by orthorexia seek help from a psychotherapist who has experience treating people with other types of eating disorders. Even without an official diagnosis, a professional with this specialization can recognize specific features of the disorder and recommend appropriate and effective treatments. Typical options for a treatment plan include a behavior modification technique called cognitive-behavioral therapy (CBT) and use of class of medications called selective serotonin reuptake inhibitors (SSRIs), which includes sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox) and paroxetine (Paxil).