Can a “healthy lifestyle” actually endanger your life? Turns out, there’s such a thing as being too healthy. A relatively new food disorder, Orthorexia Nervosa (ON), is the culmination of health consciousness and disordered eating. And it can cause serious harm.
Yes, You Can Be Too Healthy
Orthorexia often starts out with the best of intentions: caring about your health. Perhaps it begins with concern over pesticides in various foods (a legit concern), then it expands to “chemicals” in foods, as well, goes on to include GMOs (no scientific proof that GMOs are unhealthy, actually), then weaves its way into food intolerances (gluten, anyone?).
By the time ON has its grip, many orthorexics will only eat food they’ve prepared themselves, according to often arbitrary and overly-restrictive criteria. An “elimination” diet suddenly becomes the elimination of everything but a few “clean” foods.
Eventually, this takes a physical toll. The irony is all the orthorexic was originally seeking was health.
“The physical signs of orthorexia differ per person and situation. But over time, your obsession with foods, restrictions, and routines will force your body into a state of imbalance and malnutrition,” an article from Psychology Today reported. Those suffering from orthorexia may lose weight, feel tired, weak or cold, and take longer to recover from common illnesses and viruses. Malnutrition can also occur, leading to additional health issues.
Orthorexia hits the young, too. In one celebrity case, cited by E Online, Jaden Smith (son of Jada Pinkett and Will Smith) underwent a family intervention over his vegan diet. He was down to sometimes one meal per day, not getting enough protein, and turning grey.
Timberline Knolls, a residential treatment facility specializing in eating disorders, lists these warning signs for orthorexia on its site:
- Feelings of guilt when deviating from strict diet guidelines
- Increase in time spent thinking about food
- Regular advance planning of meals for the next day
- Feelings of satisfaction, esteem, or spiritual fulfillment from eating “healthy”
- Thinking critical thoughts about others who do not adhere to rigorous diets
- Fear that eating away from home will make it impossible to comply with diet
- Distancing from friends or family members who do not share similar views about food
- Avoiding eating food bought or prepared by others
- Worsening depression, mood swings or anxiety
Orthorexia Is Not Yet Official
Orthorexia is not yet an official eating disorder. It was first identified and termed by Dr. Steven Bratman MD in the 1990s.
If you think there’s some overlap between anorexia and orthorexia, you’re correct. Anorexia often involves exercise addiction and complex, increasingly restrictive eating patterns. Orthorexia, though, is less about weight and body image and more about seeking some sort of health perfection.
Bratman, in a 1997 Yoga Journal article, describes orthorexics thusly:
“Many of the most unbalanced people I have ever met are those who have devoted themselves to healthy eating,” Bratman explains. “In fact, I believe many of them have contracted a novel eating disorder, for which I have coined the name ‘orthorexia nervosa.’ The term uses “ortho,” in its meaning as straight, correct and true, to modify “anorexia nervosa.” Orthorexia Nervosa refers to a fixation on eating proper food.”
Bratman continued. “It is this transference of all life’s value into the act of eating which makes orthorexia a true disorder. In this essential characteristic, orthorexia bears many similarities to the two named eating disorders: anorexia and bulimia. Whereas the bulimic and anorexic focus on the quantity of food, the orthorexic fixates on its quality. All three give to food a vastly excessive place in the scheme of life.”
A 2019 article in Frontiers of Psychology surveyed 160 psychologists, psychiatrists, dietitians and physiotherapists in the Netherlands. Seventy-four percent felt orthorexia nervosa should be a separate and distinct diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
“Mental health professionals reported believing that ON is prevalent in the general population and that a separate diagnosis would have both advantages and disadvantages for health professionals and patients. Interview participants described the typical ON patient as being young, female, and highly educated; characteristics that overlap with typical anorexia nervosa and obsessive compulsive disorder cases,” the article stated.
Treatment for Orthorexia is Challenging
Read some of the anonymous stories from orthorexics on Bratman’s website and you’ll walk away with great compassion for the mental and physical suffering. Take “Dave’s” story, for instance.
“You go along in your life, and you have anxiety about your health,” Dave wrote. “You feel that at any moment the finger of God can come down and strike you dead. Your sword and shield against this fear is: I can eat healthy food; this will protect me.”
Dave continued, “This becomes obviously exaggerated; you think that the cheese you eat today will give you a heart attack tomorrow, that the fast you go on tomorrow will save you from coming down with colon cancer next week. But really, the sword and shield are not that pure food protects you from ill-health; rather, you use the idea that food protects you from ill-health to shield you from all anxiety.”
Sometimes, ON is rooted in reality, at least at first. People with auto-immune conditions such as lupus, fibromyalgia, and IBS might have a real need to eliminate certain foods from their diets for better health, but it can quickly unravel into the chaos of orthorexia. And then it gets very complicated.
Los Angeles-based therapist and eating disorder specialist Jackie Shapin, LMFT describes the need for lots of supervision, especially when dealing with people with actual illnesses on top of their orthorexia.
“If I’m seeing someone who’s given a dietary recommendation with restrictions due to medical conditions, I recommend and explain how they would greatly benefit from seeing a registered dietitian who has experience treating disordered eating so that they do not become “orthorexic” or lack needed nourishment,” Shapin tells Parentology. “ I would also recommend they show their dietician medical paperwork to help them both understand their auto-immune disease.”
She also recommends therapy for anyone dealing with a chronic illness.
“ Therapy would be a safe place for people who struggle with auto-immune diseases to explore how they have been coping with their medical diagnosis,” Shapin adds. “Having an auto-immune disease can change someone’s everyday life in small or big ways. Processing these changes and the feelings that come up can help someone have a healthy outlet versus the possibility of going to food or body as an unhealthy way of coping.”
Walden Eating Disorders discusses treatment on its website, stating that it’s pretty close to treatments for anorexia or bulimia. All of these disorders feature black and white thinking, thought disorders, and inflexibility; there is often some Obsessive-Compulsive Disorder (OCD) symptoms present as well. Cognitive Behavioral Therapy (CBT) can assist with reactions to what are termed “fear foods.”
There are medications, none of which directly address orthorexia, but can help with the massive anxiety and circular thinking involved. SSRI’s like Zoloft and Prozac, anti-anxiety meds like Ativan, and even medications associated with OCD and ADD like Risperdal and Luvox have all been effective in treating the symptoms of ON.
If you’re concerned you or your child might be suffering from orthorexia, you can take a quick self-test on Bratman’s orthorexia website. If that result seems at all conclusive, find a licensed and practiced therapist, like Shapin, to help navigate the disorder.
Orthorexia Nervosa: Sources
Walden Eating Disorders
Psychology Today
Orthorexia.com
Timberline Knolls
Frontiers in Psychology
Jackie Shapin Therapy