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Many of us strive to achieve that perfect balance in life. From daily sessions of yoga and meditation to a healthy diet and positive relationships, our goal is to become a better version of ourselves. But what do you do when that attempt at healthy living becomes an obsessive behavior that dominates our lives? There has been a growing number of nutrition experts who warn that some people take their commitment to clean eating to health-threatening extremes. They have attached a name to it: “orthorexia nervosa” or “orthorexia” for short.

What is Orthorexia?

Packing a bowl of fresh salad for lunch and turning down that piece of cake your colleague brought to the office shows that you’re mindful of your diet. But what if the smell and sight of that piece of cake make you feel incredibly uncomfortable and anxious? If the resolution to eat healthy causes a person to skip social events and isolate themselves, then they might be suffering from orthorexia. You might have heard of orthorexia a few years ago when the eating disorder was in the media spotlight. A successful blogger named Jordan Younger caught the public’s attention with her claims that her obsessive “healthy” dieting eventually led to a diagnosis of orthorexia. Trying to be the healthiest version of herself, she came face-to-face with an obsession of purity, and a fear of foods that might disturb that “perfection.”

The term “orthorexia” was coined in 1997 by American physician Steve Bratman. It derives from the Greek word “orthos”, which translates into “right”. Orthorexia is an eating disorder that affects people who are concerned with the nutritional quality of the food they eat, rather than the quantity.

Individuals become overly worried about the quality of the food they consume, limiting their diets according to their belief of which foods are “pure” and “healthy.” Their desire to live healthy becomes an obsession with what and how much to eat.

In the U.S. alone, nearly 30 million people are battling with some type of eating disorder. According to Google Trends, there has been a growing interest in extreme diets. Since 2004, the term “vegan” has increased in popularity by 4.33 times or 333 percent. In 2004, the term “vegan” had a score of ~10 on a scale from 0 to 100, and a score of ~20 in 2010. In 2018 it reached its peak popularity with a score of ~80.

The American Psychiatric Association has not yet officially defined orthorexia as an eating disorder. However, the medical community is beginning to recognize it as an eating disorder that can have severe consequences. Some eating disorder experts believe that orthorexia is a separate diagnosis like anorexia nervosa. Others regard the condition as similar to anorexia.

An orthorexic person may avoid eating a number of foods, including those made with:

After some time, their food choices become so restrictive that their health suffers—an ironic twist for a person who is so devoted to clean eating. In the end, their obsession can crowd out other activities and interests, taking over their entire life. Relationships can be damaged, and their health can take a turn for the worst.

What Causes Orthorexia?

Although orthorexia has received very little empirical attention, some known risk factors include former or current eating disorders.

Following a Diet Plan
In a study of 15-year old teenagers, following a dieting plan was the most important factor in developing an eating disorder. People who were dieting were 5 times more prone to develop an eating disorder. Those who restricted their diet to an extreme were 18 times more likely to develop an eating disorder than those who were not dieting.

Obsessive-Compulsive Behavior
Obsessive-compulsive behaviors are another risk factor for developing orthorexia. If the person consumes a food that is considered “unhealthy”, their thoughts can become so disturbing that the individual feels the need to perform a compulsion. It can lead to over-exercising or fasting in an attempt to relieve anxiety.

Other risk factors are proneness to perfectionism. People suffering from orthorexia can spend hours on planning, shopping, preparing, and eating their meals, so much that it interferes with other parts of their life.

Focus on Achievement
Studies also report about the link between orthorexia, high trait anxiety, and a need to exert control. Individuals who are achievement-oriented regard their adherence to a clean diet as a marker of self-discipline. A study has found that healthcare workers, opera singers, ballet dancers, and athletes are more susceptible to suffering from orthorexia.

A study of female college athletes discovered that:

25% had disordered eating
26% reported menstrual dysfunction
10% had a low bone mineral density
2.6% had all three symptoms

Food Fears
Many people who suffer from orthorexia believe that foods that are not “farm-fresh”, “organic”, or “vegan” can cause them asthma, digestive problems, low mood, or allergies. The fear of these foods causing sickness is more powerful than the urge to eat that specific food.

How Common is Orthorexia?

There is limited research on the prevalence of orthorexia. Consequently, it is challenging to know how common orthorexia really is. According to the small number of studies, it ranges from 6% to 90%. However, if you classify people whose diet has led to impairment in everyday activities and medical problems, that percentage drops down to less than 1%.

