Orthorexia Nervosa: Symptoms, Causes, and Treatment Options

Anorexia nervosa, bulimia nervosa, binge eating disorder – these are some widely known eating disorders. However, there is another eating disorder that is not as known but can lead to equally devastating consequences if not paid attention to. It is called orthorexia nervosa.

Orthorexia nervosa is an eating disorder that is characterized by an extreme focus on healthy eating. While healthy eating is good for the mind and body, an extreme of anything is not healthy. Therefore, orthorexia nervosa requires equal understanding, attention, and treatment as other eating disorders.

What is Orthorexia Nervosa?

Orthorexia nervosa, also simply known as orthorexia, is an eating disorder. It is characterized by an unhealthy fixation on healthy eating. Orthorexia nervosa was only recently coined by Steven Bratman in 1997, and is not yet fully understood. However, experts believe that it requires understanding, diagnosis, and treatment like any other eating disorder as it can lead to potentially dangerous consequences.

With the unavailability of extensive information on orthorexia, it is easy to think of it as not very serious as it focuses on healthy eating. For this reason, we need to first focus on how is orthorexia different from healthy eating.

Healthy eating refers to eating foods that are nutritious and provide the mind and body with energy, health, and wellness. This is optimal for the body, as one focuses on eating foods rich in nutrients and consuming less of unhealthy fats, sugars, and salts. However, orthorexia involves taking this to an extreme level, wherein people develop eating habits which lead to the rejection of foods they do not deem to be “pure” enough. In fact, Bratman even said that orthorexia’s definition stands for an extreme focus on “righteous eating.” Ultimately, what happens is that people with the said eating disorder end up rejecting a variety of foods that are not up to their standards.

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Symptoms and Signs of Orthorexia Nervosa

Orthorexia nervosa is not yet fully understood, but there are some signs and symptoms to look out for the purposes of diagnosis and treatment:

• Unhealthy obsession with healthy foods and eating.
• Extreme fear and anxiety regarding unhealthy foods, leading one to avoid these foods.
• Having a strict dietary regimen, and not being able to be flexible without experiencing anxiety.
• Obsessed with food research, devoting a large amount of time to thinking/planning meals, scanning product labels, surfing information on the internet regarding different ingredients.
• Avoiding foods as bad or unclean despite not having any reasonable grounds to do so. This can lead to rejecting a wide variety of foods that are not up to personal standards.
• Fearing losing control over diet if not prepared by oneself, so eating out once in a while can lead to potentially severe consequences. This leads to avoiding social events or gatherings that involve food prepared by others.
• Being overly critical of family and friends’ choices of food.
• Showing visible signs of malnutrition as a consequence of unreasonable food restrictions, especially in terms of drastic, unhealthy weight loss.

Causes and Risk Factors for Orthorexia

The causes and risk factors for orthorexia nervosa can be biological, psychological, as well as social.

– Biological Factors:

Having a close relative with orthorexia nervosa (a family history) can increase the chances of developing the eating disorder.

– Psychological Factors:

Anxiety, perfectionism, and body image issues can make one more prone to orthorexia nervosa. In fact, it has often been linked with obsessive-compulsive disorder as well.

– Social Factors:

Certain adverse social experiences, like being bullied about weight can lead to the development of orthorexia nervosa. It is also associated with higher income, rise of knowledge regarding nutrition via social media, and other biases and stigmas regarding weight.

Orthorexia Nervosa vs. Anorexia Nervosa

Orthorexia nervosa and anorexia nervosa are both eating disorders. However, they are different kinds of eating disorders. Certain differences between them are as follows:

– “Ortho” means right, and “ana” means without. Orthorexia involves taking extreme measures to eat the right kind of foods, while anorexia involves taking extreme measures to restrict food.

– Orthorexia develops as a result of extreme focus on how food impacts health. It involves eating foods deemed as pure by one’s own standards and a rejection of a wide variety of foods that are deemed impure without any reasonable understanding.

– Anorexia develops as a result of extreme focus on how food impacts body weight and image. It is characterized by extreme dietary restrictions to avoid weight gain.

While orthorexia and anorexia are different, there are also certain similarities:

– Both are related to diet control.

– Consistent, pervasive food-related thinking patterns.

– Elaborate behaviors pertaining to planning and preparation of meals.

– Refusing to eat outside.

– Avoiding social events involving food.

– Malnutrition.

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How to Recognize Orthorexia Nervosa in Yourself or Others?

Orthorexia nervosa comes with different warning signs. When recognized within oneself and others, it helps in taking steps from preventing the condition from adversely impacting one’s health any further:

– Being extremely focused, to the point of being obsessive, about the quality of food. This leads to many dietary restrictions, including going to foods that are only organic, whole, raw, or vegan.

– Extreme dietary restrictions, which leads to cutting out entire food groups, commonly involving sugar, dairy products, meat, processed foods, or gluten. Sometimes, even being around these generally avoided food groups can also lead to anxiety.

– Strict eating patterns that are rigid and inflexible. Deviating from these eating patterns can lead to anxiety or severe emotional turmoil.

– Constant anxiety regarding falling ill, especially by consuming those foods that are deemed as bad or impure.

– Social withdrawal, as one may avoid consuming foods prepared by others as they only trust in themselves to prepare food that is good and clean. This can lead to avoiding social gatherings involving food prepared by others or eating outside.

– While not everybody with orthorexia loses weight, it is characterized by weight loss in many cases to the point that one may look malnourished.

Orthorexia Diagnosis

Orthorexia nervosa does not have an official diagnosis as of yet unlike other eating disorders. However, experts believe that it is a condition that requires its own set of diagnoses and treatments. Toward the same, Steven Bratman and Thomas Dunn have come up with a two-part diagnostic criterion that is as follows:

Criterion A –

• Compulsively follow food-based rules that are based on personal beliefs of healthy eating, which only get stricter and stricter as time goes on.
• Breaking self-imposed food rules will lead to severe emotional turmoil and anxiety, even giving rise to feelings of guilt and shame.

Criterion B –

• Body image and self-esteem become related to self-imposed food rules and how well one follows them.
• Social withdrawal, resulting from a fear of breaking these self-imposed food rules, as one can fear eating food outside/prepared by others. This can lead to problems in interpersonal and social relationships as well.
• Visible signs of malnutrition, as a consequence of extreme dietary restrictions based on self-imposed food rules.

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Treatment Options for Orthorexia Nervosa

At the NuView Treatment Center, we provide comprehensive and personal treatment approaches to orthorexia nervosa. They include the following treatment paths:

Cognitive Behavioral Therapy – It involves identifying and challenging the maladaptive thinking, emotional, and behavioral patterns associated with orthorexia and reshaping them into healthy and productive patterns.

Behavior Modification – It involves understanding the adverse effects of one’s eating habits on physical and psychological health, and modifying the same.

Exposure Therapy – It involves exposing one to the foods that can trigger anxiety in a safe and gradual manner so as to reintroduce these foods.

Holistic Therapies – Incorporating healthy practices like meditation, mindfulness, and yoga can help in relaxing and adopt healthier coping patterns.

Nutrition – As orthorexia can lead to malnutrition, nutrition is paid attention to and dietary plans are designed to supply nutrients and restore weight as needed.