What is Orthorexia?
Orthorexia is an eating disorder in which a person is atypically fixated on eating in a healthy way. Although eating healthy foods is good, people with orthorexia have unrealistic standards for what they consider healthy eating. As a result, they may reject actual healthy eating habits because of those standards. In some cases, they may avoid eating entirely because of their anxiety over food. In all cases, orthorexia harms a person’s physical, mental, and/or social health.
Orthorexia is not recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a diagnosable condition. Still, many scientists and doctors accept it as a real disorder worthy of concern. Because it is not an officially recognized disorder, there is little data about how common orthorexia is. Some studies have estimated that it affects as much as 1% of the population.
Symptoms of Orthorexia
Symptoms of orthorexia can include:
- Avoidance of and anxiety about foods perceived as “unhealthy”
- Profound fixation on nutrition and healthy foods
- Feelings of anxiety after violating self-imposed rules about eating
- Rejecting food groups (e.g., carbohydrates, gluten, sugars, fats) without a medical, cultural, religious, or ethical reason
- Avoiding foods prepared by other people
- Obsession with the idea that healthy eating can cure or prevent disease
- Weight loss
What Causes Orthorexia?
The precise cause of orthorexia is unclear, and the cause of the behavior may vary from case to case. Studies have suggested that certain factors may play a role in the development of orthorexia. Some risk factors include:
- Certain personality traits, such as perfectionism or a need for control
- Other eating disorders
- Mental health-related issues such as obsessive-compulsive disorder
Some studies suggest that exposure to social media may increase the risk of orthorexia. In addition, education in health-related subjects such as nutrition or biology may also increase the risk. However, research into risk factors is limited, and more research is needed to begin to zero in on the cause of the disorder.
Is Orthorexia Hereditary?
No research has yet suggested that orthorexia runs in families or can be directly inherited by children from their parents. However, some research suggests the risk for eating disorders, in general, may run in families; some scientists believe that orthorexia is related to other eating disorders, such as bulimia or anorexia.
How Is Orthorexia Detected?
Potential warning signs of orthorexia include:
- Obsession with food labels and nutritional information
- Spending so much time planning, shopping, and cooking meals that it interferes with other activities
- Being critical of others’ food choices and judging people on the morality of their eating habits
- Avoiding social events where food is served
- Bringing pre-prepared food to events to avoid eating food prepared by others
- Malnutrition or unintended weight loss
How Is Orthorexia Diagnosed?
To diagnose orthorexia, doctors look for a pattern of symptoms and risk factors. The diagnostic process will also likely include exams to look for medical conditions that could be causing the symptoms. The diagnostic process usually includes physical examinations, tests, and a review of medical and family history.
Diagnostic steps may include:
- A physical exam. This exam aims to rule out specific physical conditions that could be causing the symptoms.
- Blood and laboratory tests. These tests will look at the patient’s blood chemistry for issues, such as infections or nutrient deficiencies, that may be present.
- Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to look for symptoms of orthorexia.
The DSM does not include diagnostic criteria for orthorexia, but scientists have proposed criteria to help doctors spot the disorder. These criteria include:
- Obsessively following rules perceived to outline healthy eating practices
- Feeling anxiety or shame if the rules are broken
- Progressively making the rules more restrictive
- Body image or feelings of self-worth are associated with perceived “proper” eating
- Malnutrition, unintended weight loss, or other health problems associated with the eating restrictions
- Social or relationship issues associated with the eating behavior
How Is Orthorexia Treated?
Treatment for orthorexia can include treatment of associated disorders (e.g., anxiety, depression, or OCD) and behavioral therapy to improve the orthorexia itself. Treatment approaches can include:
- Exposure to restricted foods
- Behavior modification therapy
- Cognitive restructuring or reframing therapy
- Relaxation techniques (e.g., yoga, meditation, breathing exercises)
Medications are typically not used to treat orthorexia.
How Does Orthorexia Progress?
