On Orthorexia Symptoms: Unpacking The Risks of The “Clean Eating” Craze

In a world saturated with 24/7 amateur cooking shows, drool-worthy Pinterest boards, Instagram feeds, and a continuous, juxtaposing movement towards ‘eating well’ with the infamous ‘don’t forget to treat yo’ self’ mantra, orthorexia symptoms can be hard to miss.

The DSM does not formally recognize orthorexia as a mental illness. However, it’s clear that this condition embodies a dark undercurrent wedged in the chaos of its more famous sisters (anorexia, bulimia, and binge eating disorder).

In fact, orthorexia has its own host of contradictory problems; why should anyone be punished for simply eating healthy?

What is Orthorexia?

In its simplest form, orthorexia refers to the obsession with proper, healthful, and even perfect eating. This isn’t just about following proper nutrition and trying to maintain a healthy, physical body- it’s about themes of control, anxiety, and perfectionism.

Orthorexia symptoms typically include:

• Incessant and compulsive checking of nutrition facts and/or various ingredient lists.
• Obsessive interest in what others are heating.
• Cutting out entire food groups.
• Increasing concerns and anxieties about the health of ingredients.
• Spending large amounts of time thinking and planning about the food provided in future events.
• Experiencing heightened levels of discomfort when foods ‘deemed safe’ are not available.
• Obsessive checking/browsing/following various food social media platforms, blogs, or books.

In general, none of these symptoms alone are inherently ‘bad.’ In fact, in some capacity, these symptoms may even be helpful for physical or psychological health. After all, the CDC endorses that nearly 100 million Americans are clinically obese (that’s about 40% of the entire population). By now, many of us comprehend the health risks, such as cardiovascular disease, Type II Diabetes, strokes, kidney disease, sleep apnea, and fatty liver disease, associated with obesity. With that said, an estimated 45 million Americans report dieting each year.

Again, in this juxtaposing sense, emerging orthorexia symptoms can seem insidious. On the one hand, many argue the importance of eating a well-rounded diet- is it even possible to have too much of a good thing?

The Difference Between Orthorexia and Other Eating Disorders

Many people confuse orthorexia for anorexia. Indeed, they can overlap. Individuals struggling with both disorders often find themselves obsessing over food and nutrition. Both may cut out entire food groups and develop criteria for ‘safe’ vs. ‘unsafe’ foods.

But, let’s digress. The primary focus of anorexia is rooted in weight loss. Thus, the individual becomes consumed with the quantity of what’s being eaten. The primary focus of orthorexia often lies in achieving optimal health. The individual’s main attention is on the quality of food consumed.

With bulimia or binge eating, individuals typically struggle with some variation of restriction (whether intentional or not) –> Bingeing –> Purging (in bulimia). Often, we see an overlay in the restriction efforts with orthorexia. In some cases, those who start out with more orthorexic tendencies can develop a compulsive or binge eating habit (as in, whenever they venture towards the forbidden foods, it becomes an all-or-nothing bender).

Orthorexia comes in all shapes and sizes. There are no weight criteria listed, which can make it an invisible problem.

For this reason, we all need to be aware of the interconnection of eating disorders. It’s very common for people to essentially trade one disordered pattern for another. What starts out as orthorexia can eventually lead to a spiraled path of extreme restriction and dangerous weight loss and/or bingeing, purging.

The Darker Nature of Orthorexia Symptoms

Most people understand the extreme risks of the powerhouse eating disorders that are anorexia nervosa, bulimia nervosa, and binge eating disorder. After all, these symptoms seem more apparent and, well, dangerous.

Again, orthorexia is often wrapped up in a more perfectionist, golden-child image. Orthorexia may be a health-conscious friend who runs a food and cooking blog. Or, it may just be the unassuming individual who wanted to get a better grasp on nutrition- who logically recognized that certain foods may not have the most nutritional value- and the spiraling started from a place built on good and healthy intentions.

Again, orthorexia symptoms are often covert. In fact, many individuals will receive praise and accolades for their habits. Think about it. If you’re on social media, all you need to do is scroll through the hashtags #eatrealfood (2.1 million Instagram posts as of date) or #cleaneating addict (185k current Instagram posts).

PS- in case you were wondering, research shows a linked connection between Instagram use and orthorexia symptoms developing, but is anyone surprised?

But here’s where the darkness lies: when the desire to do something right becomes overshadowed by the burning and increasing need to adhere to more and more rules, there could be a problem.

Orthorexia can look harmless and incredibly healthy.

The Progressive Nature of Orthorexia

Like all eating and compulsive disorders, orthorexia progresses in its severity. What may start out as eliminating refined sugars can evolve into obsessive research about the harmful effects of sugar, avoiding social events that may include the forbidden ingredient, and experiencing heightened distress when you (or others) eat foods containing these properties.

