Orthorexia nervosa: when clean eating goes too far

Disordered eating focused on extreme healthy eating has been on the rise in recent years, researchers have found. The disorder, known as orthorexia, lacks a formal designation in the Diagnostic and Statistical Manual, but experts are saying that symptoms are increasingly common, especially as ultra-healthy eating gains ground on social media.

What is orthorexia nervosa?

The term orthorexia (which combines orthos, "right," and -orexia, "appetite" to mean "righteous eating") was coined in 1997 by physician Steven Bratman in response to his patients who were "driving themselves crazy" with their eating habits. His work labelled two stages of orthorexia: "Healthy orthorexia, with an interest in healthy eating with no pathological features, and orthorexia nervosa, with an obsessive focus on healthy eating," said The Washington Post. Many people are "able to eat healthy without being orthorexic," Bratman said. "The difference is the obsessiveness and restriction that causes harm."

Although being concerned with the "nutritional quality of the food you eat isn't a problem in and of itself," people who have orthorexia "become so fixated on so-called 'healthy eating' that they actually damage their own well-being" and experience consequences such as "malnutrition and/or impairment of psychosocial functioning," said the National Eating Disorders Association. Without formal diagnostic criteria, it's "difficult to get an estimate on precisely how many people have orthorexia" and whether it is "a stand-alone eating disorder, a type of existing eating disorder like anorexia nervosa, or a form of obsessive-compulsive disorder."

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Even without the formal designation, there has been "increased awareness" and the disorder is "being identified and treated — when in the past it was getting misdiagnosed or even missed completely," said Samantha DeCaro, the director of clinical outreach and education at the Renfrew Center in Philadelphia, to Everyday Health. Currently, there is no research supporting the use of medications or drugs to treat orthorexia, but "addressing other co-occurring diagnoses with medication can help," Everyday Health added. "Eating disorders so rarely travel alone," said DeCaro. Medications that address underlying issues such as depression, anxiety, post-traumatic stress disorder or traumatic history can help, but these treatments should be highly individualized.

What is driving the rise in orthorexia symptoms?

Social media is playing a role in perpetuating an upward trend in orthorexia, experts say, although the extent is unclear. It is "hard to tell" if there is an uptick "because we're better at recognizing it, or because of social media," said Jennifer Wildes, a psychiatry professor at the University of Chicago Medicine, to the Post. "Most likely, it's both."

Higher social media use, particularly within online "clean eating" communities, has been linked to increased orthorexia symptoms, said José Francisco López-Gil, a senior researcher in lifestyle medicine at the Universidad de Las Américas, to the Post. The "post-pandemic shifts in eating habits, increased screen time and heightened health anxieties" are also possible factors. There has "always been a relationship between media consumption and perceptions of your body or eating behaviors," said T. Makana Chock, a professor at Syracuse University's Newhouse School of Public Communications, to the outlet. However, social media is "different because it's social," and "humans have a visceral desire to belong to a group, even if it's a group of people we've never met in person."

Between fad diets, the "protein-ification of nearly everything," and new wearable technology that "tracks all kinds of biometrics," it's "easy to get swept up in the health-obsession craze," said HuffPost. "Videos all over social media in which people refer to certain foods as 'bad' or containing 'fake ingredients'" have helped to "fuel a societal infatuation with 'eating healthy.'"

If you feel like your preoccupation with healthy eating might be a problem, it's "important to talk to somebody like a dietitian who specializes in disordered eating" or a "therapist who specializes in it," said Beth Auguste, a maternal wellness dietitian, to HuffPost. You can recover from orthorexia "if you have the right support," registered dietitian Beth Heise said to the outlet. "So, as soon as you feel those feelings, address it as early as possible so that it doesn't turn into something that rules your life."