Adolescent Girls and Orthorexia

One of the most disturbing manifestations of orthorexia is its common occurrence among girls in early adolescence. A high percentage of the personal communications I receive on this blog involve such young women and their distressed parents. At the fragile physical onset of puberty, these girls are following “healthy food diets” that amount to starvation.

A frequent entry point for orthorexia in this group is ethical veganism. This is a philosophy with much to admire and naturally appeals to any idealistic person. Unfortunately, in a young women this noble impulse can combine with others that are less benign to create an eating disorder.

Perhaps the most powerful complicating factor is simply weight. Veganism (especially of the raw foods variety) just so happens to involve foods that are low in caloric density. A young vegan while only intending to eat healthy and spare animals pain can easily drop her weight to subnormal or dangerous levels. As soon as she does so, she notices (whether consciously or not) that she looks like the excessively thin female images that dominate in the culture. This is emotional heroin.

But it is heroin acting unconsciously. The young women I am talking about do not think much if at all about their weight. It’s all about health. Consciously, they want to become a perfect physical specimen, immune to health problems big and small, whether bloating, or fatigue or leukemia. Deeper within, they are trying to control something that can’t be controlled, the messiness of being human.

Health foodism presents an attractive solution. By concentrating all their attention on food (and perhaps exercise) they can escape the horrible complexities of life.

But food is too small a thing to bear so much soul; these young women take the power that by right belongs to them and give it away to food.  That’s practically the definition of an eating disorder.

Also, fasting makes you high. Fruit and vegetable smoothies are so luminous and pure that they seem to feel the body with radiant health. These girls feel fantastic; their intuition doe not tell them that they are starving themselves to death.

To make matters even more complicated, a part of the teenage girl’s mind wants to starve herself to death; wants, at least, to engage in some desperate self-deprivation. She also wants to be different, special and better. Being a teenage girl is hideously hard.

And she has practically no idea what she is truly feeling. That type of insight only comes to us after another decade or more of screwing up.

Even if she did have the insight, her brain is malnourished and not working properly.

She is in deep water.


Health Food Book Responsibility

The authors of health food books bear some responsibility. Young readers (like readers of any age) tend to believe that because an idea is published it has a greater likelihood of being true. But there is no filter, no requirement of accuracy required for a book to be published. People can write whatever they want.

And they write some seriously crazy things.

One of the most ignorant and harmful (even evil) health food theories I’ve run across states that menstruation is due to impurities in diet. Under the influence of this idea, one young woman with whom I am in contact believes that her amenorrhea may indicate she has attained a higher state of purity. Needless to say, this concept flies in the face of history, biology and common sense. Menstruation is above all things natural — but truly “natural” is messy, scary and often downright weird.  How much emotionally safer it is to pretend it all has to do with impure diet.

I was once the medical director of Prima Publications, a company that published books on alternative medicine. I remember evaluating one book proposal, and phoning the author to complain. “What you write in Chapter 1 — it simply isn’t true,” I said.  I was treated to a long silence before a puzzled voice said, “Yeah. Uh-huh.  I don’t get it. What’s the issue? ”

Of course, conventional medicine is highly imperfect. But at least it has some system for vetting knowledge. The system has many loopholes and failures, but it exists and works to some extent. There is nothing whatsoever to serve this role among alternative diet books. Authors can say anything they want, and people will believe them.

This is especially the case for young people, because alternative health books belong to a paranoid subculture that naturally appeals to person just beginning to learn that authority figures can be totally wrong.

There is, in fact, much to be paranoid about. Big pharma is in fact insidious and dangerous, agribusiness does not in the least have humanity’s best interest at heart, and conventional medicine has made and continues to make many errors. However, in practice what happens that these genuine issues open a door to an unlimited world of imaginary claims, where authors say whatever they want and then shut the door to critique by saying, “Of course they will tell you this is wrong. That’s what they always say.”


Getting Help

It is very difficult for a young girl with orthorexia to even recognize that she has a problem.  But if she does seek help, either at her own initiative or at the instigation of her parents, those she encounters may assume she has anorexia and treat her inappropriately.  For example, they may strongly encourage she consumes “foods” that restore caloric intake such as Boost or Ensure but that, for obvious reasons, will be perceived as refined, processed, chemical-rich and gross. This has a tendency to invalidate the source of the advice for a young person already inclined to distrust that advice.

I earnestly implore eating disorder specialists to listen to their patients and recognize the difference between orthorexia and anorexia, so as to be able to provide help that can be received.

If you are a young woman with orthorexia, don’t just listen to me. Seek the insights of other women, just a little older, who have gone through it and come out the other side.  They have learned a lot about themselves in the process, and can tell you what the road looks like from just a bit further on. Here are some names/links.  I intend to add more.

Jordan Younger

Kaila Prins

Maddy Moon

I also encourage you to contact these authors and see if they will talk to you personally. Maybe your story will resonate with them, and they will reach out.

One last thing:  At some level, you know that what I’m writing here is true.  There is just a louder part that has its finger in its ears and is shouting, “No! No! No!”  You don’t know how to sort out these internal arguments yet.

But you will figure it out, because deep down you are whole and sane.  You will find your way through the haunted forest. It won’t be easy, but eventually you will get where you want to be, and things will start making more sense.


Steven Bratman, MD

PS. If you are a young woman who has recovered from orthorexia, and have a podcast or blog you think might be helpful for adolescent girls with this issue, please use the Contact form on this blog to get in touch with me.  I will add it to this page.


4 thoughts on “Adolescent Girls and Orthorexia

  1. Iam parent of a 14 year old daughter and extremely worried about her as reading about orthorexia,Iam convinced she has it .In the past year we have moved house and not living with her dad anymore and her poor grandad passed away so that has brought it on so I will have to see a GP before it gets worse.

  2. Ha! I went in search of the correct spelling, the orthographically correct. Here in Australia, it sounds a bit like ortharexa….so thanks! Why? Oh, I’m studying Naturopathy, and share classes with Nutrition students all of whom are vegan or lacto-vegetarian or Paleo or Ketogenic, etc…I commented that none seemed to be anorexic, and was told (by the lecturer) that they were orthorexic. I guessed the meaning, and so true! It is a word whose time has come. Thank you, Carole in Sydney.

    1. To be precise in the use of the term, people following all these diets are not necessarily orthorexic. They are just diet-believers, no matter how faddish/silly/excessive it might seem to someone who doesn’t share their belief in the urgency of eating like they do. It doesn’t become orthorexia unless an eating disorder develops around their idealization of perfect diet. See

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