Orthorexia nervosa, often referred to as simply orthorexia, is an eating disorder that features an obsession with healthy food. Specifically, a person with orthorexia will avoid foods simply from the belief that they are unhealthy, even if the evidence proves otherwise. Unlike other eating disorders, orthorexia doesn’t stem from a desire to lose weight. Instead, a person with orthorexia chooses foods they feel are healthy and make them feel “pure.” Some specialists view orthorexia as a distinct disorder while others see it as a variation of either anorexia or obsessive-compulsive disorder.

Behaviors of Orthorexia

People with orthorexia nervosa tend to exhibit obsessive behaviors as they seek out a healthy diet. The individual will often express an obsessive concern over the connection between their food and their mood, digestive issues, allergies, or anxiety. They will also typically avoid foods and cite food allergies, despite not having a medical diagnosis for an allergy. A large majority of people with orthorexia begin to increase their consumption of herbal remedies, probiotics, and supplements. As the disorder progresses, these individuals may also begin to avoid even healthy foods, to the point of limiting their diet to fewer than ten food products.

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Emotional Changes

Many people with orthorexia nervosa also exhibit symptoms of anxiety and mood disorders that frequently occur alongside other eating disorders such as anorexia. The strict rules and behaviors those with orthorexia enforce on themselves often isolate them, resulting in more severe anxiety or panic attacks. Some emotional symptoms that may indicate orthorexia has become a serious eating disorder include:

  • Immense feelings of guilt when breaking a dietary rule
  • Thinking about and planning meals days in advance
  • Intensely critical thoughts of people who don’t restrict their diet
  • Avoiding food that other people buy or prepare
  • A feeling of satisfaction or spiritual fulfillment when following their dietary rules
  • Worsening symptoms of depression or anxiety

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Foods They Avoid

Though most people with orthorexia have personal dietary guidelines, some common rules appear in many different individuals. These rules typically follow a mentality of only allowing foods that make the individual feel healthy and pure, regardless of whether or not the food is medically healthy. People with orthorexia usually avoid foods with artificial ingredients, such as artificial colors, flavors, or preservatives. They may also opt to eat only organic foods that they believe have never been in contact with pesticides. More extreme cases of orthorexia feature avoiding fats, sugars, salts, or animal and dairy products in their entirety.

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Reasons They Avoid Food

Most people with orthorexia nervosa draw their reasoning for avoiding certain foods from sources that they feel are logical, including friends, families, dieticians, websites, articles on healthy foods, or TV programs. Popular diets and trends also influence orthorexia dietary guidelines. These rules often have some involvement with spirituality, purity, or energy, though this isn’t true of all people with orthorexia. Common rules include:

  • Food must contain mostly water since the human body contains 70% water.
  • Quickly chewing food worsens the digestion of the food.
  • Eating yellow food focuses the body’s energy on productive activities and strengthens a person’s spiritual core.
  • Eating unprocessed plant-based foods helps a person connect to the divine.
  • Eating food that aligns with a person’s blood type prevents disease and enhances well-being.

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Effects of Avoiding Food

Though there is still some debate in the medical community about orthorexia, most experts agree that the symptoms go beyond a simple lifestyle or diet choice. The obsession with healthy food that drives those with orthorexia can damage relationships, eliminate time for other interests, and even become physically dangerous. Individuals with orthorexia often eliminate so many foods that they can no longer maintain a healthy weight. In some cases, this leads to malnutrition. As the disorder progresses, malnutrition may lead to cardiac issues or death.

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Orthorexia vs. Anorexia

In many cases, orthorexia nervosa resembles anorexia. Both are eating disorders that cause people to heavily restrict their diets. They share so many similarities that some specialists consider orthorexia another facet of anorexia. The two disorders share symptoms such as seeking fulfillment and self-esteem through dietary control, claiming to have food allergies, having specific rules for their food, and trying to gain control over their lives by controlling their food.

However, orthorexia does not manifest an obsession with weight, unlike other eating disorders. Instead, these individuals tend to obsess over the health implications of their diet. Where a person with anorexia may cut out a food because it's fattening, a person with orthorexia would do it because the food doesn’t make them feel pure or healthy.

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Diagnosis Criteria

Though the concept of orthorexia nervosa has existed since at least 1997, it wasn’t until 2016 that rules for diagnosing the disorder became commonplace enough for general use. In the journal Eating Behaviors, doctors proposed two criteria for diagnosing orthorexia. The first requires an obsessive focus on eating healthily and emotional distress when a food choice is unhealthy. Weight loss may occur, but the person with orthorexia merely sees it as a step in the journey towards ideal health. Weight loss is not the goal. Additionally, dietary restrictions escalate over time, and any rule-breaking leads to an exaggerated fear of disease or being impure.

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Other Diagnosis Criteria

The second criterion for diagnosis is the presence of symptoms that clinically impair the patient. These symptoms stem from the malnutrition that naturally occurs when an individual restricts their diet too heavily. Some people also develop social or interpersonal distress as a result of isolation. Diagnosis may also require drawing self-worth, positive body image, and satisfaction from a self-determined sense of healthy foods and diets. Some doctors use two other criteria when diagnosing orthorexia. The first is confirmation the patient's symptoms are not the result of another disorder. Finally, the doctor may confirm the behavior is not the result of religious or medically necessary food restrictions.

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Treatment Options

Because there is some debate in the medical community about orthorexia, the disorder has no standard treatment. Many eating disorder experts choose to treat orthorexia the same way they would treat anorexia or obsessive-compulsive disorder. Typically, this includes counseling and psychotherapy to help manage the individual’s mentality around food. The goal of treatment is to help the person overcome their anxiety through exposure to these foods. In some cases, counselors and therapists may help with weight restoration, just as they would with anorexia.

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How to Talk About It

Eating disorders, in general, are fairly difficult to talk about, particularly if the person with the disorder is a friend or family member. Many people with orthorexia and anorexia are met with dismissive attitudes or even bullying, which makes them feel their issues are not legitimate or real. Alternatively, it can be difficult for an individual to realize they have an eating disorder, especially when orthorexia causes them to feel they are healthy. When discussing eating disorders, it is important to be open and understanding. Simply pointing out worrying behaviors or symptoms is sometimes enough. It may be necessary to enlist the help of an eating disorder specialist or doctor.

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