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Orthorexia is a recently coined term which denotes an obsessive-compulsive disorder that centers on selecting and preparing food of the ‘right’ quality and purity. It is not the same as ‘clean eating,’ though many people in the latter category find themselves trapped in orthorexia later.

Characteristics

Orthorexia is characterized by three main features:

• A highly restrictive diet which is of great importance in making decisions related to social and personal life
• Formalized observances in the preparation and eating of food to avoid un-clean eating practices
• Overly strict aversion to all foods which are deemed unhealthy or not clean

Orthorexia usually begins as an attempt to eat healthy food, often to correct a chronic medical disorder. However, people with obsessive tendencies start to eliminate more and more foods from their diet to ‘perfect’ it.

They increasingly insist that they need to know exactly what they should eat, how much of it, and how to maintain their diet with the utmost strictness. Every time they fall off the wagon is considered a major issue and reason for self-condemnation.

They need to maintain their rigid diet with all their willpower. They justify their intensity on the basis of their need to correct every ‘imperfection’ in their life through a better diet.  

The ability to constantly choose to eat only clean food, to follow one’s self-imposed dietary restrictions, keep to a strict roster of healthy foods, and have more ‘right’ food habits than others, is translated into better self-esteem.

This then is fed by, and demands, an intense and compulsive scrutiny of all foods, whether home-cooked or store-bought, for unacceptable ingredients, sources, or packaging. This list often expands with time.

They may include artificial food dyes, food flavoring agents, preservatives, pesticides, genetically modified ingredients, fats considered to be unhealthy, sugars and salts, as well as a host of other components.

In addition to this daunting list of ingredients, many orthorexics will find it impossible to eat allowed food if utensils or cutting boards, which are also used for prohibited foods, have been used in its preparation, or if the right food was prepared in the wrong way.

A knife used to slice bread should not be used to cut vegetables, for instance, since that makes it unacceptable to an orthorexic.

Many orthorexics follow a careful ritual in food preparation, with an extreme sense of cleanliness, tidiness, and perfectionistic detail. They fear harm and will go to great lengths to avoid it through food-related transgressions. Frustration, guilt, and disgust, are familiar companions of the orthorexic who is forced to commit dietary violations.

Risk factors

Healthy eating is a convenient goal to push, but may disguise many other more important motivations to jump on the ‘clean eating’ bandwagon. These may include emotional insecurity, low self-esteem, a feeling of being unable to control one’s life, and lack of affection or respect from others during the critical growing-up years. A lack of self-identity is compensated for by the carefully built-up image of a person who eats clean, ignoring the fact that ‘a person’ is far more than this. Holistic life is replaced by one which is intensely focused on healthy eating alone. Their adherence to their manner of eating gives them a feeling of achievement and of being superior to other people, addressing their lack of self-worth.

Orthorexia affects women, adolescents, and certain sportspeople who require strength and speed.

Complications

An overly restrictive diet often results from orthorexia, which can actually result in the development of nutritional deficiencies. Both caloric deprivation and mineral/vitamin deficiency may occur.

A second serious complication is that social relationships are affected by the orthorexic’s refusal to eat out, even at a friend’s or relative’s home. Many friends may be alienated by the person’s inability to eat a single meal with them if even one ingredient is off-the-list. In addition, the orthorexic party may not wish to associate with others who do not subscribe to their own peculiar philosophy.

The person’s interests eventually narrow down to healthy eating, and there is a loss of interest in other hobbies and pursuits which were formerly attractive. They are obsessed with possible slips from their diet and the resulting health risks.

Diagnosis and treatment

Several questionnaires and survey forms have been produced to diagnose the condition. Treatment is preferably implemented by a team of physicians, counsellors, nutritionists, and eating disorder specialists.  

References

• https://www.ncbi.nlm.nih.gov/pubmed/18524314
• https://www.nationaleatingdisorders.org/orthorexia-nervosa
• http://www.orthorexia.com/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340368/

Further Reading

• All Orthorexia Nervosa Content
• Epidemiology of Orthorexia Nervosa
• History of Orthorexia
• Signs and Symptoms of Orthorexia
• Diagnostic Criteria for Orthorexia

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.