A dedication to eating healthy in theory sounds harmless and is usually met with praise. But when someone you know experiences heightened emotions around eating cake at their friend’s birthday celebration (a food that was once loved) and feeling distressed on multiple occasions when ‘healthy’ options are not available, then there could be something else going on beneath the surface.

Distorted view of diet and fitness

In recent years the social media and information age has exploded, resulting in a flood of popular food marketing claims and the media’s distorted view of diet and fitness. This has led to ‘clean eating’ trends and the pathological obsession of ‘healthy’ foods which has given rise to cases of orthorexia more than ever. In other words, wellness has overtaken and jeopardised the health of many individuals whose actual health is at risk. So what sets this eating disorder apart from the other types of eating disorders?

While people with anorexia nervosa, bulimia nervosa and binge eating disorder engage in some form of food restriction in terms of quantity, orthorexia is a disorder predominantly concerned with food quality. The pathological obsession with eating ‘clean’ or ‘healthy’ is another manifestation of diet culture in disguise, however the conversation of orthorexia is now coming to the surface as there is a growing body of research on the physiological and psychological harm this eating disorder causes.

What is Orthorexia?

Orthorexia behaviours and outcomes similar to other eating disorders

Although orthorexia is not officially classified as an eating disorder in the DSM-5, the overlap of orthorexia behaviours, attitudes and outcomes are closely linked among people with other eating disorders, including:

  • malnourishment,
  • mental distress,
  • turbulent impacts on relationships and
  • poor quality of life.

Studies have also shown that individuals with orthorexia often have obsessive-compulsive disorder (OCD) and perfectionistic traits which tend to drive the food-centred obsession in a different manner to other eating disorders. Like anorexia nervosa, orthorexia involves restriction which can result in consequences such as social isolation, anxiety, loss of food freedom, reduced interest in other human activities such as birthday celebrations, weddings, cooking, etc, and severe malnutrition.

Warning signs & symptoms

  • Compulsive food checking (e.g., calorie counting, macro counting, food weighing, excessive amounts of time reading nutrition labels).
  • Increasingly rigid towards “unhealthy” foods, non-locally grown, certain ingredients (sugar, fat, alcohol, artificial colours, preservatives, animal products, non-organic sources).
  • A health-related event, health complication or some other occurrence such as a food allergy that suddenly prompts greater interest in health.
  • Heightened or exaggerated concerns or fears about illnesses or health complications.
  • Extreme amounts of money and time spent on meal planning and food preparation.
  • Lack of flexible eating during social occasions or not partaking of food if it doesn’t comply with the individual’s food rules.
  • Emotional distress when ‘safe foods’ or ‘healthy’ foods aren’t available or if food has been prepared by someone else.
  • Critical of other people’s food beliefs.
  • Viewing food as a source of health versus pleasure.
  • Placing high standards or becoming virtuous about their view on diet and wellness.
  • Loss of interest in previously enjoyed activities due to obsessive ‘healthy’ lifestyle standards.
  • Obsession with following food and lifestyle blogs and social media accounts promoting ‘clean eating’.
  • Feeling ashamed or guilty when diet standards aren’t maintained.
  • Compulsive exercise.
  • Body image concerns.
  • Past eating disorder concerns.

Why isn’t orthorexia a clinically recognised eating disorder?

The exploration of this new eating disorder is still in its early stages of research, and therefore does not form part of the diagnostic manual. The difficulty with classifying orthorexia as a standalone disorder is due to the crossover with other eating disorders and psychological disorders. As research and validated measures advance, this will likely change.

Just because orthorexia is not classified in the DSM-5, doesn’t mean the disorder should be overlooked or not taken seriously. Eating disorders and disordered eating, no matter how big or small, carry physical and psychological risks if left untreated.

Treatment and management

There are no treatments specific to orthorexia to date but that doesn’t mean individuals with orthorexia cannot challenge or reverse their belief systems underlying their illness. The multidisciplinary team approach to individuals with an eating disorder can be applied as part of evidence-based practice to people with orthorexia. 

Professional input from a general practitioner, psychotherapist, and a dietitian are invaluable connections that everyone deserves to have in the recovery journey. The combination of medication, cognitive-behavioural therapy (CBT) and psycho-education can be applied to outpatient settings.

At Eating Disorders Families Australia (EDFA), we provide support to carers and family members of people with eating disorders. We help them to understand the complexities of eating disorders and provide resources and information so they can support and advocate for their loved one.

If you have a loved one – a child, sibling, family member or close friend – with an eating disorder, we invite you to learn more about EDFA and our mission. Or dive into our resources that cover different aspects of eating disorders from diagnosis to treatment and recovery.