Orthorexia Nervosa: An Emerging Eating Disorder

What is Orthorexia?
By Jason Arnold, PhD, ND

Orthorexia is a proposed eating disorder in which an individual has an unhealthy pre-occupation with “healthy” food. As a diagnosis, it is not recognized by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). An individual with Orthorexia takes “healthy eating” to a very mental and physical extreme. According to Dr. Steven Bratman, MD, an American physician who began seeing patients with these symptoms and coined the term Orthorexia, individuals with Orthorexia are entirely concerned with the types of food and the purity (i.e., none processed, whole food, low fat diets) of the food that he or she puts in their body. That person refines and restricts his or her diet to what they believe is nutritionally pure such as non-processed whole foods or those foods that he would see as being “healthy”. While many people may try to eat a healthy diet, a person who has Orthorexia unfortunately does this to the point where it paradoxically becomes unhealthy both physically, emotionally, and socially. The loss of friendships, emotional well-being, depression, anxiety, the inability to enjoy food, and in severe cases malnutrition and death.

In a recent article in Men’s Health (2018) Dr. Valerie Luxon, a clinical psychologist who specializes in the treatment of eating disorders, noted that there is a higher likelihood of men developing orthorexia due to social expectation of men with respects to health, fitness, and physical aesthetic. Social pressures lead to feelings of anxiety and vulnerability, which may prompt men to engage in healthy eating which, in turn,  can lead to extreme behaviors.

What is the treatment for Orthorexia?

While no empirically-supported treatment protocols exist for Orthorexia, treatment could be similar to the treatment of other eating disorders such as Anorexia Nervosa and Bulimia Nervosa. This could include individual therapy, medication management (if needed) as well as regularly meeting with a Registered Dietician. Similar to empirically established treatments for eating disorders, cognitive behavioral treatment strategies may be helpful for addressing thoughts around “healthy” foods.”  Other techniques could also focus on target behaviors and modifying them with emotional support including challenging patients to eating a food that they believe would be “less healthy” and then process the emotions the person is feeling and the cognitive distortions he may feel. Finally, working with a Registered Dietician to develop a meal plan that includes sensible healthy choices for meals that will provide the appropriate amount of nourishment that an individual’s body needs, not only for nutrition, but for recovery.

Where do I start?

Firstly, everyone is deserving of recovery. It can be scary to begin any type of mental health treatment. People may feel alone and overwhelmed. Many people have struggled with eating disorders and many know that recovery is possible because they have gone through this process. If you are not sure where to start and do not currently have a therapist or psychiatric prescriber, it may be helpful to talk to your Primary Care Physician about your concerns and seek out information on specialized treatment options, as described below. If you are a parent whose son is struggling with what you suspect is Orthorexia, address these concerns directly. Your doctor can often times refer you to a prescriber or therapist for further evaluation. If you would like more information on orthorexia and eating disorders more broadly, including finding treatment providers in your area, you can go to the National Eating Disorders Association (https://www.nationaleatingdisorders.org/find-treatment/treatment-and-support-groups), Eating Disorders Hope (https://www.eatingdisorderhope.com/treatment-for-eating-disorders/therapists-specialists), Academy for Eating Disorders (https://www.aedweb.org/learn/resources/patient-carers). These organizations have a wealth of information on local providers as well as support groups for those in recovery as well as families.
Again, taking the first step can be the most-anxiety provoking. But remember you and your life are worth recovery.

Be well.

The Futility of Comparisons

By Justin Mazza

All my life my I have been involved in some sort of organized physical activity and developed a competitive nature; from baseball and basketball to soccer and martial arts- I have constantly been involved in a structured sport activity. Growing up and being one of the heavier kids on these teams, I learned to use my size and strength to my advantage, especially in martial arts where I dominated my competition year after year. I won 4 national fighting championships and felt on top of the world. I embraced my size because it helped me rise to the top of my competition.

Then at 19 it all shifted when I made the decision to step away from martial arts and focus on college. I remained somewhat active but nothing as compared to my previous activities. I gained some weight in a few months of starting college and felt my size wasn’t doing anything for me anymore. It no longer provided me with a competitive advantage considering I wasn’t fighting anymore. At that time, I decided to lose weight and started to develop an eating disorder. It started with trying one change to my diet, then another, and another until it spun out of control and I was doing 5 different diets at once. In addition to that, I decided to join a gym and long cardio sessions 6 days a week.

I started comparing myself to the other men at the gym- some were “bigger” than me and others were “smaller” than me. I wanted to be smaller than what I was and ended up dropping a significant amount of weight. I was finally looking like the skinner men at the gym but being that way didn’t make me happy. It didn’t give me any sense of accomplishment where I thought it would. Now that I was “smaller”, I looked at the more muscular men who were much bigger than me and now wanted that! I went from wanting to be small to now wanted to be large- how could this be?

