Anxiety and Orthorexia

People who want to eat healthy food don’t become orthorexic unless there is something deeper going on. Often, that deeper something is best described as anxiety.

The most obvious anxiety related to orthorexia is fear of illness. You want to believe that if you are very careful with what you eat, you will be safe from every health problem that scares you, whether its cancer, bloating, blemished skin or depression. But it goes further than that. Whether you are conscious of it or not, somewhere along the line you began to use food as a primary strategy to fend off every kind of anxiety. When you are stressed about relationships, your job, the purpose of life or what your friends think of you; when it is guilt, shame, love or loss that has put you off balance, the magic cure is to eat pure food.

Deep down, you know perfectly well this is a lie you tell yourself in order to cope. While food is important for health, the slice of pizza you eat today is NOT going to give you cancer tomorrow, nor will eating the best diet in the world immunize you against illness. Furthermore, diet cannot give you love, friendship, meaning or happiness. Food, in the end, is just stuff you put in your mouth.  

One residential treatment program for orthorexia I recently heard about uses a clever strategy to help people understand how they use food to fend off all forms of anxiety. In this program, the food is served by a chef closely advised by dietitians. The rules of the game are that the chef may not under any circumstances reveal whether the food served in a given meal is organic or not, whether it has preservatives, contains GMOs, etc. In point of fact, the food served in the program is mostly organic and chemical-free, but not 100% of the time, and there is no way for the people who eat the food to know when they are consuming substances that their theory of eating would forbid. (People in the program also keep a journal of how they feel, and it turns out that they do NOT guess correctly when they have eaten “impure” food.)

As you might imagine, for a person with orthorexia this is extremely anxiety-provoking. Not only does it stimulate food-related worries, it removes the possibility of using food purity as a coping mechanism against other forms of worry. And that is the real point: The experience forces participants to begin to develop a range of ways to cope with daily stress, rather than abusing food purity as the answer to every problem. 

You might object that it is truly rational to be concerned about food additives, whether vegetables are organic, and etc. Wouldn’t any sane person would want to eat healthy food? Perhaps yes. But no matter what dietary rule you believe to be correct, it simply can’t be necessary from a health-related perspective to follow it without exception. The quantity of pesticides contained in a single serving of non-organic food is dwarfed by the quantity of chemicals taken in simply by living and breathing in the modern world. You focus on food because it’s something you can control. And that’s perfectly sensible — but only to a point. Past that point further purification of your diet won’t make you healthier; it will only make you more obsessive.

A mostly “pure” diet is good enough. Aiming for 100% is only an excuse not to come to terms with the elephant in the room: Life, in all its messy glory.

— Steven Bratman, MD, MPH

To contact me, leave a comment, or find me on Twitter @StevenBratman

10 thoughts on “Anxiety and Orthorexia

  1. Is there any correlation between stress induced Reactive Hypoglycaemia and orthorexia? MY daughter, always over particular about content of skin products and food content, went into metabolic overdrive after she Burnt out writing up her Sport and e Exercise related PhD and we grappled with her new dietary needs for RHG. Her weight, appearance and behaviour towards the exotic foods she craves and what she excludes, four years on, controls her and worries me and most of those who know her. She shrugs it off and refuses to say her weight …but then she always refused to admit she is 6 foot tall. She understands food science more than me so is always able to give me advice but won’t accept it unless she has researched it.

  2. Thank you, Dr. Bratman. My family and I have sadly and helplessly been watching a beloved daughter/sister who suffers from anxiety progress steadily down this path; from yoga to “clean eating”, to cleansing/fasting, to gluten-free/low fat/no fat/only organic/no gmo food. Regardless, she was diagnosed with breast cancer (stage I) nearly 3 years ago and would only go the alternative route (no “western medicine” approach for her)! After opting for a double mastectomy because of her self-professed certainty of recurrence (with subsequent severe complications from reconstruction), subsequent redo of the reconstruction and, finally, healing. She is now convinced that the only way to stave off recurrence and/or metastasis is through even healthier eating and supplements. She has subsequently gone from alternative practitioner to alternative practitioner – believing that Research Genetic Cancer Center (RGCG) in Greece is the only trustworthy viable and true test. She has also undergone thermography in the hope of highlighting areas of real or possible metastasis (thus far nonexistent – but which she is sure will materialize if she strays. And she does not consider herself a cancer survivor but a cancer sufferer. She is in the process of using coffee enemas and myriad nutritional supplements in an attempt to fight the cancer and keep it at bay along with her dietary regimen. Three alternative physicians have told her that her stress, anxiety and lack of sleep will do more to cause her a cancer recurrence than all the right eating in the world will achieve in staving it off. Everything now revolves around her diet and her prior cancer diagnosis. We have tried speaking to her, to no avail. Her response was to cite an article in and state: “Well, I am sure that there are many friends and family who believe I should be diagnosed with this ‘new’ mental disorder …
    ya know what – I’ll happily take on the diagnosis!!” This ultimately took me to your site and i have now familiarized myself with “orthorexia.” Thank you for clarifying – knowing we are not alone is somewhat helpful. My question is, do you know of a support group or blog for family members of those suffering from this disorder where we can find support. My sister appears to be like the alcoholic or addict – she refuses to admit to a problem or see how this is negatively impacting her (and those of us who love her) and, thus continues down this sad path. Any help or info is greatly appreciated!

