Orthorexia nervosa, as I defined it in 1996, indicates an unhealthy obsession with eating healthy food. The term is derived utilizing the Greek “orthos,” 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 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. Still, for various psychological reasons some people go overboard and become anorexic. Similarly, any reasonably health conscious person would wish to minimize intake of preservatives, pesticides, antibiotics and all the other garbage that pollutes our food supply. 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, psychologically limiting and sometimes physically dangerous disorder, related to but quite distinct from anorexia. Often, orthorexia seems to have elements of OCD, as does anorexia. Some people with orthorexia may in fact additionally have anorexia, either overtly or covertly (using pure food as a socially acceptable way of reducing weight.) But orthorexia is usually not very much like typical OCD or typical anorexia. It has an aspirational, idealistic, spiritual component which allows it to become deeply rooted in a person’s identity. It is most often only a psychological problem in which food concerns become so dominant that other dimensions of life suffer neglect. In rare cases, however, 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 orthorexia obsesses about purity. People with anorexia possess a distorted body image in which they see themselves as fat regardless of how thin they really are, whereas those with orthorexia constantly struggle against feelings of being unclean or polluted by what they have eaten, no matter how carefully they monitor their diet. Both conditions involve control, but whereas an anorexic seeks continually to reduce weight, an orthorexic feels compelled to achieve ever great heights of dietary perfection; to feel entirely clean, pure and transparent. Sometimes people recovering from anorexia “graduate” to orthorexia, keeping their disordered eating habits and moving the focus from weight to purity.
Although widely discussed by eating disorder experts, 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, even spirituality? Does your diet make you feel better than other people? Does it interfere with relationships or work, friends or family? 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, including my occasional blog posts. You might consider reading my book, Health Food Junkies. But most of all, if you feel your condition has become too much for you to manage on your own, visit an eating disorder specialist who understands orthorexia.
Steven Bratman, MD
To contact me, leave a comment, or find me on Twitter @StevenBratman