Orthorexia nervosa (ON or Orthorexia) is a newly coined term which denotes an obsession with eating healthy food. It is still debatable whether it is a new condition in its own right, or a variation of an obsessive or anorexic tendency.

Orthorexia is thought by many to be an eating disorder because though it focuses on eating for wellness, it paradoxically reduces the quality of life by malnutrition, reduced social interaction, or causing anxiety, and loss of a well-rounded life.

Symptoms

Bratman and Knight identified many of the typical symptoms and signs of orthorexia:

• Highly restrictive diet which becomes progressively narrower, excluding many previously accepted foods in the name of healthy eating
• Intense focus on the quality, source, packaging, and preparation of food which often takes up a disproportionate amount of energy, time, and expense, with an average of more than three hours a day spent in terms of time alone, on proper eating
• Ritualized preparation and eating patterns typical of obsessive individuals, often with detailed attention to cleanliness, separation of clean and un-clean utensils and foods, and precise order

Orthorexics typically spend a good deal of their lives shopping for clean food. Their search does not end with finding the right food. They must read the fine print on the label, to determine questions such as:

• Is it 100 percent organically grown?
• Is the dairy product from the right type of cow?
• Did the food undergo any type of processing?
• Were any micronutrients, or flavors, or preservatives, added?
• Is it cooked or raw?
• Is the packaging non-carcinogenic and without significant associated carbon imprint?
• Is the label informative enough?

Meal preparations are also prolonged and require careful consideration because certain foods should not be combined, certain postures and timings are not appropriate for all foods, and some foods are altogether excluded though they are organic and nutritious.

Reasons why this focus on clean eating exists may be when food is valued strictly for its nutritional value, but also because it contributes richly to one’s sense of self-worth and achievement. Moral or religious reasons are characteristically missing in instances of orthorexia.

In addition to this long and elaborate process of meal planning, preparation, and consumption, orthorexic patients find that they experience intrusive thoughts about food which disturbs their life outside meals as well.

Many orthorexics may use their clean eating as a rationale to justify eating less than they want to or should, because most ‘clean’ foods are also low-calorie. in this way, anorexic tendencies may be hidden behind the veil of eating healthy.

Orthorexic individuals also tend to attribute unrealistic tendencies to natural or clean foods, displaying a fanatical devotion to such substances as a result.

Emotional symptoms

Emotions related to food in orthorexics include:

• Frustration and anxiety if they are faced with any situation in which they must consume un-clean food, because of their real and intense feeling that it will adversely affect their health and well-being
• Guilt and feelings of having to ‘do penance’ related to violations of their clean food code, which are treated as unforgivable lapses from self-discipline
• Judgmental and intolerant attitude towards others who eat ‘dirty’ food, with a disgust towards such foods
• Boastfulness about their ability to maintain a clean diet
• Frustration and feelings of incompetence resulting from impaired ability to carry on with a normal life in other fields because of the enormous effort associated with clean eating behavior
• Social isolation – this is either self-imposed or as a result of others’ reaction to the abnormally strict eating style and critical attitude of the orthorexic to their food habits
• Eventual realization that eating has become the central focus and meaning of life, without room for any other activity or relationship. Eating no longer confers joy, only loneliness, hard work, and eternal struggle for perfection

Symptoms related to other predisposing conditions

Many orthorexics also have co-morbid conditions such as anorexia nervosa (AN) and obsessive-compulsive disorder (OCD). These share many strong and striking similarities with ON, such as:

• Strong trait anxiety
• High perfectionism levels
• Intense need for control
• High potential to lose weight
• Focus on excellence and achievement in the form of dietary compliance, which signals impeccable self-control and gives them a feeling of self-esteem

References

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340368/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943279/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359442/

Further Reading

• All Orthorexia Nervosa Content
• Epidemiology of Orthorexia Nervosa
• Clean Eating and Orthorexia
• History of Orthorexia
• Diagnostic Criteria for Orthorexia

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.