What is Orthorexia?
gray bowl of strawberries, blackberries, and blueberries with granola and yogurt on top
Today we want to share information about another eating disorder diagnosis our team sees on a regular basis, Orthorexia. In the New Year, the focus in January is often on starting a new diet, losing weight, taking control of your health, incorporating new health behaviors, cutting out certain food groups, and more. While there is no singular cause of an eating disorder, diet culture behaviors and mindset can contribute to the development of eating disorders, including orthorexia. In fact, as you read, you might notice that many of the behaviors and thought patterns associated with orthorexia are often glorified or accepted in diet culture.
What is Orthorexia?
Orthorexia, a term coined in the late 1990’s by Steven Bratman, is the obsession with proper or ‘healthy’ eating to the point that it can damage well-being [1]. Though the symptoms and warning signs of orthorexia are significant, it has yet to be added to the DSM-5 as a diagnosable mental health condition. Though orthorexia does not have a specific diagnostic classification, it has been the topic of many studies that aim to provide a better understanding of orthorexia.
Studies have found the rates of orthorexia may be twice as high in women as men [5]. Additionally, it’s estimated that 10% of the population is at risk for orthorexia and 21-57% of the general population engage in orthorexic behaviors [5,6].
Orthorexia Diagnostic Criteria
Because orthorexia is not classified in the DSM-5, it falls under the umbrella of Unspecified Feeding or Eating Disorders. This category exists for symptoms and characteristics “of a feeding or eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning...but do not meet the full criteria for any of the feeding or eating disorders diagnostic class [2, pg. 354].”
While the DSM-5 is a very helpful tool, the classification of eating disorders presents challenges for those who do not meet all the diagnostic criteria but are significantly impacted by disordered eating/an eating disorder. Labeling disordered eating/an eating disorder ‘unspecified’ can further add to stigmatization or the belief of not being ‘sick enough’ for treatment.
So, while there are no specific diagnostic criteria listed in the DSM-5, there are many signs and symptoms of orthorexia. As you review this list, be on the lookout for things that are more commonly accepted or even glorified in our culture (aka diet culture).
obsession or fixation with the quality of food (think: ‘clean eating’)
rigid or inflexible eating patterns
food rules and/or food labels (good, bad, healthy, unhealthy, etc.)
cutting out or demonizing entire food groups
emotional distress (eg. guilt, shame) when food rules are broken or ‘unhealthy’ food is consumed
excessive concern with certain foods or food groups causing health consequences like allergies or gastrointestinal issues
spending your day obsessing about food or your next meal
increased use of supplements
focus on nutritional labels and only consuming foods that are ‘clean’, ‘natural’, or ‘unprocessed’ or minimally processed
avoiding social gatherings that involve food, bringing your own food to social gatherings, or not eating at social gatherings due to how the food is prepared
severe anxiety with how food is prepared
attaching self-worth or self-esteem to food rules
feelings of power and satisfaction from only eating healthy foods or placing your identity in being ‘the healthy one’
weight fluctuations and vitals/labs fluctuations
dehydration
constipation
malnourishment
difficulty concentration and sleeping
body image concerns may or may not be present* [1,3,4]
Please note that this is not an exhaustive list.
What causes orthorexia and why is it so serious?
After reviewing the list of signs and symptoms, hopefully, you can see the role diet culture plays in the development of orthorexia. Looking at a bio-psycho-social model, we can see that, like all eating disorders, there are a variety of factors at play.
Biological factors include:
perfectionistic, rigid, or obsessive personality traits
family history of eating disorders or disordered eating
childhood illness related to diet or digestive distress [1]
Psychological factors include:
low self-esteem or self-worth
past trauma
history or dieting
co-occurring mental health diagnosis of generalized anxiety disorder or obsessive-compulsive disorder [1]
Social factors include:
messaging that worth and acceptance are tied to appearance
Eurocentric beauty standards and the ‘thin ideal’
disguising laxatives and diuretics as shakes, candy, or weight loss supplements [1]
Please note that this is not an exhaustive list.
Treatment
With other eating disorders, treatment for orthorexia should include a multidisciplinary team comprised of a physician, an eating disorder-informed dietitian, and an eating disorder-informed therapist. Studies show that Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are the most promising treatments for Orthorexia [1].
It is also worth examining how Intuitive Eating can play a role in treating Orthorexia. Intuitive Eating focuses on either removing barriers to interoceptive awareness or increasing interoceptive awareness. Notice that food rules, rigid thinking about food, food labels, and attaching morality to food are common signs of orthorexia. Intuitive Eating teaches how to remove food labels and allow all foods to fit, among other things.
Seeking Help
The therapists and dietitians at Collaborative Counseling and Nutrition specialize in treating eating disorders, including Orthorexia. If you or a loved one is struggling with Orthorexia, please reach out to our team today! We know it can be difficult to reach out, but we would love to help!
This post is for education purposes only and should not be used as a substitute for treatment for an eating disorder. If you believe you have an eating disorder or would like to talk to a team member about dietetic or therapeutic services, please fill out the contact form and someone will get back to you within 72 hours.
Resources Used:
[1] Eating Disorder Hope. (2022, July 29). What is Orthorexia? | Symptoms, Complications & Causes. https://www.eatingdisorderhope.com/information/what-is-orthorexia-nervosa
[2] American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5th ed.). American Psychiatric Publishing.
[3] Discovery Contributor. (2021, April 14). Warning Signs of Orthorexia Nervosa. Center for Discovery. https://centerfordiscovery.com/blog/more-orthorexia-nervosa-warning-signs/
[4] Wick, K. (2022, September 22). 8 Warning Signs of Orthorexia. Walden Eating Disorders. https://www.waldeneatingdisorders.com/blog/8-warning-signs-of-orthorexia/
[5] Ramacciotti, C. E., Perrone, P., Coli, E., Burgalassi, A., Conversano, C., Massimetti, G., & Dell’Osso, L. (2011). Orthorexia nervosa in the general population: A preliminary screening using a self-administered questionnaire (ORTO-15). Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 16(2), e127–e130. https://doi.org/10.1007/bf03325318
[6] Dunn, T. M., Gibbs, J., Whitney, N., & Starosta, A. (2016). Prevalence of orthorexia nervosa is less than 1 %: data from a US sample. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 22(1), 185–192. https://doi.org/10.1007/s40519-016-0258-8
Collaborative Counseling & Nutrition is an outpatient nutrition and body image counseling center, with locations in Indianapolis and Carmel, that provides compassionate, holistic eating disorder treatment. Through practicing mindfulness, intuition, and Health At Every Size, we are on a mission to help you find a true state of well-being! We take an anti-diet, weight-inclusive approach with all our clients and work to help guide you towards a way of healthy living designed by you, just for you! This post is for education purposes only and should not be used as a substitute for treatment for an eating disorder. If you are looking for a registered dietitian or therapist to assist you on your recovery journey, please reach out today!