Again, I want to reiterate the nuances. The act of refraining from a particular ingredient, like refined sugars or dairy or meat or gluten, does not represent a standalone problem. It’s the intensity of emotions and the distress it can cause one’s daily functioning that indicates a more layered issue.

If what started out as a ‘good diet’ has become a part-time job without pay, this could be a strong indicator of mental illness developing. We must never forget that mental illness often manifests from a place of excellent intentions. Unfortunately, when good intentions go awry, we’re often stuck feeling ashamed, anxious, depressed, and isolated.

Finding Balance In a World of Extremes

Obvious disclosure: I’m not a registered dietitian or medical doctor. I’m not an expert on nutrition or weight loss or the ABCs of what composes each food. I’m just a concerned therapist who works with a ton of eating disorders, obsessive thinking, and elements of extreme behavior. Oh, and for what’s it worth, I also like eating healthy and taking care of my physical health!

Balance is hard, and finding in a world that likes to polarize the ‘good’ from the ‘bad,’ and the ‘right from the ‘wrong’ can seem impossible. Again, orthorexia becomes nuanced. Nobody is going to argue that vegetables are healthy. Moreover, nobody is going to argue that eating too many cookies can lead to an expanding waistline.

I think it’s important for us to look at other ‘healthier’ passions that can become unhealthy when consumed in excess. What comes to mind? Exercise, work, sex, and technology all come to mind for me. Even if we enjoy and need these things for a balanced life, the key here is that infamous word: balance.

With orthorexia, the balance seems not only impossible, but it also seems dangerous- like a slippery slope ending in a drowning pile of brownies and cheeseburgers. However, the “resolution” for orthorexia typically comes in the form of balance. One must learn to live in a world with triggering situations.

There is a profound difference between refraining from certain foods or dietary habits and being scared or distressed of them. Focusing on nutrition is not the problem. The time, energy, resources, and eventual obsessiveness spent on devoting one’s livelihood to nutrition is the problem.

Balance isn’t just for yogis!

What Does Treatment for Orthorexia Look Like?

Like most other eating disorders, treatment can be complicated, and it largely depends on a variety of factors. For example, it’s always important to consider the level of distress. Is healthy eating getting in the way of socializing or work performance? Is it creating sleep problems or health issues? Do you want to be able to enjoy a bag of chips on occasion without bingeing or spiraling into a vicious cycle of self-deprecation?

Good treatment requires a level of honesty with yourself and with your mental health professional. Again, even the best therapists can mistake good physical health for good mental health. Those with orthorexia often look like ‘superstars,’ those who enjoy making AND completing New Year’s resolutions and daily to-do lists.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy remains a leading contender for eating disorder treatment. With CBT, you can expect to:

• Learn various coping skills to manage symptoms associated with uncomfortable feelings (depression, anxiety, fear).
• Challenge unrealistic or unhelpful thoughts about yourself or the world.
• Learn relaxation strategies.
• Identify the pros/cons of engaging in orthorexic behaviors.
• Better understand core beliefs (i.e. “the world is inherently dangerous) that may maintain orthorexia patterns.

Therapists practicing CBT typically follow a structured focus within sessions. He or she acts as a coach collaborating with you to ensure successful treatment outcomes. Many provide homework assignments to complete between sessions.

Dialectical Behavior Therapy

DBT is another common treatment modality used in psychotherapeutic settings. With DBT, you can expect to:

• Learn how to assess distress tolerance as it arises.
• Practice and implement mindfulness throughout daily living.
• Identify facts from feelings and practice non-judgmental stances towards yourself and others.
• Identify individual needs and inherent rights.

DBT and CBT share many similarities, but I find that DBT has a special edge in eating disorder treatment (probably because I’m a huge fan of radical acceptance and practicing non-judgmental stances).

Expressive Therapies

Therapists may employ numerous interventions in sessions to help intervene and treat orthorexia. These range from Gestalt suggestions (such as empty-chair practices) to art therapy assignments to psychodynamic work.

Any or all of these techniques can help you better identify the nature of orthorexia- and how to break the habits and associations you may struggle to release.

Self-Help Suggestions

I don’t believe all mental illness warrants the need for formal treatment. Sometimes, the first step is an intervention for yourself! I also encourage the following options:

• Limiting or abstaining from triggering social media content.
• Creating attainable goals for expanding eating habits.
• Practicing affirmations for self-confidence and good health.
• Reaching out/sharing your struggles with a trusted friend or source of support.

Orthorexia: Just a Fad or Here To Stay?

We are in an interesting predicament in modern society. While we have more food options and health advice available to us than ever before, we also struggle with climbing rates of obesity and health. As food becomes more of a social and emotional element in daily living, our patterns and behaviors around eating will continue to evolve.