Understanding Orthorexia Treatment

Understanding Orthorexia Treatment

Orthorexia: What happens when healthy eating becomes an eating disorder?

Authored by Jane Squire MSc

Edited by Hugh Soames B.A.

Reviewed by Michael Por, MD

Each year, millions of people pledge that they will eat healthier and exercise. Many individuals are able to change their lives and improve their health and well-being thanks to altering their diet. Healthy foods can improve your body and mind, and give you a greater outlook on life. Yet, healthy eating can also lead to a disorder known as orthorexia and it can have detrimental effects on your well-being.


On the surface it seems strange that eating healthy foods can lead to an entirely unhealthy eating disorder. Like bulimia and anorexia, orthorexia is a serious issue that individuals can find mentally and physically debilitating. Orthorexia is not easy to identify.1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6376377/ It can be well concealed by loved ones just like other eating disorders and Orthorexia treatment is just as complex and challenging.


What is Orthorexia?


What makes orthorexia different from other eating disorders is it gives individuals the impression that they are eating healthy foods. That is the crux of the problem, however, as an obsession with eating healthy foods leads to the disorder’s development.


Orthorexia occurs when individuals focus on eating healthy foods. This focus is on the level of obsessive behavior and individuals pay close attention to consuming foods that will ensure they do not gain weight. Individuals suffering from orthorexia obsess over the quality of the food they consume. For the most part, orthorexia focuses on quality over quantity of the food eaten. While people suffering from anorexia and bulimia are concerned with losing weight, individuals with orthorexia are typically not specifically driven by this compulsion.


Orthorexia sufferers have an obsession with a food’s “purity” and the advantages of having a heathy diet. Orthorexia is a newer eating disorder that is still being researched by the medical community. The term “orthorexia” was only coined in 1997, thus showing just how new it is as an eating disorder. Orthorexia is not specifically recognized as an eating disorder by the American Psychiatric Association although it does broadly fall under Avoidant and Restrictive Food Intake Disorder (ARFID) in DSM 5.


What are the symptoms of Orthorexia?


Individuals seeking to eat more healthy foods can start with good intentions. However, over time, those intentions can manifest themselves into obsession. This is when orthorexia begins. Social media culture and the desire to look like other people is one of the causes of orthorexia. You may attempt to eat healthy foods to be more like a social media influencer only to become too focused on dining on high-quality items.


According to researchers, social media channels such as Instagram play a big part in individuals developing orthorexia.2https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2208-2 Celebrities and influencers often write about their diets and the number of calories they eat on Instagram while posting images of themselves or foods.


This creates a perfect storm of “wellness” that Instagram promotes and markets. Influencers use Instagram to promote meal eating plans that are not necessarily good for you. Most of the time, these meal plans are sponsored by companies who want to reach more consumers. Instagram influencers then lead followers to believe eating a specific way will allow them to be like and look like the influencer.


It is believed orthorexia is an obsessive-compulsive disorder. Individuals with current or past eating disorders can be at risk of developing it. Research has found other risk factors individuals show are obsessions with being perfect, a need to control others, and high anxiety.


What are the warning signs of Orthorexia Nervosa?


Warning signs for orthorexia can be hard to find. You may believe your friend or loved one is merely focused on eating healthy foods. However, orthorexia is experienced by individuals seeking to have the “perfect” diet. The diet is more important than losing weight, thus creating a fixation on the foods eaten.


Some of the signs that an individual may be suffering from orthorexia include avoiding foods containing or cooked with:


  • Artificial flavors and/or preservatives
  • Grown using pesticides
  • Genetically modified foods
  • Fat, sugar, and/or salt
  • Non-vegetarian or non-vegan foods
  • Ingredients considered unhealthy or currently in the public eye

A person suffering from orthorexia may display behavior changes such as:


  • Obsessing over their relationship with food choices and health issues such as asthma, digestion, mood, anxiety, or allergies
  • Avoiding foods due to food allergies without medical advice
  • An obvious increase in the taking of supplements, herbal remedies, and/or probiotics
  • May reduce the overall number of foods they find acceptable to eat
  • Obsessive and concerned with food preparation, including the washing of food items and/or cleaning of utensil


What are the effects of Orthorexia?


Due to the focus on food in modern society and medical advice claiming certain foods such as gluten can cause health issues, it can be difficult to tell when someone is suffering from orthorexia. You may think they are just being healthy or jumping on the latest health trend. Symptoms of the eating disorder are extremely serious and are more than just someone eating healthy foods.


Orthorexia can lead to individuals eliminating activities and interests they previously did. It can also cause friction in relationships as the sufferer is obsessed with their diet and food purity. Individuals can develop a superiority complex believing their friends and loved ones do not have healthy diets. As the strain on relationships grow, the sufferer of orthorexia believes they are better off alone.


Ultimately, it can lead to physical and mental harm. Individuals suffering from orthorexia begin focusing on eating healthy foods to be healthier. Yet, the end result on their physical appearance can be anything but healthy. Focusing on eating purely healthy foods limits the number of calories they take in. A person can lose weight and resemble an individual suffering from anorexia. Malnutrition can also occur.