A 2011 survey of psychologists, psychiatrists, nurses, and social workers gave useful insight into the case of orthorexia:

Two-thirds said they had observed patients in their practice suffering from clinically significant orthorexia.
Two-thirds of clinicians also reported that the syndrome deserves more scientific attention than it receives.
Studies also show that 71% of college students engaged in behaviors that are symptomatic of orthorexia. A study with students from the University of Castilla La Mancha in Spain found that 17% of students were at risk of orthorexia.

High-achieving individuals are at a higher risk of developing this food-related condition. Some findings from a research conducted in Turkey include:

81.8% opera singers suffer from orthorexia nervosa
32.1% ballet dancers suffer from orthorexia nervosa
36.4% symphony orchestra members suffer from orthorexia nervosa
Also, orthorexia happens in both men and women, and it is most common in middle-class adults who are 30 years of age.

What are Some of the Symptoms?

A symptom of orthorexia is not following a vegan diet for ethical reasons, or eating a lactose-free diet because it makes someone feel better. It is eating at the same exact time every day and obsessively following self-made rules about what is healthy and what is fattening. It is also about feelings of guilt and shame after eating food that does not fit the rules.

Behavioral Symptoms:


Behavioral Symptoms


Emotional Symptoms

What are the Long-term Effects?

People’s desire to eat healthily can get out of hand. It becomes a concerning issue when it prevents individuals from interacting socially, impacts their self-perception, and weakens their health.

If orthorexia is left untreated, it can lead to long-term health damages and negative life consequences. The effects fall under three separate categories, including physical, psychological, and social effects.

Physical Effects
Many people who are suffering from orthorexia also end up battling other medical conditions. By cutting out an entire food group from their diet including grains, animal products, and gluten, they become more susceptible to developing life-threatening conditions like malnutrition and anemia. Moreover, malnutrition can lead to low heart rate as weak heart muscles cannot pump at a healthy rate.

Additional physical effects of orthorexia include digestion problems. Although many individuals adopt a clean diet to remedy minor indigestion issues, a strict diet can trigger an even deeper issue. Many people have reported having difficulties digesting solid foods after they have been reintroduced into their diet.

Psychological Effects
Straying from self-enforced dietary rules can have long-lasting psychological effects on a person. Feelings of guilt, shame, and self-loathing seem to become more frequent and overpowering. These symptoms emerge after an individual consumes food that they consider to be “fattening” and “unhealthy.” Obsessive-compulsive episodes can also occur after straying from the diet and are manifested through strict cleans and fasts.

Further research reports a link between orthorexia and cognitive weaknesses in task switching, external attention, and working memory.

Social Effects
Having no flexibility when it comes to nutrition can also lead to social isolation and emotional distress. Sharing is how humans form bonds and spend quality time together. However, individuals with orthorexia have a fear of eating out and prefer cooking at home. Their rigid eating patterns can prevent them from engaging in social activities like dining out, office parties, and celebrations.

Individuals suffering from orthorexia can be overly critical of other people’s food choices. This can negatively impact their relationships with friends and family. Moreover, the predisposition to think their food habits are superior to other people’s choices may additionally strain social interactions.

