How to recognize the symptoms of orthorexia and get the help you need

Ava English

Sep 19, 2020, 01:36 IST

How to recognize the symptoms of orthorexia and get the help you need

Checking food labels obsessively is one of the symptoms of orthorexia.Aja Koska/Getty Images

People develop orthorexia when they become fixated on healthy eating to the point it impedes on their quality of life.
Common symptoms of orthorexia include obsessive nutrition label checking, labeling food as "good" or "bad", and not eating out at restaurants.
Orthorexia can be treated with therapy and nutritional counseling.
This article was medically reviewed by Alisa Ruby Bash, PsyD, LMFT, a licensed family therapist in Malibu, California.

Orthorexia is an eating disorder that is characterized as an unhealthy obsession with healthy eating.

It often involves restricting certain food groups and over emphasizes "clean eating" to a point where it interferes with quality of life.

It is difficult to estimate how many people have orthorexia as there is currently no formal diagnostic criteria.

Here is what you need to know about orthorexia from common symptoms to how it's treated.

What is orthorexia?

People develop orthorexia when they obsessively fixate on "healthy eating." While deciding to pursue a healthy lifestyle isn't bad, people with orthorexia become compulsive and inflexible with their eating.

Unlike other eating disorders, orthorexia is usually not motivated by weight concerns or body image issues, says Meghan Windham, a registered dietitian at Texas A&M University.

Orthorexia often starts because a person wants to improve their overall health by taking control of the foods they eat. For many, this means turning to fad diets that restrict certain food groups or promote specific eating patterns. Windham says following these types of diets can quickly become obsessive, even if they don't start out that way.

People with orthorexia tend to be concerned about the quality of the foods they eat, rather than the amount of food that they eat. Food concerns can vary among individuals with orthorexia. For example, some may restrict major food groups — such as dairy or gluten — while others may be fixated with only consuming raw foods.

Orthorexia is not considered an official mental health condition by the DSM-5 — the manual used to diagnose mental illnesses. One reason for this is because symptoms of orthorexia tend to overlap with other conditions such as obsessive-compulsive disorder, anorexia, and other avoidant/restrictive food intake disorders (ARFIDs).

If left untreated, orthorexia can progress and lead to lasting mental and physical health consequences and may even take the form of other eating disorders like anorexia nervosa or bulimia, says Paula Quatromoni, DSC, RD, an associate professor and chair of the Department of Health Sciences at Boston University.

Signs you may have orthorexia

Like most eating disorders, the signs and symptoms of orthorexia are mental, behavioral, and physical. Orthorexia presents differently in individuals, so symptoms may vary from person to person.

Mental symptoms

Mental, or emotional symptoms, of orthorexia tend to be similar to those of other eating disorders and obsessive-compulsive disorder (OCD). These include:

Impaired memory
Anxiety
Intrusive thoughts
Rigid thinking
Perfectionism

Behavioral symptoms

Behavioral symptoms are some of the earliest signs of an eating disorder. According to Windham, those associated with orthorexia include:

Obsessively checking nutrition labels on foods
The need to look up the menu at a restaurant before agreeing to eat there
Avoiding going out to dinner or having other people cook for you
Eating before or after social events involving food
Indicating a fear of certain foods by using language such as, "I can't eat that" or "I am afraid to eat that"

Physical symptoms

People with orthorexia are at a higher risk of developing micronutrient deficiencies because they tend to restrict certain food groups. This can lead to physical symptoms if the deficiency is left untreated.

Here are some common micronutrient deficiencies in people with orthorexia and their corresponding physical symptoms:

Food restricted	Risk of micronutrient deficiency	Physical symptoms
Meat products	B12, Iron	Anemia :
Dairy products	Calcium, Vitamin D	Loss of bone mass
Gluten	B vitamins, iron, and other minerals	Weakness and fatigue

These obsessive and compulsive behaviors around food choices can impede on a person's social life. "Some people find it easier to compulsively stay at home, rather than socialize to have complete control over their food environment, which quickly becomes a really isolating way to live," says Quatromoni.

Early warning signs of orthorexia

It is important to try to recognize when someone needs help with orthorexia sooner, rather than later. "The longer someone has been in the trenches with this, the greater the health risks, and the longer the road to recovery will be," says Quatromoni.

It can be tricky to tell if someone has orthorexia or if they are just a healthy-eater. Windham says healthy eating has progressed to orthorexia when, "your food intake is governed by strict rules, rather than day to day choices."

According to Quatromoni, here are some signs that may indicate a person is developing orthorexia:

They assign moral values to food, such as it being "good" or "bad".
They avoid large food groups such as carbohydrates, dairy, or sweets.
They participate in fad diets such as intermittent fasting or the ketogenic diet.

Early identification and intervention can help people with this disorder have the best possible outcomes in recovery.

If you are worried that someone you know may be experiencing these symptoms, here is some advice on how to approach them about your concerns, says Lauren Smolar, the director of programs at the National Eating Disorders Association.

Talk to them in a non-confrontational and non-judgemental way
Cite specific behaviors you are concerned about
Encourage them to get help when they are ready to do so
Be supportive when they do seek help

Risk factors and causes of orthorexia

"Oftentimes the symptoms we see in people with orthorexia are extensions of underlying psychiatric conditions or they are triggered by psychological stressors," says Quatromoni.

There are certain factors that place some people at higher risk of developing orthorexia. These include:

Other mental health conditions like anxiety disorders, OCD, and depression.
Stressful life events such as divorce, losing a job, or beginning college. People may use strict eating patterns to gain back a sense of control in their lives and cope with uncontrollable situations, says Quatromoni.
Athletes are at risk because they often use diet as a means to improve their performance or change their body composition which makes them especially susceptible to developing orthorexia.

Treatment options for orthorexia

Orthorexia is treated with a combination of nutrition counseling and therapy. "It's important to work with a dietician to correct nutrient deficiencies and restore physical well being, as well as a mental health professional to treat the psychological side of this disorder," says Quatromoni.

"Nutrition counseling can help people with orthorexia relearn what a healthy plate looks like," says Windham. Nutrition counseling is education-based and can help people with orthorexia re-incorporate food groups they are scared of and understand the benefits of a varied diet.

Meanwhile, therapy can help people with orthorexia understand underlying mental health issues and stressors that may be driving their rigid food behaviors. If people are also suffering from anxiety or OCD, they may be prescribed medication to treat those conditions.

Read more about finding the best treatment options for eating disorders.

The bottom line

If you are concerned your healthy eating habits have become disordered or started to impede on your quality of life, you should seek help from a dietician, therapist, or contact the National Eating Disorders Helpline. "Even if you don't meet any official diagnostic criteria you are still deserving of care to help you work through the concerns you have about your behaviors," says Smolar.