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Orthorexia Nervosa

Working towards a healthy mind and body is something most of us strive for. We all have an assortment of reasons for wanting to be healthy and thriving.  Some want to lose weight, some want to gain weight.  Some hope to remedy a disorder, disease or virus they are suffering from.  Others want to achieve peak performance in athletics, either competitive or for a hobby. Some have very specific intentions in changing eating habits, like gaining energy, improving a digestive issue, relieving one’s struggle with kidney or gallstones, or just want to detoxify the body.  There’s even some that just simply know they don’t eat the healthiest foods, and want to find out the most optimal and sustainable way to maintain a healthy eating regimen and lifestyle for a long period of time, before the unhealthy lifestyle catches up to them, so-to-speak. But there are many people around the world that allow eating to become a disorder, and it essentially takes over their life.

Many are aware of certain eating disorders such as Anorexia, Bulimia, Binge Eating Disorders, or simply over-eating on a regular basis.  But not as many are familiar with Orthorexia.

Orthorexia is simply an eating disorder involving an obsession with consuming what would generally be considered ‘healthy’ food. This term has only been present for about 20 years, in fact, was only coined around 1998. It is still not officially recognized as its own category of eating disorder, nor is it yet recognized in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.  However, there is no denying that the type of mentality and behaviour that is used to describe Orthorexia, is real and relevant. I know, because I’ve experienced it. 

I want to make sure that nobody mistakes the idea of just wanting to eat healthy with an obsession that takes over your life. As per the National Eating Disorders Association website, the following symptoms are linked to Orthorexia:

  • Compulsive checking of ingredient lists and nutritional labels 
  • An increase in concern about the health of ingredients
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
  • Unusual interest in the health of what others are eating
  • Spending hours per day thinking about what food might be served at upcoming events
  • Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
  • Obsessive following of food and ‘healthy lifestyle’ blogs on Twitter and Instagram
  • Body image concerns may or may not be present

I personally don’t believe one has to experience all of these symptoms or warning signs to be experiencing this eating disorder.  However, I also don’t believe that anybody that experiences only 1 or maybe a couple of these symptoms necessarily fall under this category. Just because one checks the ingredients list on groceries they either intend or don’t intend to buy, doesn’t mean someone is mentally unstable by any means!  In fact, checking labels of products in grocery stores is a good way to educate yourself!  Doing it compulsively though, and having this action occupy one’s full focus during a grocery trip, may apply more to these warning signs.

Because this very specific type of eating disorder is still not fully recognized by certain manuals such as the one mentioned above, orthorexia is hard to diagnose and pinpoint in a way. Taken from the website by The Refuge, A Healing Place  there is reference to a couple studies done in the last decade, with some loose results such as 71% of college students were involved in behaviour linked to symptoms of orthorexia, and a separate study stating that anywhere between 21-57.6% of the general population could have symptoms or eating behaviours that are linked to those of orthorexia.  Unfortunately, these studies were of a fairly small sample size, and gave very general results.

There is some research that’s been executed about this eating disorder though. One piece is an article titled ‘Treatment of Pathologic Healthy Eating (orthorexia nervosa)’ by Dr. Hana F. Zickgraf, PhD.  Not only is a connection made between orthorexia and certain eating disorders such as Anorexia nervosa & Bulimia Nervosa, but Dr. Zickgraf also states a slight link between all 3 of these diseases and Obsessive-Compulsive Personality Disorder.  

This report gives its own criteria for distinguishing what orthorexia is pertaining to warning signs, much of which, is similar to the list stated above.  However, it also states that it is believed that 2 or more of these behaviours should be exhibited before raising concerns. Dr. Zickgraf states that there is less of a relationship between orthorexia nervosa (ON) and OCD tendencies, and that orthorexia tendencies are linked more to the behaviour related to anorexia nervosa (AN) and Bulimia nervosa (BN).  But finding a scientific link between ON and OCD is still being investigated, so I guess there is some credible evidence to support a link.

