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Author: Dr Charlie BailyClinical Psychologist

As people become more entrenched in their orthorexia, they often isolate from others, further limiting their perspective and ability to cope. By then the original health goals have often long since been overridden.

Dr Charlie Baily - PhD, CPsychol

What is orthorexia?

Orthorexia nervosa is an unhealthy obsession with eating healthy foods.

Whilst it is not yet a discrete classification in the DSM-V – the authoritative guide to the diagnosis of mental disorders – it is recognised as a very real and often serious eating disorder.

Orthorexia is a restrictive eating disorder, centering around the sufferer taking extreme control over what they eat. It shares some characteristics with anorexia.

Anorexia is typically characterised by a drive for thinness, fear of becoming fat and body dissatisfaction.

Orthorexia is typically characterised by a desire to be healthy, “pure” and “natural” in their eating1.

People with orthorexia may:

  • Progressively increase their food restrictions over time
  • Cut out certain food / entire food groups
  • Base their self-esteem and identity on their ability to adhere to their food rules
  • Judge others for making less “heathy” choices
  • Devote excessive amounts of time to food shopping and preparation, to the detriment of other activities
  • May develop a phobia of being around others who are eating foods they deem unhealthy
  • Feel unable to socialise

1 Setnick, (2013)

People with orthorexia may start limiting their diet for a variety of healthy intentions. However, restriction can inadvertently become a focus for traits such as perfectionism or become an outlet for current stressful circumstances.

The narrower and more restricted a person’s diet becomes the more they are impacted both physically and psychologically, heightening their aversion to “bad” foods and increasing obsessive thinking.

Dr Charlie Baily - PhD, CPsychol


What causes orthorexia?

Like the other eating disorders, there is no single reason why someone develops orthorexia (read about the causes of anorexia). Instead it is likely to be the result of multiple biological, psychological and social influences.

1. Biological causes of orthorexia:
Research on the biology of orthorexia remains very limited. However, it is thought to share genetic and other biological risk factors with anorexia, anxiety disorders, obsessive-compulsive disorder and other disorders of over-control.

The malnutrition and weight loss that frequently accompany orthorexia can impair cognitive functioning, increasing anxiety and elevating obsessionality in ways that serve to maintain and strengthen the disorder.

2. Psychological causes of orthorexia:
There are certain personality features that make someone more vulnerable to developing orthorexia, including:

  • Perfectionism
  • Social conformity
  • Low self-esteem
  • Rigid thinking style

For people with orthorexia, their pursuit of healthy and pure eating typically struggles to keep pace with their increasingly restrictive food rules. This, and occasional lapses in which the sufferer eats “bad” foods, can lead to intense self-criticism and self-labelling as weak and self-indulgent and serve to generate ever harsher restrictions.

Whether at a conscious or unconscious level, for people with orthorexia pursuing healthy eating may provide an internal sense of control when their lives otherwise feel chaotic or unmanageable. However, as the disorder becomes increasingly pervasive, the feeling that life is out of control is often only exacerbated.

People with orthorexia may wrongly attribute feeling physically poorly to unhealthy eating and further restrict their diet as a result.

3. Environmental causes of orthorexia:
Some environmental circumstances may increase the likelihood of orthorexia developing.

In particular, people may embark on purported healthy eating regimes as part of a “cleanse,” after finding out about a food intolerance or in response to other medical advice.

People working in certain industries that demand healthy eating may be especially vulnerable – for instance one study showed that 30% of athletes met the criteria for orthorexia2.

High usage of social media also presents a risk factor for the disorder. “Clean” eating forums are common on all social media platforms, but those that are image rich, such as Instagram, seem particularly associated with the disorder.

2 Segura-Garcia, C., et al (2012)

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Symptoms of orthorexia

  • Obsessive thoughts about health eating
  • An increasingly restrictive diet
  • Happiness levels are linked to healthy eating
  • Eating choices interfere with socialising or work
  • Eating habits are used to control anxiety
  • Straying from permitted foods results in feeling shame, dirty or guilt
  • Extreme anxiety about how food is prepared
  • Feeling superior to others because of diet choices
  • Lowered immune system
  • Weight loss
  • Kidney failure
  • Brain fog / dizziness
  • Heart palpitations

It is common for people with anorexia to develop orthorexia as they recover and, similarly, there is a risk that orthorexia can develop into anorexia if left untreated.

Orthorexia can also share some features with OCD, to include intrusive thoughts relating to food and health, excessive and unsubstantiated concerns about food contamination and impurity, and ritualised food preparation eating patterns.

In their quest to eat healthily, people with orthorexia cause themselves considerable physical harm. Malnutrition and weight loss are common, and in some cases the condition can prove fatal – extreme dietary limitations can leave the muscles of the heart weakened and cause dangerous imbalances in electrolytes and minerals that the body needs to function.

Take our orthorexia test


Treatment for orthorexia

One of the problems with orthorexia is that it often starts innocently enough – someone may decide they want to cut out baked goods or reduce their sugar intake.

These restrictions can continue and develop over time, until the individual may only have a very small number of foods they can "safely eat".

It isn’t until they have lost weight and people are concerned about them or they know something isn’t right—perhaps they are feeling very depressed or anxious—that many people with orthorexia will come forward for help.

Orthorexia is a serious psychological condition and can lead to significant medical problems (and in extreme instances even death). For this reason it is important to seek help as soon as you realise that your eating behaviours are getting out of control or you recognise that you are beginning to suffer emotionally or physically as a result of them. The earlier you seek help, the easier it is to make a full recovery and get back to living life to the full.

Read more about eating disorder treatment

People with orthorexia may be very reluctant to seek help. They may find it hard to see anything wrong with their efforts to eat healthily and struggle to see that their restriction has become emotionally and physically damaging. They may become angry or defensive in response to the suggestion that they need to change their eating habits. And underneath it all they have likely become terrified of the “bad” foods they have been avoiding. Given these attitudes tend to become more rigid over time, it is vital to seek help early. With the right support, people with orthorexia can make complete recoveries.
PhD, CPsychol

Clinical Psychologist
London

Dr Charlie Baily is a Clinical Psychologist currently working in the private sector. He has a PhD in Clinical Psychology and is a member of The British Psychological Society and Health and Care Professions Council.

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