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.