Now in my third year of outpatient recovery and 25 years old, my entire mentality has started to change. Since I lost all that weight so quickly at a muscular developing age, my bone structure is wide especially around my hips and shoulders. I used to think of this as I look “big” but now I embrace it as part of my journey. I now look at other men- some who are “smaller” than me and others who are “bigger” than me and no longer compare myself to them. I no longer say I want to look like that. I am focused on my own health and what my body needs to be happy, not what others look like as compared to myself. I even have men and women compliment my “big” shoulders that I used to be self-conscience about. Its amazing looking back at my recovery journey from where I was to where I am now. I am so excited to see the future of my recovery and hope to help others in their own recovery journey.

It’s Time to Talk About ARFID

By Anne Bouchard

Our family has a son with an eating disorder. He’s had it since the age of three, and his condition has not really changed. We found out by accident that he had a food allergy to peanuts (and tree nuts), which happened even earlier than the eating disorder. Certainly, having a food allergy makes the cautiousness around foods – especially “new foods” – even more present.

Though the years have not brought big changes to our son’s eating disorder (he is almost 15, and is still allergic and highly selective with foods), we know that eating disorders are not caused by individuals or circumstances: No one is to blame. 

Aversion to trying new foods was something we noticed in our boy as early as the feeding years. People still ask us how long his condition has existed and we still answer, “Since we can recall.” It’s been a long time.

We’d share our experiences and concerns with family, friends, and medical experts, though our explanations and observations were often dismissed. Most reassured us the “picky eating” was just a phase. We felt dismissed and alone in our quest for answers about the definite feeding limitations. It was clear to us that something was not being acknowledged.

Over time, we’ve learned to listen to our “gut feeling” and to advocate for what we are experiencing and for what we need. We never received an actual diagnosis for our son. We accept this, though we hope other families may be heard and believed to get the needed help early on.

Our son is almost 15 now, and he still has the eating disorder. Luckily, there’s a diagnosis that’s finally made it into the DSM-5, and that means a lot. The condition used to be called Selective Eating Disorder (SED) and is now officially Avoidant Restrictive Food Intake Disorder (ARFID).  It’s a longer name, but it seems more accurate in describing the often early onset of the disorder (during the feeding years).

We still continue to explain the disorder and refer professionals and anyone else to look up the name and condition, accept it as an actual disorder, and gain awareness about its existence.  This is key for families like mine who were dismissed for too long. Recognize and diagnose; accept it and treat it. We accept that a disorder is not a choice and so a big part of our efforts is to make that known to more people. Let’s inform and inspire. It’s Time to Talk About It!  

Like all disorders, an eating disorder is not a choice. Our son did not choose to have a disorder, yet he accepts and manages it one day at a time. We’re impressed by his wit, his positive attitude on life, his supportive friends, and his performance at school and on the soccer field.  He’s developing well despite the limited selection of foods. He’s physically and mentally fit and has the endurance needed to excel at competitive “travel” soccer. In fact, he plays overseas as part of international tournaments. What to eat and what to bring to those trips can be challenging, but the boy with ARFID is undeterred!

After all these years, his diet is still limited and consists mostly of dried and packaged snacks.  Favorite foods remain the crunchy, dried type like potato chips, pretzels, bread sticks, fries, and mostly brand name snacks. Preferred foods are classic finger foods.

As for treatment, we’ve seen allergists, specialists at nationally-renowned centers for eating disorders (teams of occupational therapists, researchers and psychotherapists). Maybe anxiety experts can help. We’ve also explored hypnotherapists, though we have yet to work out a match with someone in our area (Maryland). We’re basically not giving up, though “new food adventures,” eating together as a family, and seeing improved eating are not yet regular happenings in our life.

We don’t push and we don’t give up.  We are here to listen, encourage, and withhold judgment regarding a disorder that is real yet still not well-understood. What’s hopeful is to see that our son is thriving in so many ways and is not showing major concerns about how he will manage ARFID in the future.  Gotta love that!

Anne Bouchard is a proud advocate for the National Eating Disorders Association (NEDA), and an active fundraiser for programs and services specific to eating disorders (especially ARFID).  She’s a parent, spouse, former media advertising professional, and current substitute teacher in Maryland.  She lives with her husband, son, and teen daughter in Maryland. Anne continues to advocate for ARFID awareness and treatments. Her fundraising page for ARFID is here.


Society for Adolescent Health and Medicine. Published by Elsevier Inc., copyr. 2014.

Google Alerts- Anyone can subscribe to getting these.  I get alerts for anything coming up on Selective Eating Disorder (SED) since that is the earlier name for ARFID.

Diagnostic and Statistical Manual 5th edition (DSM-5)

Learn more about the symptoms, warning signs, and health consequences of ARFID here.


This piece originally appeared on the National Eating Disorders Association’s blog.