Orthorexia: the obsession with healthy eating

By Cristiano Antonino On Mar 14, 2023

The focus on eating well and a healthy lifestyle has become an integral part of our society

There is not a day goes by without the media dispensing advice and tips on what and how to eat.

About how food affects our health and how a particular diet allows us to lose weight in a short time.

Or rather allows us to significantly improve our well-being.

The result is perhaps to turn the pleasure of the table into an anxious relationship with all things food-related.

As much as everyone can benefit from healthy changes to their diets and lifestyles, for some, the commitment to healthy eating can degenerate into a full-blown obsession known as orthorexia.

What is orthorexia nervosa?

The term orthorexia nervosa, first coined by Bratman and Knight in 1997, describes a condition characterised by eating behaviour that follows a pathological obsession with biologically pure and healthy eating.

This condition is often associated with a restrictive diet that, in an attempt to achieve optimal health, can lead to serious medical conditions related to malnutrition, as well as emotional instability and social isolation.

Symptoms of orthorexia

Orthorexics are concerned with the quality of the food in their diet, rather than the quantity.

They spend considerable time examining the origin (e.g. whether the vegetables have been exposed to pesticides).

They check the processing (e.g. if the nutritional content may have been lost during cooking).

They study the packaging (e.g. whether labels provide enough information to judge the quality of specific ingredients) of foods that are then put on the market.

The obsession with food quality, in terms of the nutritional value of food and its ‘purity’, stems from the desire to optimise one’s physical health and well-being.

Rules and beliefs

Such a preoccupation in the case of orthorexia can trigger complex eating behaviour, e.g:

internal rules about which foods can be eaten together with each meal or at specific times of the day
beliefs that optimal digestion of a certain food should take a specific amount of time.

Outside of meals, a considerable amount of time is spent in planning and realising daily meals.

This is in order to be able to pay attention to thoughts about what will be eaten.

But also the gathering of information with regard to each ingredient, the preparation of ingredients, and finally the intake of food.

What are the consequences of orthorexia?

Since the focus is on pure and healthy foods, individuals with orthorexia nervosa tend to avoid foods that may contain genetically modified ingredients.

As well as those that contain significant amounts of fat, sugar, salt or other undesirable components (dyes, preservatives, pesticides…).

Such dietary restrictions usually lead to the omission of essential nutrients from daily energy requirements, resulting in unbalanced and insufficient diets.

Impact on quality of life

Psychologically, orthorexic individuals experience intense frustration when their eating rituals are impeded or interrupted in any way.

They feel disgust when the purity of food seems to be violated, as well as an emotion of guilt and self-loathing (sometimes outright hatred) depending on the degree of adherence to the internal rule system that revolves around the subjective perception of what is right or wrong.

Social isolation

And it is precisely the rigidity of the rules and beliefs related to food that can produce another negative consequence on a psychological level: social isolation.

Sharing a meal is one of the key ways in which we socialise and build interpersonal relationships.

But for people suffering from orthorexia, the occasion of a meal can turn into a real minefield.

Eating food that is not considered pure, or food that someone else has prepared, generates considerable anxiety. Here, the meal does not represent an opportunity for joy and serene conviviality.

Rather, it becomes a breeding ground for a whole series of negative thoughts and emotional states that do not allow one to enjoy food.

Quality of food superior to quality of life

Orthorexic individuals firmly believe that they can maintain a healthy diet as long as they live alone and in full control of everything around them.

They feel righteous to eat foods that they consider to be healthy and this pushes them to assume an attitude of moral superiority.

Consequently, they do not wish to interact with others who have eating habits that differ from their own.

The quality of food takes precedence over one’s personal, moral values, social, work and emotional relationships, to the point of compromising the overall functioning and well-being of the individual.

The vicious circle of orthorexia

Those who suffer from orthorexia hyper-monitor their diet and carefully select every single foodstuff by assessing its quality.

The over-investment in ‘healthy eating’ and self-control generates a sense of superiority over those who do not.

At the same time, strong emotions of guilt, anger, sadness and anxiety are generated whenever one fails, transgressing the rule.

And it is precisely as a result of these negative emotions that the behaviour and the rule itself become even more rigid, thus helping to maintain the vicious circle.

Disturbance in its own right or a combination of a few known ones?

Although not included within the latest edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5), orthorexia nervosa has recently been the subject of scientific research that has stimulated international debate on whether or not this disorder should be included within the official nosography of the psychiatric world.

In this regard, researchers from the University of Colorado published an article in 2014 in the journal Psychosomatics entitled ‘MIcrothinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal ‘orthorexia nervosa’ and proposed diagnostic criteria’, in which they proposed specific diagnostic criteria for this disorder.

Orthorexia and anorexia: what difference

Some of the characteristics described above are reminiscent of symptoms of anorexia nervosa.

Indeed, orthorexia and anorexia share perfectionistic and hyper-controlling traits.

They tend to value adherence to their diet as synonymous with self-discipline and interpret transgression as a failure of self-control.

Given the strong overlap between anorexia and orthorexia, research has shown how the latter may constitute a less severe variant of anorexia or a possible coping strategy for anorexic subjects (kinzel et al., 2006; Segura-Marcia et al., 2015).

In particular, the study by Segura-Marcia and colleagues (2015) indicates how orthorexia is often clinically associated with a transition to less severe forms of eating disorders.

Differential diagnosis

However, there are also elements of differentiation.

The most significant difference between orthorexia and anorexia concerns the underlying motivation for the specific eating behaviour.

Unlike anorexia in which the concern is about the quantity of food ingested and the aim of the eating pattern is to lose weight, in orthorexia individuals constantly strive for the quality of food.

A person with orthorexia will be obsessed with defining and maintaining the perfect diet, rather than an ideal weight.

Obsessive personality and orthorexia

Orthorexia also has characteristics that overlap with other diagnostic categories, for example obsessive-compulsive personality disorder, in terms of perfectionism, rigid thinking, and hypermorality.

Illness anxiety and hypochondria

Symptoms of orthorexia can also be found in disease anxiety disorder, in which obsession with a healthy diet may be a strategy aimed at making one’s body resistant to the risk of contracting disease.

Psychotic disorders

Finally, the possibility remains that orthorexia may be a sign of a more serious psychopathology within the psychotic spectrum.

On a theoretical level, the feature of orthorexia of greatest relevance to psychosis is food-related magical thinking (e.g. eating fruit on an empty stomach 30-60 minutes before a meal prepares the stomach for proper absorption of nutrients).

Also found are erroneous beliefs based on intuitive laws (for example, the notion that objects that have been in real or imaginary contact continue to influence each other in time and space).

The pursuit of healthy eating, therefore, can also drift towards a kind of food fundamentalism/fanaticism, based solely on foods deemed pure and uncontaminated.

In such cases, the obsession with healthy food grows in intensity to the point of taking away space and time from other activities and interests, to the point of compromising that very health, so much desired, of which nothing remains.

If not the neurosis of healthy eating.