Recently, I’ve been stopped in my tracks by one too many headlines warning that orthorexia is on the rise. I did some research only to realize it’s an eating problem that’s all too pervasive. CNN calls it something “few people understand, and many accidentally applaud.” Other articles with photos of colorful Erehwon aisles make the case that trends, gym bros and social media have a hand in the rise of the disordered behavior.
While orthorexia is not formally recognized in the DSM as an eating disorder, more people have acknowledged it. Awareness of orthorexia has been on the rise for the past several years, says psychologist and NYU School of Medicine professor Rachel Goldman, PhD, who notes it was first coined by Dr. Steven Bratman in 1997. Many of us fall victim to overthinking how healthy our diets are, but orthorexia is a more extreme version of this. It “comes with obsession, hyperfixation and a more extreme way of eating than simply eating healthy,” explains food freedom and intuitive eating coach Sloane Elizabeth. Ahead, we asked experts to break down orthorexia, signs of the disorder and how to start the path to healing.
Featured experts
- Rachel Goldman, PhD, is a psychologist and NYU School of Medicine Professor
- Sloane Elizabeth is a food freedom and intuitive eating coach
What is orthorexia?
Although not formally recognized in the DSM as an eating disorder, it has parallels to the disorder. “As opposed to dealing with the quantity of the food, orthorexia involves an obsession with the quality of the food,” says Dr. Goldman. “Orthorexia is a disordered eating pattern characterized by an obsession with eating as ‘healthy’ as possible. This obsession typically feels like an extreme hyperfixation that comes with intense fear, anxiety and/or guilt if the person eats something they deem to be ‘unhealthy,’” explains Elizabeth.
How is orthorexia different from healthy eating?
“Many times, orthorexia starts with good and harmless intentions to improve one’s health and eat better,” notes Elizabeth. So when does it become an issue? “When this goal starts to become obsessive, all-consuming and impact other areas of life (like being able to spontaneously socialize at a restaurant or eat an unplanned dessert), then it becomes a harmful disordered eating habit.” Dr. Goldman notes that there’s a distinct difference between wanting to be healthier and more mindful of the food you’re eating and completely eliminating certain good groups and only eating “healthy” foods.
“Although orthorexia and healthy eating might look similar from an outsider’s perspective, the mindset is very different. With orthorexia, there is an extreme hyperfixation on food and how ‘healthy’ it is. If something is ‘unhealthy, eating it will likely cause abnormal levels of anxiety, guilt and shame,” notes Elizabeth. “Many times, people who struggle with orthorexia feel like they are thinking about food 24/7 and constantly worrying about what to eat, what they just ate and what they will eat next.”
Elizabeth notes that orthorexia may also lead to someone over-exercising or taking other healthy habits to the extreme. “It is a very extreme, black-and-white, all-or-nothing mindset with very little room for flexibility or balance. It can feel all-consuming,” says Elizabeth. When the perceived health goal is the person’s number one priority, it can start to impact other aspects of their life.
Warning signs of orthorexia
Compulsive behaviors
Compulsive behaviors or preoccupations around diet are some of the more common warning signs of orthorexia. Constant “Fear or worry about how ‘clean’ food is or if it’s ‘bad’ for one’s health,” should be a red flag, notes Dr. Goldman.
Ignoring your body’s needs
Those with orthorexia may find themselves ignoring cues from their body about what they truly need to function. Instead, they eat what they think is healthiest, even if that’s not what they want.
Having rigid rules
Rigid rules with food can be a sign of orthorexia or other disordered eating patterns. For example, having strict eating times with little flexibility, like, “I have to stop eating at 6 PM no matter what,” explains Elizabeth.
Constantly thinking about food
If you’re spending a lot of time thinking about food, researching food, reading food labels, etc., you may want to examine your relationship with food. “There’s a difference between being mindful and scanning a food label and it taking up so much of your time that it consumes your day and your thoughts,” says Dr. Goldman.
Food restriction
Restricting foods that are not deemed ‘healthy’ and eliminating whole food groups like carbs, sugars and fats from one’s diet can be signs of orthorexia. Additionally, refusing to eat anything processed, even if it’s the only food available, or refusing to eat anything deemed “unhealthy,” even if it’s a food you want or like, can also be signs that there is an issue, notes Elizabeth.
Malnutrition
Noticeable malnutrition and getting physically ill more often can be a scary warning sign. “When you start to limit foods or limit the variety of foods one is eating, you may not get all of the nourishment you and your body need to function,” explains Dr. Goldman.
Feeling shame and guilt
Feeling shame or guilt is a common throughline of many different disordered eating patterns, and orthorexia is no different. Dr. Goldman notes that for someone with orthorexia, shame and guilt too often creep in when one deviates from their perceived “healthy diet.”
Noticing an impact on your social life
“If one’s food choices and behaviors cause distress and impact other areas of their life,” that’s an issue, says Dr. Goldman. “This type of eating may be so restrictive that individuals start canceling plans or not eating while out.”
Skipping social events because of the food being served, always eating before going to restaurants in case the food isn’t prepared in the ‘healthiest’ ways and fear of eating foods you didn’t cook yourself or foods you deem to be unhealthy, can lead to isolation and loneliness that only further compounds the issues, says Elizabeth.
What to do if you think you’re experiencing orthorexia or other disordered eating
“If you think you may have orthorexia or are concerned about your relationship with food, your eating or your body, it can be helpful to seek professional help. If you’re questioning if you should seek professional help, it’s typically a good sign to do so,” says Dr. Goldman. Seeking support from a specialized expert can help you heal much faster than on your own.
If it’s easier, Dr. Goldman says you can begin by talking to the medical provider that you feel comfortable with, especially if you believe your food choices have impacted your physical health or you feel malnourished. However, she also recommends finding a therapist who specializes in disordered eating behaviors and has CBT training. “Techniques like behavior modification, cognitive restructuring/reframing, and exposure and response prevention (slowly starting to incorporate additional food groups and a variety of foods back into your diet), are helpful for individuals struggling with these symptoms,” explains Dr. Goldman.
Elizabeth notes that the subconscious root reason someone develops orthorexia might go deeper than the food. Orthorexia often develops because of “people’s relationship with control and perfectionism, not necessarily because of food.” So, you’ll want to ensure you speak with a qualified professional who considers all aspects of your mental health.
“This is why I always have my clients start healing their relationships with food by rewiring how they think about control and perfection. When you feel out of control in life, it’s very common to start controlling and hyperfixating on your food choices since it’s one thing you ‘can’ control,” says Elizabeth. “By healing your relationship with control, you’ll feel more grounded and regulated, and you won’t need to control food to feel safe. It’s important to heal the root cause of your orthorexia before eating the foods you’re scared of.” Elizabeth notes that she often sees people jump straight into changing their eating habits without undergoing deeper subconscious healing first. She warns that this can potentially re-trigger someone since the root cause hasn’t been addressed.