Untreated orthorexia can lead to many different physical, psychological, and social complications if the behavior continues for an extended period of time. Potential complications of orthorexia include:
- Nutrient deficiencies
- Iron deficiencies (anemia)
- Irregular heart rate
- Electrolyte imbalances
- Hormonal imbalances
- Muscle weakness
- Immune system problems
- Social isolation
- Relationship problems
- Problems at work or school
How Is Orthorexia Prevented?
There is no sure way to prevent orthorexia, but managing stress or anxiety may help some people. Treatment of any associated mental health or developmental conditions may also improve orthorexia symptoms.
Orthorexia Caregiver Tips
Many people with pica also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with pica:
Orthorexia Brain Science
The cause of orthorexia is unclear, but its association, in some cases, with other brain-related disorders may offer a clue to the neurological basis of the disorder.
- Obsessive-compulsive disorder (OCD). Some case studies have associated orthorexia with OCD. Imaging studies have found certain structural and functional changes in the brains of people with OCD. The affected areas of the brain include the orbitofrontal cortex and the thalamus. It is possible that atypical nerve cell circuitry and activity in these areas could play a role in both OCD and orthorexia.
- Anorexia nervosa. Orthorexia is also sometimes associated with anorexia, and both disorders involve severe food restrictions. Studies have identified a problem with the neurotransmitter chemical dopamine in the ventral striatum and the hypothalamus in some people with anorexia. This chemical imbalance may be a factor in the eating behaviors of anorexia and, in theory, orthorexia.
Title: Personalized Treatment for Eating Disorders Versus CBT-E Trial (PT)
Principal investigator: Cheri A. Levinson, PhD
University of Louisville
The scientific premise, developed from past work, is that treatment personalized based on idiographic models (termed Network Informed Personalized Treatment; NA-PT) will outperform the current gold-standard treatment (Enhanced Cognitive Behavioral Therapy: CBT-E). The study goals are to (1) develop and test the acceptability, feasibility, and preliminary efficacy of randomization of NA-PT versus CBT-E and (2) test if network-identified precision targets are the mechanism of change. These goals will ultimately lead to the first personalized treatment for ED and can be extended to additional psychiatric illnesses. Specific aims are (1) To collect preliminary data on the feasibility and acceptability of the randomization of NA-PT (n=40) for EDs versus CBT-E (n=40), and (2) To test the initial clinical efficacy of NA-PT versus CBT-E on clinical outcomes (e.g., ED symptoms, body mass index, quality of life) and (3) To examine if changes in NA-identified, precision targets, as well as in dynamic network structure, are associated with a change in clinical outcomes.
Title: Brain Function in Adolescent Eating Disorders and Healthy Peers
Principal investigator: Christina Wierenga, PhD
University of California, San Diego
San Diego, CA
This study of adolescent eating disorders (ED) will examine the association of temperament-based classifications, brain activation during incentive processing, and ED symptoms at the time of scan and 1 year later to better understand the neurobiology and symptoms of ED. We will recruit 150 females currently ill with an ED and 50 controls ages 14-17 to investigate how temperaments reflecting greater inhibition, impulsivity, or effortful control correspond to 1) clinical symptoms and 2) the brain’s response to anticipation and outcome of salient stimuli, and 3) by collecting follow-up clinical data one year later, identify how temperament-based subtypes predict ED symptom change (e.g., clinical prediction). Data collection will rely on functional magnetic resonance imaging (fMRI) technology.
Title: The Role of Estrogen in the Neurobiology of Eating Disorders
Principal Investigator: Madhusmita Misra, MD, MPH
Massachusetts General Hospital
This is a randomized, double-blind, placebo-controlled study of the effects of transdermal estradiol versus placebo on cognitive flexibility, reward processing, and eating disorder pathology in hypoestrogenemic female adolescents and young adults (ages 14-35 years) with an eating disorder characterized by extreme dietary restriction and/or excessive exercise. Subjects will be randomized 1:1 to 12 weeks of transdermal estradiol with cyclic progesterone or placebo patches and cyclic placebo pills. Study visits include a screening visit to determine eligibility and visits at baseline, 8 weeks, and 12 weeks. Study procedures comprise behavioral, neuroimaging, and endocrine assessments.