What is Orthorexia?

Orthorexia nervosa, as I defined it in 1996, indicates an unhealthy obsession with eating healthy food. The term is derived utilizing the Greek “ortho,” which means “right,” or “correct,” and is intended as a parallel with anorexia nervosa. I originally invented the word as a kind of “tease therapy” for my overly diet-obsessed patients.  Over time, however, I came to understand that the term identifies a genuine eating disorder.

Please note that I do not, and have never claimed that vegetarianism, veganism, or any other nutritionally sound approach to eating healthy food is in itself a disorder. That would be absurd! Nor do I think that people who pay very close attention to labels on the foods they mean to purchase are demonstrating a psychological problem (as some web articles on orthorexia would appear to imply.) Finally, I entirely agree that the problem of addiction to junk food is immensely more prevalent than obsession with healthy food.

Nonetheless, it is possible to have an unhealthy obsession with healthy food.

Anorexia is the parallel.  Obesity is by far the biggest lifestyle-related health issue today, and every reasonably health-conscious person does what is necessary to achieve and maintain a normal BMI.  But for various psychological reasons some people go overboard and become anorexic.  Similarly, any reasonably health conscious person would wish to minimize intake of the preservatives, pesticides, antibiotics and other garbage that pollute our food supply and choose healthier food. However, some people who are devoted to healthy eating go overboard and develop an eating disorder in relation to that focus, just as some people in their quest to avoid obesity become anorexic.

For people with orthorexia, eating healthily has become an extreme, obsessive, painful, psychologically limiting and sometimes  physically dangerous disorder, reminiscent of but quite distinct from anorexia. Often, orthorexia seems to have elements of OCD.  Some people with orthorexia may also have a touch of anorexia. But orthorexia is often not very much like typical OCD or typical anorexia.  It is usually only a psychological problem, but in rare cases it can be much more severe, even resulting in death via malnutrition.

The primary feature distinguishing orthorexia from anorexia is that while a person with anorexia focuses on weight, a person with othorexia obsesses about purity.  Anorexia involves a desire to reduce food intake while orthorexia invokes the desire to cleanse. Both are about control, but whereas an anorexic wants to control body fat, an orthorexic wants to achieve dietary perfection.

Orthorexia is not yet a DSM diagnosis, and I am not sure that it should be.  There is a tendency in the modern world to pathologize an increasing number of human behaviors and I have no desire to contribute to this trend. On the other hand, naming has power.  I have heard people say, “I want to eat healthfully, but I don’t want to be orthorexic.” Perhaps this is the best possible use of the word.

Do you have orthorexia?  Ask yourselves these questions: Do you turn to healthy food as a primary source of happiness and meaning? Does your diet make you feel better than other people? Does it interfere with relationships? Do you use pure foods as a sword and shield to ward off anxiety, not just about health problems but about everything that makes you insecure? Do foods help you feel in control more than really makes sense? Do you have to carry your diet to further and further extremes to provide the same kick? If you stray even minimally from your chosen diet, do you feel a compulsive need to cleanse? Has your interest in healthy food expanded past reasonable boundaries to become a kind of brain parasite, controlling your life rather than furthering your goals?

Food, no matter how pure, cannot fill the space in your soul that longs for love and spiritual experience. If you are trying to use it for this purpose, you may have gone astray on your journey.

Perhaps the resources on this site may be helpful. You might consider reading my somewhat dated but entertaining book, Health Food Junkies. But most of all, if you feel your condition has become too much for you, visit an eating disorder specialist who understands orthorexia.

Sincerely,

Steven Bratman, MD