warning signs and symptoms of orthorexia nervosa

7 Symptoms and Signs of Orthorexia: When “Clean Eating” Goes Too Far

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Ever notice how now, more than ever, an increasing amount of people are concerned with “clean eating”, avoiding certain foods like the plague or evaluating everything that goes into their bodies? Sure, we’ve all heard the phrase “you are what you eat”, so it kind of makes sense to be aware of good nutrition practices. But what happens when we’ve become obsessed with whether what we’re eating is “healthy enough”? Do we dismiss it as case of just being “health conscious”, or could something more dangerous be at hand? Can healthy living become an obsession? In this post, I talk about orthorexia nervosa, a quickly emerging eating disorder that’s yet another result of toxic diet culture. Wondering how this eating disorder manifests itself and what the common symptoms and signs of orthorexia are? Keep reading to discover how yes, you can be “too healthy”.

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What is Orthorexia Nervosa?

According to the National Eating Disorders Association (NEDA), the term “orthorexia” was “coined in 1998 and means an obsession with proper or ‘healthful’ eating”. The term is derived from the Greek “orthos,” meaning “correct”, and was coined by Steven Bratman.

“Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being.”

National Eating Disorders Association

Orthorexia is a fairly new eating disorder, and it’s challenging to diagnose it because it’s not formally recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) . It’s also difficult to recognize since the current diet culture actually commends so called “clean eating”, associating it with “wellness” and good health in general. In a society that routinely recommends cutting out whole food groups (carbs, sugars, dairy), that moralizes foods into “good” and “bad” categories, that polices our bodies and equates thinness with health, eating disorders will find a fertile breeding ground. Society’s fixation on perfection, social media, and health-ism also help to reinforce this obsession with “clean eating”.

Orthorexia manifests as an unhealthy obsession with eating pure and “healthy” diets. While, yes, it is important to practice gentle nutrition, individuals with orthorexia become so fixated and obsessed on eating healthy, that their physical and mental well-being, as well as their daily lives, begin to suffer.

Orthorexia vs Anorexia

Many people become confused over the difference between orthorexia and anorexia. And indeed, orthorexia is very similar to anorexia, in that they’re both eating disorders that involve restriction of the amount and variety of foods eaten, making malnutrition likely. In fact, the two disorders share many of the same physical consequences. 

Both orthorexia and anorexia share traits of perfectionism, cognitive rigidity, and guilt over food transgressions. However, while anorexia nervosa patients are preoccupied with the quantity of food, orthorexia patients are preoccupied with the quality of food. Those suffering from orthorexia may also present intrusive thoughts about food, as well as ritualised food preparation.

Obsession with weight is one of the primary signs of anorexia. However, this is not usually one of the common signs of orthorexia. Instead, the focus for people with orthorexia is an excessive obsession with the health implications of their dietary choices. Those suffering from orthorexia strive to feel “pure, healthy and natural”.

As you can see, there are definite similarities as well as differences between orthorexia and anorexia. Both of these eating disorders tend to provide a sense of control and stability around the consumption of food. Likewise, both eating disorders are dangerous to mental and physical health, and require treatment from a skilled health professional.

How do you know if you have orthorexia?

So how do you know if it’s orthorexia or just a normal desire to take care of your health? Since orthorexia is a newer diagnosis, it’s still challenging to diagnose even within eating disorder treatment professionals. However, let’s jump right in and investigate seven of the most common symptoms and signs of orthorexia.

What are the warning signs of orthorexia?

Orthorexia may begin more subtly than other eating disorders, because the initial intent is to eat a “healthy diet” (which doesn’t really exists, since eating to promote our health can be different for everyone). But when “clean eating” or eating healthy becomes an obsession, health starts to move to the back burner. In my professional opinion, the seven most common warning signs that “healthy eating” can spiral into a health hazard are the following:

