A Quick Guide to Orthorexia Nervosa

July 08, 2022

Although Orthorexia Nervosa is not included as a standalone disorder in the DSM-V, it’s recognized by most in the psychiatric and eating disorder treatment communities as a serious disorder. Because it’s not as prominent as other types of eating disorders, Orthorexia Nervosa may go under the radar, but hopefully, we can shed some light on it.

What Is Orthorexia Nervosa?

Orthorexia Nervosa is a type of eating disorder characterized by an extreme focus on “healthy” eating. The term was first used by Stephen Bratman, MD, in 1996. He called it a “fixation on righteous eating.” This put a formal name to what psychiatrists, nutritionists, and doctors had been noticing for years. There is a bit of irony here. In some cases, it helped those professionals understand that some of their well-intentioned advice could have contributed to their patients’ eating disorders.

When a person has Orthorexia Nervosa, they go beyond trying to eat “healthily”. They may try to avoid saturated fats, watch their cholesterol, or go vegan to better their health, among other reasons. Normally, this is not an issue (and if you take anything away from this blog, please remember that trying to eat healthful foods is not in and of itself a bad thing), and may be encouraged by their doctors.

When healthy eating becomes an obsession, the individual may start to cut out more and more foods and food groups from their diet. They may, for example, stop eating gluten (without a diagnosis of an allergy or celiac disease), any processed food, seafood or fish, all sugars, and so on. People with Orthorexia Nervosa usually start with a few foods they won’t eat and then progress to more and more.

With Orthorexia Nervosa, the desire for healthy eating begins to affect a person’s physical and psychosocial health. Even though the root cause is not a desire to lose weight, in advanced cases extreme weight loss can occur, similar to the weight loss seen in Anorexia Nervosa. In addition to the health risks associated with malnutrition and weight loss, the individual also faces psychological trauma and social difficulties.

What Causes Orthorexia Nervosa?

Like other eating disorders, Orthorexia Nervosa doesn’t have a single cause, but rather is a combination of several factors. Previous experiences with other kinds of disordered eating indicate a higher risk for Orthorexia Nervosa, but it can begin with no earlier disordered eating symptoms. Many aspects of Orthorexia Nervosa share symptoms of obsession with OCD, such as a compulsion to behave a certain way out of fear of negative consequences. This also manifests in an obsession with only eating healthy foods. In a similar vein, a high tendency for perfectionism is common in people with orthorexia, just as it’s common in other eating disorders and OCD.

Family history is another indicator that there is a risk for Orthorexia Nervosa developing. People whose family members have experienced an eating disorder are more likely to develop one themselves. Households with a strong focus on “healthy” eating and calorie counting may create an environment more likely to produce Orthorexia Nervosa, although of course this is only rarely the case. In addition to these factors, Orthorexia Nervosa is often a response to high stress and anxiety situations.

What Are the Symptoms of Orthorexia Nervosa?

As discussed, the main symptoms of Orthorexia Nervosa are refusal to eat certain foods out of magnified concerns about their “healthiness”, and weight loss due to inadequate nutrition. However, there are several other behavioral signs that a person might be struggling with Orthorexia Nervosa:

  • Constantly checking ingredient labels and nutritional information
  • Spending inordinate amounts of time on “health food” or nutritional sites, or similar social media sites (i.e. Instagram “healthy eating” groups)
  • An outside sense of pride in their health and eating habits (body image is not always a concern, but it can be)
  • An increase in concern about the health of ingredients
  • Increasing inability to eat certain kinds of foods and an increasing amount of “fear foods”
  • Cutting out an increasing number of food groups
  • Showing great interest in what close associates are eating
  • Becoming stressed when thinking about social events where food is served
  • Avoiding eating with others if they do not control the menu
  • Difficulties at work or school events where “unhealthy” foods are shared
  • Showing high levels of distress when “safe” or “healthy” foods aren’t available
  • Frequent “cleanses” where the person fasts or eats a specific diet intended to rid the system of “toxins”

Many of these symptoms might be observed in people with other eating disorders, especially Anorexia Nervosa. However, in making a diagnosis, eating disorder treatment specialists will ascertain whether body image distortion and desire to lose weight are primary causes. If not, they are likely to recommend specialized Orthorexia Nervosa treatment rather than Anorexia Nervosa treatment.

What Does Orthorexia Nervosa Treatment Look Like?

Eating disorder treatment, in general, is a combination of psychological treatment, mindfulness training, and nutritional education. If the client is underweight or malnourished, medical care may be necessary along with a weight restoration plan.

Although Orthorexia Nervosa shares some commonalities with OCD, there are no medications specifically designed for it. However, medications like SSRIs and anti-anxiety drugs might be prescribed for co-occurring disorders. Instead, psychological treatment is the core component of a treatment plan. There are several kinds of psychotherapy that might be used:

  • Group therapy – Sharing your story with others who know what you’re going through is a powerful experience. Many people eating disorders, before they go into treatment, feel like they’re all alone in their disorder. Hearing others speak on their experiences and comparing them to your own allows for a feeling of solidarity and comfort opening up. Group therapy leads to connections with peers and often facilitates breakthroughs in treatment.
  • Behavioral therapy – Evidence-based techniques like Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT) are all slightly different takes on how to change behavior. They normally begin with working to identify how disordered thoughts lead to disordered behaviors. Using mindfulness techniques, clients in treatment learn to experience these thoughts without acting on them.
  • Exposure therapy – This form of therapy is especially useful in Orthorexia Nervosa recovery. During exposure therapy sessions, the client is gradually exposed to their “fear foods” over time. They may start by just being in the same room as those foods, or watching someone else eat them. Then they will try to eat a tiny bit of one of those foods, then a bit more, then several of the foods, and so on.

Getting Help

Despite some of the challenges discussed above, Orthorexia Nervosa is treatable. If you or a loved one is becoming obsessed with healthy eating to the point it affects your wellbeing, please reach out for help and support. A life in recovery is within reach.

Monte Nido & Affiliates delivers clinically comprehensive, research-backed treatment to adults and adolescents with eating and co-occurring disorders, within a healing environment. As a Miami, FL-based company, Monte Nido & Affiliates has over 40 programs in 13 states, offering a full continuum of care. Founded in 1996, Monte Nido & Affiliates specializes in the treatment of eating disorders for all genders and includes five distinct clinical programs: Monte Nido, Walden Behavioral Care, Clementine, Oliver-Pyatt Centers, and Rosewood Centers. For over two decades, our tenured and expert staff — which includes recovered professionals — has delivered treatment that leads to full recovery.