Zickgraf states “All three (ON, AN & BN) are characterized by distressing, intrusive thoughts or preoccupations that usually center on the nutritional and macronutrient content of food; all three involve rigid, compulsive and restrictive eating behaviours...”[1]

Because ON has only been associated with these other eating disorders and OCD, rather than having its own classification,  it has only been suggested as a variation of anorexia or bulimia. 

I can’t talk too much about anorexia nor bulimia specifically, as I am quite sure I’ve never experienced these diseases first-hand.  But orthorexia’s similarities to these eating disorders is interesting, if nothing else, hard to deny. 

It is recommended by psychologists to treat ON in the same way a professional would treat Anorexia, Bulimia, and even OCD in some cases.  Basically, Dr. Zickgraf states patients known to suffer from OCD can exhibit tendencies of extreme focus on healthy food to consume.  However, people that may suffer from orthorexia may not necessarily qualify to be suffering from OCD. Again, unfortunately because of the lack of knowledge, exposure and data pertaining to ON, no one can officially make that connection.

Dr. Zickgraf goes further by comparing ON with AN & BN by simple classifications. She states ON sufferers restrict their diet because of specific health beliefs, while AN/BN patients restrict intake by fear of gaining weight or becoming overweight, or the influence of what is portrayed as ideal body shape or ideal weight, based purely on self-evaluation. 

The is a similarity within all three of these eating disorders though: someone that restricts the consumption of certain nutrients for a specific outlook, goal or belief. 

One thing I do know is that this altering of certain nutrients is a disease that can directly effect the brain, and cognitive function. When looking at it from that standpoint, it’s very easy to see how extreme eating disorders can be a revolving circuit of altered information between the brain and the gut, and everything in between. As I stated before, I can not speak on behalf of those that have suffered from diseases such as Anorexia, Bulimia or binge eating disorders.  But I can empathize with the idea that when you are in the middle of this disordered thinking, you think you KNOW that this is the best thing for you.  And, I know in my case, I was probably the last one to realize it.  Even if a close friend came up to me and said, “I hope you don’t mind me saying, but you look really thin!” Of course I would justify it by saying “I’m eating the best I’ve ever eaten! I’m eating vegetables, no refined sugars, eating grains, and I’m not eating meat! Don’t worry about me.” Then I’d walk off and say to myself “I’ll bet they’re eating like crap!” 

I’ve stated this before, there is a deep connection between our mental health, gut health, and the food that we eat. Experts still have trouble to this day explaining exactly what causes eating disorders. But it’s known that food can effect our thinking, and that our thinking can alter the way we view and consume food.  But that doesn’t explain exactly which comes first, the mental aspect, or the types of food we eat. Food and cooking should be fun, it should be something to look forward to each day, and it should be a testament of love towards not just others, but towards ourselves.  And if the time comes where you don’t enjoy cooking for anybody, or you don’t look forward to the idea of nourishment, or the thought of eating food is always present throughout the day, you’re not the only one.  It is very easy in fact to not like food, nor the idea of eating, and many people have a bad relationship with food.  This is definitely something worthy of talking to a professional about. I am always available to my clients to talk to about this, but the best person to help really deal with an eating disorder is always a therapist.  Either way, there is definitely help out there. Every part of you is worth it!


[1] Zickgraf HF. Treatment of pathologic healthy eating (orthorexia nervosa). In: Storch EA, McKay D, Abramowitz JS, editorsAdvanced Casebook of Obsessive-Compulsive and Related Disorders. Cambridge, MA: Academic Press; (2020) p. 21–40. 10.1016/B978-0-12-816563-8.00002-4

If you or someone you know is suffering from an eating disorder, please do not hesitate to find some help, or at least talk to somebody!  Below are some resource links to check out:

Kids Help Phone in Canada : Just Text CONNECT to 686868; it’s free!

NEDIC – resources and referrals for those suffering from eating disorders, can contact by telephone or online chat

Ontario Community Outreach Program for Eating Disorders – Ontario only

Kelty Eating Disorders – B.C. residents only – Linked to the B.C. Children’s hospital 

Sheena’s Place – Ontario Residents only 

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