Some of the common symptoms and signs of orthorexia
Here’s a summary of some of the common signs of orthorexia nervosa
  1. Obsession over “eating healthy”: Becoming obsessed and extremely focused on the quality of the food eaten, specific ingredients, or health and diet trends is one of the most tell-tale warning signs. As the obsession progresses, it becomes the center of your world and begins to interfere with your personal, social, and work life. This includes obsessively checking food labels and ingredient lists, concerns over where the food comes from, and looking up nutritional information online regarding the particular food. A person suffering from orthorexia may also spend hours daily thinking about food and what they can or can’t eat.
  2. Eliminating specific foods or groups of food without a medical reason to do so: Now it’s one thing to eliminate gluten because you don’t tolerate it (ie. celiac disease) and quite another ditch it because it’s dubbed “unhealthy” by diet culture. Remember that the society we live in encourages orthorexia by perpetuating fear-based thoughts around food. Cutting out foods like dairy, legumes, carbohydrates, fats, etc, just because social media is promoting it everywhere is unfortunately all too common. And quite frankly, dangerous. In fact, this research paper suggests that “within the study population, higher Instagram use was associated with stronger orthorexic symptoms”. Relying on social media “health gurus” for guidance can also perpetuate misinformation about healthy eating. Remember that although these “influencers” have a powerful social media presence and can reach thousands, they often have no formal training in health sciences or nutrition.
  1. Excessive planning around a “healthy” lifestyle: This includes irrational concerns over pre-prepping, cleaning, the health benefits, and the preparation of your food. The extensive time planning, researching, and meal-prepping your food in order to achieve your idea of a healthy diet may distance you from other aspects of your life. As one of the signs of orthorexia, this may also lead to avoiding eating food prepared by others or eating at restaurants.
  2. Judgment of others on their eating habits: An orthorexia mindset may lead you to judge family and friends on their eating habits and lifestyle. This may also include behaviors such as restricting your social situations so that you do not need to be around “unclean” food or people who do not share your same “rules.” These types of judgments may make you secretly feel “better than” others and provides an excuse to isolate from them.
  3. Fears of Food, Sickness, or Disease: The dietary obsessions may also lead to crippling fears over being “unhealthy”. This symptom of orthorexia gives rise to fears of sickness and disease, which leads to even more compulsive control over foods and eating.
  4. Severe anxiety and food dictated control over your emotions: The unhealthy obsession with eating pure and healthy diets can also result in emotions being regulated by your eating habits. A common sign of orthorexia is having certain “rules” or patterns within your food fixation that control how you feel. Thus, you may feel severe anxiety and emotional turmoil when your “rules” are broken, yet superficial happiness when your obsession has brought results. According to this article from Psychology Today, “this creates an imbalance and a vicious cycle, where you may experience mood swings; often switching between feelings of shame and self-loathing to feelings of euphoria, depending on how your “lifestyle” is going. The more depressed and anxious you feel, the farther into your obsession you may go to retrieve more euphoric feelings”. High levels of distress may also appear when a “healthy” food option is not available, and it’s not uncommon for someone suffering from orthorexia to spend hours searching for a particular “clean” food.
  1. Physical symptoms of malnutrition: Restricting your diet to such few “healthy” foods can bring about malnutrition. Symptoms often include feeling fatigued or weak, significant weight loss, as well as nutrient deficiencies. You may also feel tired more often, feel cold, and take longer to recover from common illnesses and viruses. Other symptoms of malnutrition may include cognitive problems, osteoporosis, infertility, kidney failure and heart disease. If left untreated, malnutrition can lead to additional dangerous physical and psychological problems.

How common is orthorexia?

As a “lesser known” eating disorder (and one that’s not easily diagnosed) there’s still much to learn about just how common orthorexia is. According to this article, “There is very little information on the prevalence of orthorexia, however, research suggests that it is growing in prevalence each year. In addition, it is believed that orthorexia occurs equally in people of all genders, but is most common in middle-class adults who are in the 30-year-old range”.

This paper from Eating and Weight Disorders found that the prevalence of orthorexia nervosa is less than 1 % in United States. The authors conclude that orthorexia nervosa is “is not a common condition”. However, it is on the rise, and new tools are needed in order to diagnose and assess the signs of orthorexia more accurately.

How do you develop orthorexia?

The compulsive need to improve one’s health is one of the main detonating factors in developing orthorexia nervosa. However, there are often many underlying causes that can lead an individual to go to extreme lengths with “healthy eating, including:

  • Genetic factors, or a family history of eating disorders, personal history of trauma or other mental health concerns
  • Compulsion for complete control or obsessive personality traits
  • Trying to overcome a chronic illness
  • Using food to create an identity
  • Improving self-esteem
  • Social pressure to comply with socially constructed body ideals

Orthorexia treatment

treatment for orthorexia
Eating disorders can be devastating, but recovery is very possible

As with all other eating disorders, orthorexia nervosa requires treatment from qualified and properly trained health professionals. Recovery is very possible, and it may include seeking treatment from a:

  • Medical Doctor
  • Psychologist
  • Psychiatrist
  • Registered Dietitian

Treatment may include some (or all) of the following modalities:

  • Individual therapy 
  • Group therapy 
  • Family therapy 
  • Support groups
  • Cognitive behavioral therapy (CBT) 
  • Dialectical behavior therapy (DBT) 
  • Acceptance and commitment therapy (ACT) 
  • Experiential therapy
  • 12–Step recovery principles  
  • Medication management of underlying mental health conditions

Conclusion

In conclusion, if you or someone you know if suffering from symptoms and signs of orthorexia nervosa, don’t hesitate to find appropriate help. If you don’t know where to start, the National Eating Disorders Association has a variety of great resources such as a call helpline, screening tools, chat availability and a supportive community to assist those who are battling eating eating disorders such as orthorexia.

And now I’d love to hear your thoughts on this subject. Had you heard about orthorexia nervosa before? Do you believe healthy eating can be taken to extremes? Do you think social media influence can have a negative impact on the quest to protect one’s health? Sound off in the comments section below.

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