What is orthorexia?
Orthorexia nervosa is a relatively new condition that was coined by Dr. Steven Bratman in the 1990s. It describes a pathological preoccupation with eating only the “healthiest” or “cleanest” types of foods. Orthorexia is not currently classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and therefore is often combined with other restrictive eating disorders such as anorexia nervosa. Recent findings have indicated that orthorexia has been on the rise for the past decade. Because of its increasing prevalence, there is much debate around whether orthorexia should be classified as its own individual diagnosis or be considered a co-occurring condition with other established diagnoses such as anorexia nervosa or obsessive-compulsive disorder.
Why is orthorexia dangerous?
Individuals who struggle with orthorexia often suffer nutritional deficiencies, impaired social life, emotional instability, and generally diminished quality of life.
The obsession with eating very specific, “clean” types of foods can lead to serious medical conditions such as malnutrition, osteoporosis, and a weakened immune system (Horovitz & Argyrides, 2023). Individuals with orthorexia or orthorexia-related symptoms also run the risk of experiencing refeeding syndrome, a condition that occurs when severely malnourished patients begin the refeeding process too quickly and experience rapid shifts in fluids and electrolytes that can lead to death (Moroze, 2015).
Who does orthorexia most commonly affect?
While ON is a condition that can affect anyone, certain demographics are at an increased risk. Females, college students pursuing fitness-related degrees such as exercise science, and non-professional athletes, are at an increased risk for developing ON compared to the general population.
Other risk factors
Other populations that are at risk for the development of orthorexia include individuals who exhibit obsessive-compulsive traits and those with a history dieting or another eating disorder. Recent studies have found that orthorexia is highly correlated with obsessive-compulsive tendencies.
Among a sample of eating disorder patients, those individuals who struggled with orthorexia more commonly dealt with high levels of preoccupation and rituals surrounding their food – common tendencies among individuals with obsessive-compulsive disorder.
Additionally, compulsive adherence to rule-driven exercise behaviors, preoccupation with the caloric content in foods, and a fear of eating around other people were positively correlated with orthorexia (McComb & Mills, 2019).
Research consistently reflects that a history of dieting is a strong predictive factor for the subsequent development of orthorexia. Similarly, history of an eating disorder has been shown to be a strong predictor of orthorexia. In a sample of women with a previous anorexia diagnosis, as high as 85% had comorbid orthorexia. In a different sample, those who self-reported struggling with an active eating disorder also more frequently reported exhibiting orthorexia symptoms than those individuals who did not self-report as struggling with an active eating disorder (McComb & Mills, 2019).
Treatment recommendations
Similar to other eating disorders, one of the most important components of successful treatment for orthorexia is mental health therapy. While having a therapeutic relationship that is characterized by trust and mutual respect is the greatest indicator of success in counseling, some specific approaches to the treatment of orthorexia that have been proven to be effective are cognitive behavioral therapy (CBT) and psychoeducation (Horovitz & Argyrides, 2023). The evidence-based intervention utilized by CBT targets dysfunctional cognitive processes and behaviors related to orthorexia. This therapeutic modality can help clients to identify the rigid thought patterns that are characteristic of orthorexia and other eating disorders and develop coping strategies to manage the distress that comes along with challenging these harmful thought patterns.
Psychoeducation works in tandem with therapeutic approaches like CBT to give individuals evidence to counter their distorted thoughts and beliefs associated with orthorexia. When someone is able to understand the physical, psychological, and social toll that a condition like orthorexia is taking on their lives, they can feel catalyzed to make changes.
If you or someone you know is struggling with orthorexia and is ready to seek support, please feel free to reach out for a free 15-minute phone consultation.
Andie Chilson, LGPC is a Psychotherapist at Greenhouse Psychotherapy, and a Licensed Graduate Professional Counselor in the District of Columbia.
References
Horovitz, O., & Argyrides, M. (2023). Orthorexia and orthorexia nervosa: A comprehensive examination of prevalence, risk factors, diagnosis, and treatment. Nutrients, 15(17), 3851.
McComb, S.E., & Mills, J.S. (2019). Orthorexia nervosa: A review of psychosocial risk factors. Appetite, 140, 50-75.
Moroze, R.M., Dunn, T.M., Holland, C.J., Yager, J., & Weintraub, P. (2015). Microthinking about micronutrients: A case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics, 56(4), 397-403.