Orthorexia Nervosa: When does the pursuit of health become unhealthy?

By Laura Bumberry, Psy.D.

The term Orthorexia Nervosa refers to an obsession with healthy eating. Many may wonder what could possibly be wrong with a concern about nutrition and desire to consume healthy foods. Couldn’t we all benefit from eating more fruits and vegetables? In short, nothing is wrong with being concerned about health, as long it remains balanced with other important areas of your life. Dr. Bratman, author of Health Food Junkies, alternative medicine physician, and self-pronounced recovered orthorexic, states “It’s the quality of obsession that defines orthorexia, not the desire to eat healthy food; it’s the absence of moderation, the loss of perspective and balance, the transfer of too much of life’s meaning onto food. When diet becomes an escape from life, it begins to resemble an eating disorder more than a sensible choice.”

Of course, not everyone who is interested in nutrition or who practices healthy eating habits has a problem. A plethora of data suggests that good nutrition can help ward off illness and extend life expectancy. Dr. Bratman offers the following questions to assess if your own quest for health may, in fact, be unhealthy. He suggests that if you answer “yes” to two or three of these questions, you may struggle with some components of orthorexia. If you answer “yes” to four or more of these questions, there is likely a problem. These questions are not shared as a means for diagnosing oneself, but more to encourage reflection upon how your relationship with food may be impacting your life.

1. Do you spend more than three hours a day thinking about healthy food?
2. Do you plan tomorrow’s food today?
3. Do you care more about the virtue of what you eat than the pleasure you receive from eating it?
4. Have you found that as the quality of your diet has increased, the quality of your life has correspondingly diminished?
5. Do you keep getting stricter with yourself?
6. Do you sacrifice experiences you once enjoyed to eat the food you believe is right?
7. Do you feel an increased sense of self-esteem when you are eating healthy food? Do you look down on others who don’t?
8. Do you feel guilty or self-loathing when you stray from your diet?
9. Does your diet socially isolate you?
10. When you are eating the way you are supposed to, do you feel a peaceful sense of total control?

Why is this important? 

Orthorexia nervosa is not an official diagnosis, but several of the characteristics listed above do overlap with those of anorexia nervosa and bulimia nervosa. However, while someone suffering from anorexia or bulimia nervosa may know their behaviors are harmful, someone with orthorexia may feel proud of taking such good care of their health, doubting it is a problem at all. Others may acknowledge the problem but believe it is “not bad enough” to seek treatment because they do not fit the specific criteria for anorexia or bulimia nervosa. For example, someone may have the same kinds of rigid rules about eating, fears about weight gain and severe body image distortions commonly found in anorexia nervosa, yet their weight remains in acceptable weight range according to height and weight charts. Or the orthorexia might involve an obsessive commitment to exercise that might function very much like purging. Such individuals might not meet full criteria for either anorexia or bulimia nervosa, but are diagnosed with Eating Disorder Not Otherwise Specified (EDNOS). Regardless, the threat to well being and the degree of impairment can be every bit as severe.

In clinical practice, many individuals being treated for an eating disorder report a significant concern about health and nutrition prior to the onset of their eating disorder behaviors. Orthorexic thoughts and behaviors can put individuals at a higher risk to develop eating disorders as time passes and the focus on “health” intensifies. Conversely, individuals who are recovering from anorexia and bulimia nervosa often continue to struggle with distorted beliefs about food and rigid eating behaviors that significantly interfere with their quality of life, such as those seen in orthorexia. If these issues are not addressed as part of their recovery, not only will life continue to be dominated by food, but their risk of relapse will be higher.

If you are concerned that your own pursuit of health has taken a turn for the worse, consider consulting a professional who specializes in eating disorders to assess and address the problem. As Dr. Bratman states, “life is too short to spend it all thinking about how to live longer.”

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Laura Bumberry, Psy.D.
Licensed Clinical Psychologist

Dr. Bumberry earned her doctorate in Clinical Psychology at Xavier University with an emphasis on child and adolescent psychology. She is a licensed clinical psychologist at Webster Wellness Professionals and provides treatment services for eating disordered behaviors. Dr. Bumberry has specialized training in evidence-based treatments, including Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), and Family-Based Treatment (FBT), also known as the Maudsley Approach. She treats children, adolescents, and adults, and has specific interest in the relationship between disordered eating, self-injury, and trauma-related issues.

www.websterwellnessprofessionals.com