Choosing quinoa over pasta and veggies over French fries, finally reading food labels and rejecting refined sugar. Over the past several years, there’s been a shift among Americans in our attitudes toward food. Slowly but surely, more of us are choosing wholesome foods and paying closer attention to what we’re consuming in what’s been dubbed the “clean eating movement.”
And that’s terrific news. Focusing on a clean eating meal plan that includes fresh foods and eliminating highly processed ingredients can lead to reduced inflammation, the root cause of many diseases; a lowered risk of diabetes and certain types of cancers; and an overall happier, healthier feeling.
But what begins for many as a genuine desire to feel better about themselves and the foods they put into the body has the potential to become a dangerous fixation, often propelled by social media. Meet orthorexia, a new cousin to anorexia nervosa and bulimia nervosa.
Orthorexia: At First “Tongue in Cheek,” But Not for Long
“Orthorexia nervosa” was named by Dr. Steven Bratman in 1996. (1) While seeing patients in his alternative medicine practice, he noticed an increasing amount of them were fixated on eating healthy. He coined the phrase as a way to help a particular patient work through her extremist attitude about food. As Dr. Bratman describes, “It is formed in analogy to anorexia nervosa, but using orthro, meaning ‘right,’ to indicate an obsession with eating the right foods.”
But what began as a tongue-in-cheek way to work through a patient’s troubled relationship with food and getting “overly obsessed health foodists to take a look at themselves” has evolved into a term that describes a real eating disorder that some young women and men are finding themselves all too familiar with.
While eating clean, reading labels and being cognizant of the foods we consume (mindful eating) isn’t a bad thing, particularly in a society that’s seeing increasingly high rates of obesity, for some, it becomes an unhealthy obsession with otherwise healthy eating .(2)
And while social media isn’t to blame for orthorexia — after all, the phrase came about in the ’90s, years before Instagram and Pinterest even existed — experts agree that easy access to all those pretty photos of kale smoothies and meticulously arranged salads makes it easier to feel the pressure to eat clean. (3) The 24/7 access we have to popular food feeds and celebs accounts means comparing diets or “outdoing” someone else’s (“She’s vegetarian? I can go vegan!”) is always at our fingertips.
Is Orthorexia a Genuine Eating Disorder?
While many people, mainly young white women, identify as having orthorexia, mention the term to a doctor and you might get a blank look. (4) That’s because orthorexia isn’t yet considered an eating disorder. It’s not included in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) that’s published by the American Psychiatric Association and considered the “bible” of disorders.
Some experts believe that orthorexia is not different enough from other existing disorders, like anorexia or obsessive compulsive disorder (OCD), to warrant its own definition. Similar to anorexics, individuals with orthorexia become fixated on food and their bodies, though the preoccupation is not on calories or weight but on what types of food are being eaten.
For those struggling with orthorexia, there are constant feelings of being “unclean” or having their bodies marred by the foods they’re eating, no matter how “healthy” their diets are. According to Dr. Bratman, recovering anorexics sometimes shift or “graduate” to orthorexia. These people keep their disordered eating habits but focus on purity, rather than losing weight. (5)
And like people with OCD, orthorexics use their eating habits as a way to gain control. For some, the fact that these people are obsessing over something — not what they are obsessing over — means orthorexia is a type of OCD.
Of course, that theory might be self-prophesizing, as more research on orthorexia as a unique eating disorder is needed. (6) As Dr. Cynthia Bulik, professor of eating disorders at the University of North Carolina, Chapel Hill, told The Guardian, diagnosing orthorexia can be a vicious cycle.
“It is not a bona fide diagnosis, so there is no research on it; however, since there is no research on it, we know very little about whether it actually should be a disorder,” she says.
Eventually, however, “orthorexia” might officially enter the medical lexicon. That’s because of the way eating disorder evolution tends to occur. (7) After bulimia was recognized as a disorder in 1979, for example, doctors started recognizing that some patients were first binge eating and then purging their food, or just binge eating altogether. But it wasn’t until 2013 that binge eating disorder was added to the DSM-5.
In orthorexia’s case, when Dr. Bratman first came up with the name, most of his clients were fixated on cleanses, the popular healthy eating fad at the time. Today, it’s cutting out gluten, eliminating dairy or nixing entire food groups. And while these might be positive, healthy changes for some people — like you have Celiac disease or are lactose-intolerant — for some people, the obsession with eliminating certain “bad” foods becomes all-consuming.
Tricky Business: The Symptoms of Orthorexia
So is reading restaurant menus before meeting friends for dinner or cutting cheese out from your diet orthorexia? Not necessarily. Empowering yourself to make healthy choices or restricting foods that truly don’t work for your particular body because they make you sick or contribute to health issues is not a bad thing.
That’s what makes recognizing orthorexia especially tricky. Eating clean and choosing healthy foods is, in general, a positive thing. It’s much more difficult to identify the problem because it’s cloaked in a “healthy” disguise.
But if you plan your day and social activities around food, attach your self-esteem to how well you can stick to your diet, or find yourself restricting more and more foods, it could be time to seek help. When clean eating becomes a fixation that’s dominating your life, there is a problem.
Dr. Bratman and his colleague recently released formal criteria to diagnose orthorexia. It includes two sets of criteria. Criterion A comprises an obsessive focus on “healthy eating”; an exaggerated fear of disease, a sense of personal impurity, anxiety and shame if an individual violates self-imposed dietary rules; and increasing dietary restrictions over time.
In Criterion B, the compulsive behavior leads to malnutrition from a restricted diet; impairment of social, academic or vocational functions because of healthy diet behavior; and a positive sense of self-worth being excessively dependent on a person’s self-defined “healthy” eating behavior.
Remember, choosing good-for-you foods isn’t a bad thing — just like enjoying a pizza or nibbling on chocolate now and again isn’t the end of the world. But with orthorexia, there’s really no longer a choice when it comes to eating “healthy.” Food has become a psychological obsession.
Do You Have Orthorexia?
Do you believe you might be suffering from orthorexia? Consider these questions provided by the National Eating Disorders Association. The more questions you answer “yes” to, the likelier it is you might have orthorexia.
- Do you wish that occasionally you could just eat and not worry about food quality?
- Do you ever wish you could spend less time on food and more time living and loving?
- Does it seem beyond your ability to eat a meal prepared with love by someone else — one single meal — and not try to control what is served?
- Are you constantly looking for ways foods are unhealthy for you?
- Do love, joy, play and creativity take a back seat to following the perfect diet?
- Do you feel guilt or self-loathing when you stray from your diet?
- Do you feel in control when you stick to the “correct” diet?
- Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?
If you believe you might have a problem with orthorexia, it’s important to reach out for help. Working with a professional who specializes in eating disorders can help you rethink your relationship with food and address the underlying issues that contribute to orthorexia.
While eating clean and focusing on a healthy lifestyle is great, it’s just one part of our lives. Food is a way to nourish our bodies, enjoy time with friends and family and feel good — not an enemy.