Healthy Eating is Everywhere. When Does It Cross the Line to Orthorexia?
Photo by Farhad Ibrahimzade via Unsplash
Content Warning: This blog contains information about eating disorders.
For the most part, our society has evolved from the old-school diet culture that encouraged things like diet pills, severe calorie restriction, or strange fads like cabbage soup. Nowadays you’re more likely to hear about “clean eating,” which can sound pretty healthy and balanced — but is it really?
Whether it’s Whole 30, Paleo, or the recent raw milk craze, it’s easy to assume that thinking more about the quality of your food is the right thing to do, especially if you’ve struggled with weight, stress, fatigue, or sleep disturbances that have been blamed on processed foods. But I’ve noticed that the narrative has gradually shifted from just awareness of quality to more of a fixation, and for some, even an obsession.
There’s a name for that: orthorexia. And research shows that it may be way more common than anorexia, bulimia, or other eating disorders that you’ve probably heard more about.
Orthorexia is the hyper-fixation on the quality of one's food – as opposed to the quantity which is typical of anorexia, binge eating, or bulimia. Of course, eating organic, clean, or whole foods isn’t always a problem. Being mindful of the quality of your food can help you achieve a balanced intake of good nutrients and vitamins. But everyone’s relationship with food is different, and for some, a hyper-fixation can cause significant emotional and mental distress.
“But everyone’s relationship with food is different, and for some, a hyper-fixation can cause significant emotional and mental distress.”
Some people are more susceptible to orthorexia if they have obsessive-compulsive disorder, struggle with perfectionism, are athletes or fitness practitioners, or were raised by parents who placed an extreme importance on food. A recent meta-analysis showed that 28% of people in the studies met the criteria for orthorexia, with the rates increasing over the years.
Warning Signs of Orthorexia
Orthorexia is complicated to identify because these tendencies of “clean eating” don’t necessarily look problematic on paper. To a non-eating disorder specialist, it can seem like you’re taking your health very seriously. But just because it sounds healthy, doesn’t mean there’s actually a healthy relationship with food present.
Some common signs that orthorexic tendencies have become a problem include:
Inability to focus due to thoughts about food and the quality of the food
Anxiety related to food
Depression or guilt when consuming “unclean” foods
Inability to eat anything other than a narrow group of food items and an overwhelming concern with the quality and health of ingredients in food
Disruptions to one’s daily life due to food concerns
Impact on social relationships
In my work as an eating disorder specialist, I’ve seen these restrictive behaviors create other eating disorder behaviors like over-exercising, binge eating disorder (eating a large amount of food in a short amount of time and feel you can't control what or how much you are eating), and even purging disorder like bulimia.
Although orthorexia isn't officially listed as a separate disorder in the Diagnostic and Statistical Manual of Mental Disorders, experts in eating disorders widely recognize it. Unfortunately, without the standing of a formal diagnosis, people may not be as aware of it as they are of other eating disorders. This makes it especially important to be familiar with the signs of orthorexia.
How to Cope with Orthorexia
There’s so much information out there about diets. It can be incredibly confusing to decide what to trust. Research has shown that higher Instagram use was associated with a greater tendency towards orthorexia, with no other social media channel having this effect. It can be infinitely challenging to filter out the good advice from damaging advice.
In my practice, I’ve found that focusing on the following can help combat orthorexic tendencies:
Learn to Spot Inflexibility
Staying away from any programs like the 75 Hard Challenge, articles, or influencers who don’t highlight flexibility. When I’m working with clients who are dealing with disordered eating, I like to focus on the importance of flexibility. If you have a flexible relationship with food, you can change things up as needed.
Rigid relationships with food can cause an undue, preoccupied, and obsessive relationship with food that can cause mental and emotional distress.
Carry the Trio With You
The only thing you should eliminate are binary labels like "good" or "bad." Instead, focus on the healing trio: balance, variety, and moderation. If you’re able to approach food with the basic premise of “all foods fit in balance, variety, and moderation,” you’re more likely to practice flexibility than rigidity. The important thing to remember is that you need all three. You can’t practice moderation without balance and variety, balance without moderation and variety, and variety without balance and moderation.
When In Doubt, Seek Therapy
If the tendencies are causing mental distress, disruptions to daily life, anxiety, depression, withdrawal or development/enhancement of other eating disorder behaviors, you may want to consider seeking additional support from a therapist who specializes in eating disorders.
Therapists who specialize in eating disorders are trained to identify maladaptive thought patterns and behaviors and gently point out how those might be harming rather than enhancing someone’s activities of daily life. An eating disorder specialist can support you in introducing more variety, balance and moderation while practicing flexibility and provide the tools needed to manage any anxiety or depression that might arise while you are doing so. Eating disorder specialists also have a wealth of resources they can provide so you don’t have to feel like you are alone in the recovery process which in turn helps with any internal feelings of shame and/or embarrassment.
TJ Mocci, LMFT, specializes in eating disorders, anxiety, and phobias. She has over a decade of experience working within the eating disorder community and has supported hundreds of clients in their eating disorder recovery journey.
If you think you might suffer from orthorexia, Octave has dozens of therapists trained to support you and your unique needs.
More Resources
In addition to therapists at Octave who can support eating disorder recovery, here are some great resources:
NEDA - Find Treatment
The National Eating Disorders Association (NEDA) is the largest nonprofit organization dedicated to supporting individuals and families affected by eating disorders. NEDA supports individuals and families affected by eating disorders and serves as a catalyst for prevention, cures, and access to quality care.
Crisis Text Line - Helpline
Crisis Text Line provides free, 24/7, high-quality text-based mental health support and crisis intervention by empowering a community of trained volunteers to support people in their moments of need.
Project HEAL - Treatment Access
Project HEAL’s goal is to break down barriers to treatment to give every person a shot at recovery. Their programs help people with eating disorders get the care they need and have been repeatedly denied.