What Is Orthorexia Nervosa?

When a desire to eat healthily becomes an obsession, it can change from a smart lifestyle choice to an eating disorder. Here's what you should know.

Can healthy eating go too far? So far, in fact, that it becomes a disorder?

At first, the idea might seem absurd. After all, it’s become standard practice for doctors tell their patients to eat healthy and exercise more. Healthy eating is generally considered an unconditionally good thing.

But when a desire to eat healthy food becomes an obsession, it can develop into a disorder known as orthorexia nervosa.

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What is orthorexia nervosa?

The term orthorexia, which comes from the Greek words for “proper” and “appetite,” was introduced in 1997 by Steven Bratman, MD. Although the idea did not receive much mainstream attention during the next decade, in the 2010s a growing cultural preoccupation with clean and healthy eating brought orthorexic behavior back into the spotlight.

The term does not imply that following a diet, trying to eat organic food, or diligently checking nutrition labels are inherently disordered behaviors. Orthorexia nervosa is a specific type of eating disorder that develops when a person’s efforts to eat clean or healthy food become so extreme that they turn into an obsession and begin to harm that person’s social and physical well-being.

Symptoms of orthorexia nervosa

Orthorexia goes beyond a simple desire to eat healthily. Orthorexic individuals are constantly worried about the quality and purity of their food, often refusing to eat rather than consume something that might not be “clean.” 

They will obsessively examine the source of their foods to determine whether something might have been exposed to pesticides, contain additives or hormones, be processed beyond what they consider acceptable, or be packaged in a way that could cause “contamination” from plastics or other undesirable products. 

Their focus is on their own health, rather than on a concern for the environment or animals, religious beliefs, or the treatment of human workers involved in the preparation of their food. 

A person with orthorexia may also develop a rigid, compulsive set of rules that define when and where it is acceptable to eat or what foods they eat together. They may also spend large amounts of time planning meals, researching food, and thinking about food outside of mealtimes. 

The obsession often has the same effect as other eating disorders. An orthorexic person loses weight and becomes malnourished, sacrificing social interaction and personal relationships in favor of carefully managed eating patterns.

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Diagnosing and treating orthorexia nervosa

The current edition of the “Diagnostic and Statistical Manual of Mental Disorders” does not include orthorexia, and research has found that it can be difficult to distinguish from obsessive-compulsive behavior or other eating disorders, such as anorexia nervosa. Some research even advocates abandoning the concept of a distinct diagnosis as an eating disorder.

Oftentimes, disorders will overlap, or a person might “graduate” from anorexia (in which their focus is on losing weight) to orthorexia (in which their focus is on food’s purity and cleanliness). 

It can be difficult to distinguish between a person who is simply very health-conscious when it comes to their food and a person who suffers from truly disordered eating. Since orthorexia is not an official diagnosis, many health professionals rely simply on personal interaction to determine whether their patient’s healthy eating has become an obsession. 

An official test to evaluate orthorexic behavior, the ORTO-15, does exist. The test, a lifestyle habits questionnaire, is still being investigated for its usefulness in a clinical setting. Some research seems to indicate that it could be a useful tool to diagnose orthorexia nervosa and other forms of disordered eating. Other researchers say the test is not adequate to detect orthorexic behaviors and attitudes.

At the moment, orthorexic eating is treated in the same way as other eating disorders, with a focus on lifestyle modification and therapy to work through underlying mental and emotional triggers. As orthorexia becomes more widely recognized, however, additional research on what distinguishes it from other disorders may point health practitioners in the direction of more specific and effective treatment options. 

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