  3. Your article has provided me with a huge insight to the issues that I am encountering. The traits and characteristics of orthorexia are parallel to my husbands behaviour. We are on the verge of separating because of his “healthy food” observation and today I find out that this is medical recognised issue. Orthorexia is the mistress of our marriage and I do not know what to do? If I showed this article to my husband he would dismiss this entirely and would never admit to having this condition which is attributed to his need for perfection at all times. Where can I please seek help/advise??

  4. Dear Dr Bratman,
    thank you for this article (and all the other ones). Recently I realized that in the last few months I’ve been more and more obsessed with healty food. Reading your article made me think about anxiety and perfection. I believe the reason for my obsession is probably the pressure I always feel to be perfect in every aspect of life.
    Thank you for reminding me of “the messy glory” of life.

  5. Hei Steven,
    Im a norwegian psychology student doing my thesis on orthorexia. In Norway there are almost no focus on eating disorders on the institute of psychology, in which I think is critical cause of the growing unhealthy body image focus in my country. Among young people (specially girls), there are lots focus on diets and muscle building in which has exploded the last years.

    According to the growing problem of eating and body disturbances I find it really interesting to discuss whether orthorexia are supposed to be an official concept of a diagnosis in DSM-IV/ICD-10 or a not so healthy trend in western society. I find it interesting to see how the society shapes the needs and perception of human being and specially how to control and cope with life using food and training as a tool. Then I wonder about your comments on this. The drawback of making a new diagnosis is i.e. making people more ill then they are, at the same time it is maybe necessary to get a diagnosis to treat people properly whilst they are in healthcare.
    Then I wonder if you’ve got some comments about this or could possibly help me to find some articles and so on in which could be necessary for my thesis?
    Sincerely Liv

  6. Dear Dr. Bratman, my 20 daughter has orthorexia. It all started out last winter when she was leaving in London on her own, and she simultaneously got a personal trainer and started select healthy food, completely avoiding carbohydrates, fat and sweets.
    The training she chose was pretty hard and on top of that she used to walk around London for kilometres almost every day. She has never been fat before this crazy change of habits. I only realized that at the end of May when she got back to Italy. Although I’ve already tried to take her to a psychologist-orthorexia expert- the problem is still there. As we’ll be moving to London for three years could you please suggest me the very best specialist there, before the situation would get worse and more dangerous ? She is already 4 kg under the lowest range of the BMI. Many thanks Sissi

  7. Hey Steven, thank you for this article. I have been struggling with orthorexia and am looking for advice about how to just eat normally and intuitively without obsessing. In 9th grade, having seen Food Inc., my whole perspective about food has changed. I am right now vegetarian but feel an imbalance because it seems to be driven by a fear of harming or eating animals from watching how poorly they are treated in captivity. All in all, the diet and the orthorexia is an escape from dealing with my fears within life and living a social more productive existence in general. Thank you again and take care.

    Steven Kovachev

  8. Oh my goodness, I knew I wasn’t anorexic as some people claimed, but I think I tick every box here. The thing that is missing, is the impact in my stomach, if I try and eat something ‘unhealthy’ such as a marshmallow, I feel sick 5minutes later, and so decide I am intolerant and throw the rest away. I can’t establish if this is a consequence of the viral gastroenteritus I have now had twice in the last 6 months, or if it is all in my head.
    I have a high level of education, have a stressful job, and don’t think I am stupid. I just can’t work out if I am leading a healthy lifestyle in this world of junk food, or if I have a condition such as this that will require help and support.
    I live in the UK, any ideas as to how I can sort this out?

    1. It is probably complicated, a combination of a sensitive stomach and a lot of ideation around food that compounds the former. I will email you.

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