Orthorexia Nervosa: What It Is and Why Its a Concern

By Anne Watkins

Orthorexia nervosa is a pathological obsession with food, diet and healthy eating. It is closely associated with obsessive-compulsive disorder, which is characterized by persistent, intrusive, uncontrollable thoughts that can lead to severe anxiety and a feeling that the sufferer is not in control of herself.

Orthorexics describe themselves as perfectionists who need everything in their diet to be just right, and they can be severely hard on themselves when they stray from their rigid diet plans. They may also direct this perfectionism outward as feelings of superiority or contempt toward people who eat junk food.

Orthorexia is not a medically recognized syndrome, but that doesn’t mean that it doesn’t exist. It’s part of the complex of issues that have come to prominence over the last half century of largely negative changes to the American diet, combined with increasingly unrealistic ideals of beauty and body type presented by the media.

Although some doctors view this particular disorder with skepticism, there’s no denying that the behaviors associated with orthorexia nervosa can cause serious negative health consequences. Orthorexia may damage relationships with family, friends or spouses, and can get in the way of other important aspects of life such as work, hobbies and sleep. It may also lead to other eating disorders.

Even though orthorexia is not yet an officially recognized illness, people whose lives are seriously affected by this problem should seek treatment from a therapist experienced with eating disorders. The first step is to recognize that there’s a problem. After that, one must try to find ways to loosen the grip that food has over them.

Orthorexia and Other Eating Disorders

Many people with eating disorders such as anorexia or bulimia recognize themselves in descriptions of orthorexia’s symptoms. But you don’t need to have one of these disorders for orthorexia to have serious negative health consequences. Because orthorexics tend to self-impose extreme versions of certain health food diets, this can lead to emaciation and malnutrition on a level that approaches anorexia.

The problem is particularly serious among orthorexics who adhere to highly restrictive diets or plans such as raw veganism or cleansing programs. In some cases, obsessively following such restrictive diets amounts to nothing more than an eating disorder masked as healthy eating. The orthorexic may not even be consciously aware that she’s doing it. Sometimes, it’s much more obvious to the people around her, who may find that she reacts defensively or with hostility when confronted about her unhealthy behaviors.

The crux of the problem is that orthorexia sufferers assign an irrational amount of meaning to their food and dietary choices. Rather than just eating for health and enjoyment, they begin to associate their dietary practices with their sense of self-worth. Food becomes almost a moral issue: Eating foods that are “not allowed” makes you a bad person.

Recent studies have shown that sufferers of orthorexia tend to have very specific associations with certain types of foods. For example, they’ll regard things like preservatives and artificial sweeteners as dangerous, and they’ll think of organic or biologically produced foods as clean and pure.

Also, because orthorexics are so emotionally involved with food and diet, anxiety and stress tend to drive them to food, and they’re liable to use food as a reward for achievements or as a way to celebrate. These behaviors are closely tied to emotional eating, binge eating and compulsive overeating, all recognized disorders in their own rights.

But Isn’t Healthy Eating a Good Thing?

With the obesity epidemic and the prevalence of fast food, factory farms and unnaturally processed foods, many people feel that it is their duty to take a stand against these unhealthy trends by exploring healthier alternatives. Non-severe orthorexics may be in this category. Their persistent interest in food may simply come from a strong desire to be healthy and to have a positive impact on the world, and their belief in things like the organic movement, local food or vegetarianism may be deep and genuine. There’s nothing wrong with taking a non-obsessive interest in these issues, but it’s debatable whether people with a moderate approach are orthorexics in the first place.

On the other hand, orthorexics who truly have a problem may defend themselves by saying that they’re part of this healthier food movement – that they’re just trying to be healthy in a society where unhealthy dietary choices seem far more the norm than the exception. Of course, while they may be genuine in their convictions, orthorexics take their interest in healthy living to darker, more self-destructive levels. In these individuals, real concerns about health, animal rights or the environment combine with obsessive-compulsive tendencies to create a serious pathology that calls for therapy. 

Signs of Orthorexia

Any combination of two or more of these factors may mean that you have orthorexia:

• Do you obsessively plan your meals days ahead of time? While it’s not unhealthy to think about what you’re going to eat in the future, many orthorexics create rigid diet plans for the coming days or weeks, and then punish themselves for any tiny deviation from the plan.
• Do you think about food for more than three hours a day? Thinking about diet is important, but it can become so much that it interferes with other aspects of life.
• Do you feel that your healthy diet makes you superior to others?
• Are you hard on yourself about what you eat? Do you punish yourself, feel guilty or get depressed when you eat food that is “wrong” or that deviates from your plan?
• Are you emotional about food? Orthorexics often have strong emotional responses to food. They may get unreasonably worked up and agitated during food-related conversations. They may also resort to emotional eating during times of stress, joy, anger or sadness.
• Do you talk about food more than is normal, to the extent that it bothers people around you? While people with other eating disorders tend to hide their pathologies, orthorexics may do just the opposite.