Understanding Orthorexia Treatment


Unfortunately, there are no official Orthorexia treatment at this time. However, mental health care professionals are routinely used to treat the condition of other eating disorders and intense Psychotherapy may be used to change an individual’s obsessive thought patterns about eating and food. Regular sessions with a therapist can address conditions such as depression, anxiety, and panic. Addressing these issues could help treat an individual’s orthorexia condition. Residential rehab at a specialist eating disorder clinic may also be an option.


Cognitive Behavior Therapy (CBT) is especially useful for the treatment of Obsessive Compulsive Disorder (OCD), a condition that shares many traits and characteristics with Orthorexia. CBT teaches a person different ways of thinking, behaving, and reacting to situations that actively reduce feelings of fear without simultaneously experiencing obsessive thoughts compulsive actions.


Dialectical Behavioral Therapy (DBT) has been proven to work exceptionally well in the treatment of both acute and generalized anxiety disorders, and is an approach that has been effectively combined with CBT in the treatment of Orthorexia. DBT is a powerful combination of behavioral, cognitive, and meditative therapies .


Orthorexia Treatment with Medication


Both CBT and DBT are often used by therapists to treat Orthorexia, in combination with medically supervised pharmacology treatment consisting of powerful anti-anxiety medications and anti-depressants.3https://www.sciencedirect.com/science/article/abs/pii/S1471015315300362?_docanchor=&_fmt=high&_origin=gateway&_rdoc=1&dgcid=raven_sd_recommender_email&md5=b8429449ccfc9c30159a5f9aeaa92ffb#! These medications often start to work immediately on the brain by altering specific neurological pathways and receptors.


Generally, these medications should not be taken for long periods though they do often provide a window of opportunity for CBT and DBT to have a positive and lasting impact on a persons life. Many Orthorexics find ongoing support networks to be of great benefit, after an initial period of healing has occurred.

References: Orthorexia Treatment

  1. Arusoğlu G., Kabakçi E., Köksal G., Merdol T. K. (2008). Orthorexia nervosa and adaptation of ORTO-11 into Turkish. Turk Psikiyatri Derg, 19(3), 283–291. [PubMed] []
  2. Babor T. F., Higgins-Biddle J. C., Saunders J. B., Monteiro M. G., & World Health Organization. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care (2nd ed.). Geneva, Switzerland: World Health Organization. []
  3. Barthels F., Meyer F., Huber T., Pietrowsky R. (2017c). Orthorexic eating behaviour as a coping strategy in patients with anorexia nervosa. Eating and Weight Disorders, 22(2), 269–276. doi:10.1007/s40519-016-0329-x [PubMed] []
  4. Beierlein C., Kovaleva A., László Z., Kemper C., Rammstedt B. (2014). Eine Single-Item-Skala zur Erfassung der Allgemeinen Lebenszufriedenheit: Die Kurzskala Lebenszufriedenheit-1 (L-1) [A single-item scale for the assessment of general life satisfaction: The short scale life satisfaction L1]. Köln, Germany: GESIS. []
  5. Dell’Osso L., Carpita B., Muti D., Cremone I., Massimetti G., Diadema E., Gesi C., Carmassi C. (2018). Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy. Eating and Weight Disorders, 23(1), 55–65. doi:10.1007/s40519-017-0460-3 [PubMed] []
  6. Dunn T. M., Gibbs J., Whitney N., Starosta A. (2017). Prevalence of orthorexia nervosa is less than 1%: Data from a US sample. Eating and Weight Disorders, 22(1), 185–192. doi:10.1007/s40519-016-0258-8 [PubMed] []
  7. Koven N. S., Abry A. W. (2015). The clinical basis of orthorexia nervosa: Emerging perspectives. Neuropsychiatric Disease and Treatment, 11, 385–394. doi:10.2147/NDT.S61665 [PMC free article] [PubMed] []
  8. Missbach B., Dunn T. M., König J. S. (2016). We need new tools to assess orthorexia nervosa. A commentary on “prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies”. Appetite, 108, 521–524. doi:10.1016/j.appet.2016.07.010 [PubMed] []
  9. Pollack L. O., Forbush K. T. (2013). Why do eating disorders and obsessive–compulsive disorder co-occur? Eating Behaviors, 14(2), 211–215. doi:10.1016/j.eatbeh.2013.01.004 []
  10. Staehr J. (1998). The use of well-being measures in primary health care-the DepCare project. In World Health Organization, Regional Office for Europe (Ed.), Well-being measures in primary health care – The DepCare Project. Geneva: World Health Organization. []
  11. Turner P. G., Lefevre C. E. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders, 22(2), 277–284. doi:10.1007/s40519-017-0364-2 []

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Orthorexia Treatment
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Orthorexia Treatment
Both CBT and DBT are often used by therapists to treat Orthorexia, in combination with medically supervised pharmacology treatment consisting of powerful anti-anxiety medications and anti-depressants. These medications often start to work immediately on the brain by altering specific neurological pathways and receptors.
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