Popular Misconceptions About Orthorexia

Many medical professionals see similarities between anorexia nervosa and orthorexia. Both conditions show excessive focus on food, rigid diet, perfectionism, compulsion, anxiety, need for control, and lengthy preparation of meals. However, even with these multiple similarities, there is an important distinction between the two diseases. In orthorexia, the focus is on the quality of food, while in anorexia, the focus is on the quantity. Obsession with weight is a primary symptom of anorexia, but a person with orthorexia is obsessed with feeling pure, healthy, and natural.
Many people believe that eating disorders affect only the female population. However, studies have shown that while eating disorders are more common among women, men can also suffer from an eating disorder. Men are also more likely to experience depression along with the eating disorder (67% of men compared to 43% of women). Additionally, men are less likely to access mental health services (10% of men compared to 21% of women).
Another misconception about orthorexia is that the disorder cannot be so detrimental to a person’s health as it focuses on clean eating. However, people with orthorexia have a very narrow perception of what they consider to be “clean” or “healthy.” In an attempt to live as healthy as possible, they end up cutting off essential minerals and vitamins from their diets. As a result of all these restrictions, they become malnourished and their health suffers.
Many people assume that orthorexia is just perfectionism portrayed through food. Although orthorexia does include tendencies towards perfectionism, it is very hard to determine whether perfectionism is the main cause.
Bipolar I has a lifetime prevalence of about 1% of the general population. Notably, the overall prevalence of bipolar spectrum disorders is around 2.4%. The prevalence of bipolar I in the USA is at 1%, which is slightly higher than most countries. In England, research found that the lifetime prevalence for bipolar disorder is 2%. However, some reports showed that these results were an underestimate. Following the fact that the study did not distinguish among the different subtypes of bipolar disorder, this would account for the percentage. In a meta-analysis involving 25 studies, the lifetime prevalence for both bipolar I and II disorders was 1.06% and 1.57% respectively in the USA. This percentage mirrors similar studies in the UK, Germany, and Italy, while review from African countries demonstrates a prevalence of 0.1 to 1.83%. The difference observed globally can be attributed to the differences in ethnicity, diagnostic criteria, and research design. Research has shown the equal prevalence of bipolar disorder in both men and women. Studies have reported that women are three times more likely to present rapid cycling. Rapid cycling is described as the event when an individual presents four or more episodes of mood swings within a period of twelve months. Other studies have found that women may present more depressive symptoms along with mixed episodes compared to men with the same disorder.

Is Treatment Possible?

When your desire to live healthy starts to impair your ability to socialize, impact your health, and undermine your performance at work or school, then treatment is required.

The first step toward treatment is becoming aware of the problem. It is also the most challenging step, as people affected by orthorexia often fail to acknowledge its adverse effects.

Once you identify and recognize the problem, you should seek help from a multidisciplinary team consisting of a doctor, dietician, and psychologist. The team can help individuals whose lives have been negatively impacted by this life-threatening preoccupation with what they believe to be a healthy lifestyle.

Psychotherapy is often useful in treating obsessive-compulsive disorder. Doctors recommend a type of psychotherapy called cognitive-behavioral therapy (CBT) that teaches a person new ways of thinking, behaving, and reacting to situations. During treatment, patients learn how to identify and alter destructive thought patterns that have a negative effect on behavior and emotions. CBT is a short-term treatment option and more affordable than other types of treatment. It is also supported by extensive research and has been shown to help patients cope with a wide range of negative behaviors.

Dialectical Behavioral Therapy (DBT)
DBT is a type of cognitive behavioral therapy that is used in the treatment of anxiety disorders. The patient participates in individual therapy with a trained professional who provides guidance on coping with the disorder. During DBT, people learn how to change their negative behavior through:

• Mindfulness or focusing on the present
• Distress tolerance, or learning how to accept oneself
• Interpersonal Effectiveness, or how to be assertive in a relationship
• Emotion regulation, or recognizing and coping with negative emotions

Doctors may prescribe medication to help patients overcome their symptoms of orthorexia. Patients may receive anti-anxiety medications and antidepressants. The doctor should closely monitor their medication intake and modify it as needed to ensure the individual is receiving the maximum benefit.

Group Therapy
Group therapy is another common type of treatment for people suffering from orthorexia. Some of its benefits include:

• Forming productive relationships with others who are struggling with the same disorder
• Learning to work together with others to solve problems
•Developing healthy ways of processing negative emotions

Patients will learn how to develop new coping strategies, avoid situations that can trigger a relapse, get involved in social situations, and deal with co-occurring conditions.

Nutritional Support Therapy
A professional dietitian provides medical nutrition therapy. This type of therapy is useful for maintaining or restoring a patient’s health and overall well-being. The patient attends weekly meetings in an attempt to reshape their relationship with food. The program will introduce changes in diet by adjusting the quantity, quality, and methods of nutrient intake.


Finding Happiness After Diagnosis

Wanting to eat more healthfully and being mindful of the food you buy is perfectly normal. Whether it is for weight loss or feeling better about yourself, a healthy and balanced diet can keep your body and mind strong and nourished. However, there is a thin line between being mindful of the food you eat and an eating disorder.

If you feel that your desire to live clean has become an obsession and has negatively affected your well-being or social life, it is possible that you are suffering from orthorexia. Consult with your doctor or psychologist to prevent the progression of life-threatening symptoms.


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