Orthorexia Explained: When healthy eating becomes harmful

We’re talking all about orthorexia today. The eating disorder that's not technically an eating disorder but affects so many people.

The history of orthorexia:

The term orthorexia was first coined by Steven Bratman, M.D. - an alternative medicine provider - in 1997 when he published an article in the Yoga Journal magazine.

He noticed a couple of things that were happening with his own clients and in the medical field at large:

👉 Health and wellness trends were increasingly being prescribed as medicine.

👉 Patients would get consumed by trying to eat the "right" foods in the name of health - to the point that their thoughts and behaviors resembled those of someone battling an eating disorder.

This pattern, this obsession with health, was named orthorexia nervosa. The root “ortho” means straight, correct, or true. And the full term was defined by Dr. Bratman as “a fixation on eating proper food.”

Simply put, orthorexia is when healthy eating becomes obsessive.

The primary concern for someone battling orthorexia is the quality of the food they’re eating, not the quantity.

Orthorexia is not currently listed as a clinical eating disorder in the DSM-5 (although there's discussion of adding it to the next edition).

That being said, eating disorder specialists should be familiar with orthorexia and should know how to support you if this is something you struggle with.

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The difference between healthy eating and orthorexia:

Bratman states in his publication that a “healthy diet turns into orthorexia when a boundary is crossed and a person’s relationship with food begins to impair various essential dimensions of human life.”

Much like any other mental health disorder, a person’s behaviors are deemed disordered when they create distress in their life.

For people with orthorexia, healthy eating has become extreme and obsessive.

Most people with orthorexia would describe their diet as "clean" and, similarly, many people who jump on the "clean eating" train are at risk of developing orthorexia if taken too far.

"Clean eating" is a term that's used to describe "real food" - food that's free from preservatives and artificial ingredients.

I use quotes because although presented as facts, so much of "healthy eating" is subjective. Scientists have a thousand different theories on whether gluten, caffeine, alcohol, sugar, organic products, meat, and other varieties of food are "healthy" for us.

👉It’s important to understand that not everyone who is gluten-free, experimenting with Whole 30, or subscribes to a vegetarian diet is battling orthorexia.

There's nothing wrong with pursuing health (whatever that means to you).

👉The danger is when this pursuit becomes obsessive and hinders you or your loved one from living life to its fullest.

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A growing problem:

Here’s the deal:

The wellness industry is moving away from “diet-talk.”

Companies are starting to realize that diets are out, but wellness trends, cleanses, and “lifestyle changes” are in.

The problem is that this still easily breeds disordered eating. Just under a new name and a new look.

👉 Strict nutritional guidelines like “clean eating,” “paleo,” and “keto,” can trigger someone with a predisposition for obsessive thinking, a need for control, or perfectionism to engage in extreme behaviors.

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Signs and Symptoms:

Bratman describes orthorexia as

"an emotionally disturbed, self-punishing relationship with food that involves a progressively shrinking universe of foods deemed acceptable. A gradual constriction of many other dimensions of life occurs so that thinking about healthy food can become the central theme of almost every moment of the day, the sword and shield against every kind of anxiety, and the primary source of self-esteem, value and meaning. This may result in social isolation, psychological disturbance and even, possibly, physical harm.”

The most notable behaviors present in someone with orthorexia are:

• Avoiding social situations that may not support their “clean” and “healthy” lifestyle.

• Spending a lot of time keeping up with wellness trends and paying close attention to new research about what foods are "good" or "bad."

• Cutting out entire food groups. This is often cumulative and ongoing so that the person's "acceptable food" list becomes extremely limited - sometimes compromising their ability to get adequate nutrition.

• Increasing supplement use and herbal remedies.

• Compulsive checking of food labels. This can prove difficult when going out to eat, attending a potluck, or being served a homecooked meal where there is no way of verifying what ingredients were used.

• Rigid eating patterns - a shared characteristic with other eating disorders.

The most notable emotional experiences of someone with orthorexia are:

• Guilt when eating food that’s not “clean.”

• Fear around food - especially food without nutritional labels and an ingredients list.

• General stress in one's life as a result of such rigid food guidelines.

• Fear of becoming sick via food that's not 'clean." For instance, having an irrational fear of illness after eating food that's not organic.

• Feelings of spiritual fulfillment or increased self-esteem when eating healthy. A distinct characteristic of orthorexia is the sense of worth and superiority a person feels when eating. Which can lead to 👇

• Judging others who don't subscribe to their way of eating.

• A mental obsession with the quality of food.

• Concern over food prep techniques when food is prepared by anyone other than them.

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Resemblances with other mental health disorders:

There's some overlap in diagnostic criteria between orthorexia, anorexia, and obsessive-compulsive disorder.

An important difference between anorexia and orthorexia is that anorexia is about weight and orthorexia is about health.

The obsessive and rigid patterns of thinking mimic those of OCD, but orthorexia has an idealistic and spiritual component to it.

Someone with orthorexia attaches their sense of worth and personal identity to their decision to eat "healthy" foods.

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Where do we go from here?

I believe the answer to almost everything is to find the middle path. To find a way to honor both/and. To find the balance between health and relaxation. Enjoying food, enjoying life, AND tending to the nutritional needs of your body.

Bratman shares the story of a man who says,

"It came to me last night in a dream. Rather than eat my sprouts alone, it would be better for me to share a pizza with some friends.”

This quote brings tears to my eyes.

Because life is meant to be LIVED. And food is meant to be ENJOYED. And true health is the combination of those two things.

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A screening tool:

It's hard to recognize orthorexia in others. We often describe people who appear “healthy” as inspirational, having good self-control, and being disciplined.

The fixation on eating “clean” is normalized in our society therefore it is easy to overlook someone who's struggling.

Bratman has made a free screening tool available on his website.

He suggests you ask yourselves these questions:

• Do you turn to healthy food as a primary source of happiness and meaning, even spirituality?

• Does your diet make you feel better than other people?

• Does it interfere with relationships or work, friends or family?

• Do you use pure foods as a sword and shield to ward off anxiety, not just about health problems but about everything that makes you insecure?

• Do foods help you feel in control more than really makes sense?

• Do you have to carry your diet to further and further extremes to provide the same kick?

• If you stray even minimally from your chosen diet, do you feel a compulsive need to cleanse?

• Has your interest in healthy food expanded past reasonable boundaries to become a kind of brain parasite, controlling your life rather than furthering your goals?

• Does eating in a specific way give you a feeling of moral superiority or spiritual satisfaction?

If you or a loved one is struggling with orthorexia, please email me so we can discuss the best support options for you!