I recently attended a webinar called “When ‘Healthy Eating’ Goes Too Far: An Overview of Orthorexia & Disordered Eating” hosted by BALANCE eating disorder treatment center. With a basic knowledge of (and sadly a strong identification with) this particular type of disordered eating, I wanted to learn more about how healthy eating can tip the scales toward dangerous behaviors and how it can be treated.

See below for a summary of what I learned.

What is orthorexia nervosa?

First coined in 1997, orthorexia nervosa (ON) is defined as an unhealthy obsession with otherwise healthy eating and is based on patterns of extreme diets intended for health reasons.

With today’s abundance of dietary restrictions, emerging allergies to certain ingredients, and elimination diets, it can be difficult to notice when a fixation on healthy eating crosses the line into disordered behaviors that can have lasting negative consequences on the body.

Normal eating vs. disordered eating

Because of the blurred lines between normal eating, disordered eating, and a full-blown eating disorder, it’s hard to pinpoint the moment your daily habits become problematic. Here are a few signs and symptoms that can help you discern whether your dietary regimen is venturing into harmful territory.

Diagnostic criteria for orthorexia nervosa

Although not officially recognized by the DSM-5 (yet), here are 6 basic criteria that clinicians use to diagnose orthorexia nervosa.

• An obsession or preoccupation with eating “healthy foods” focusing on the quality and composition of food

• Two or more of the following:

  • Consuming a nutritionally unbalanced diet owing to preoccupying beliefs about food quality

  • Preoccupation and worries about eating impure or unhealthy foods

  • Rigid avoidance of foods believed by the individual to be “unhealthy”

  • Spending excessive amounts of time (3 hours per day or more) researching food

  • Feeling guilty about transgressions when “unhealthy food'“ is consumed

  • Intolerance to others’ food beliefs, food shaming

  • Spending excessive money on foods that meet the individual’s criteria for health, purity, etc. (e.g., buying only organic food)

• The obsession impairs health, social life, academic life, daily functioning

• The traits above are NOT associated with traits of obsessive-compulsive disorder (OCD) or other psychotic disorder

• The traits above are NOT related to any religious beliefs or food allergies

Orthorexia nervosa vs. anorexia nervosa

The signs and symptoms of orthorexia nervosa may seem similar to those of anorexia nervosa given that both eating disorders involve extreme restriction and resulting guilt if the rules the individual has set for themselves are broken.

Orthorexia nervosa can be a risk factor for anorexia nervosa, meaning that it can progress into a real fixation on calories and body image.

Treatment for orthorexia nervosa

Orthorexia nervosa can be treated using some (or all) of the following methods:

1. Treating existing malnutrition - Caloric restoration, ensuring the individual is consuming adequate vitamins and nutrients

2. Exposure and response prevention therapy (ERP) for “unsafe” foods

3. Psychotherapy - To help the individual explore why, when, and how these fears and fixations may have begun

4. IF NECESSARY: Anti-anxiety medication

I hope this helps clears up any confusion or misconceptions surrounding orthorexia nervosa. If you think I’ve missed something, let me know.

If you or someone you know may be struggling with food and/or body image, visit the Rules & Resources page to find support near you.