Is Your Healthy Eating Actually Healthy?

Definition

Orthorexia Nervosa (ON) is a pattern of disordered eating characterized by excessive fixation on
“healthy” eating. “Healthy” is put in quotation marks as many sufferers of ON succumb to an
irrational, obsessive concern with a particular ideology of “health” that is typically not grounded
in scientific fact. In fact, most people with ON are nutritionally imbalanced and malnourished
despite their efforts to maintain what they perceive to be clean eating. ON results in significant
detriment to the daily function, psychological well-being, and nutritional status of affected
individuals.

Prevalence

Despite the overall lack of ON research, recent studies estimate that about 7% of the adult US
population suffers from ON. Other sources have indicated that upwards of 58% of Americans
display ON-like food and eating behaviors. Additionally, ON cases are on the rise. Women and
young adults may be particularly susceptible to ON. The condition is especially prevalent among
users of social media due to widespread health and fitness propaganda. Approximately 50% of
individuals who follow “clean” or “healthy” eating accounts on Instagram meet the diagnostic
criteria for ON.

Risk Factors

The combined influence of multiple factors contributes to the development of ON. Several risk
factors are listed below.
●Family history of eating disorders
● Weight- and appearance-oriented careers (i.e. athletes, models)
● Influences of social media and “diet culture”
● Conformity to societal pressures and beauty standards
● Unresolved past trauma
● Perfectionist personality
● Bullying and otherwise abusive social relationships


There are several mental health conditions that commonly coexist with ON. These diagnoses
may contribute to the development and progression of ON, and vice versa.
● Obsessive Compulsive Disorder (OCD)
● Eating Disorders
● Anxiety
● Depression
● Substance Abuse Disorders

Diagnosis

Although ON is not yet represented in the DSM-V (the official diagnostic manual for mental
health disorders), the Bratman & Dunn Questionnaire can be used to diagnose ON.

A positive response to one or more of the following criteria may indicate ON:

● Spending 3+ hours per day thinking about, planning, or preparing clean food
● Consuming foods based on its nutritional quality rather than for personal enjoyment
● Depriving food or otherwise punishing self for failing to comply with a restrictive diet
● Feeling superior to others who do not share the same dietary beliefs and practices
● Establishing sense of self-worth on ability to adhere to a restrictive diet
● Replacing interests, beliefs, values, and relationships with obsessing over clean eating

Health Effects

ON manifests in many different ways depending on the individual’s perceptions of “health”. For
example, one person with ON may choose to restrict calories or a particular nutrient (i.e.
protein), while another may maintain a certain diet such as vegetarianism or veganism.
Regardless of individual differences in behavior, ON can result in a number of serious health
complications.

The list below includes some of the possible health effects of ON:
● Emotional and mental distress
● Dehydration
● Nutritional deficiencies and imbalances
● Loss of muscle
● Cognitive impairments
● Impaired immunity
● Infertility
● Social isolation


Left untreated or poorly managed, ON may begin to present more and more like mainstream
eating disorders (anorexia nervosa, binge eating disorder, etc.).

Additional health concerns may arise including the following:
● Malnutrition
● Electrolyte imbalances
● Bone disease (osteoporosis)
● Kidney disease
● Liver disease
● Heart disease


In extreme cases of ON, death may result.

Treatment & Recovery

Since ON is a relatively new pattern of disordered eating, standards of care have not been
established. However, full recovery is possible with the proper treatment and support. Outpatient
care settings suffice in most situations, but critical patients may need to spend some time in a
facility where they can receive more around-the-clock care and supervision to get them to a place
where they are not a risk to themselves or others. It is important to keep in mind that there is no
One-Size-Fits-All strategy to recovery; treatment plans will look different for every person.

Cognitive Behavioral Therapy (CBT) is the most traditional approach used in ON treatment.
CBT is centered around helping patients identify and reverse harmful thoughts and stimuli that
contribute to the characteristic behaviors of ON. Through a variety of individual and group
therapies, distorted internal processing pathways are replaced with more healthful coping
mechanisms.


In addition to CBT, alternative treatments can be effective in treating ON. These therapies use a
bottom-up approach to uncover deep-rooted, often unprocessed trauma that may be driving the
behaviors of ON. Because obsession over controlling food and health is a defensive mechanism,
helping ON patients realize that food is not the enemy is important. Through trauma-informed
counseling and support, patients learn to identify perceived threats and use healthful grounding
and coping resources for improved emotional regulation. Patients work with an RD to reestablish
a healthy relationship with food as they learn to be aware of and trust their own nervous system
responses. Over time and through using skills such as intuitive eating, a patient can fully recover
from the burdens of ON.

Resources

  1. Health Food Junkies (Book): Overcoming the Obsession with Healthful Eating by David
    M. Knight and Steven Bratman
  2. Nutrition Counseling: Tracy Brown, RD (trauma-informed somatic nutrition therapist)
  3. Non-profit Organization: National Eating Disorder Association (NEDA) Prevention,
    support, & referrals for sufferers of eating disorders

References

1) Villa, M., Opawsky, N., Manriquez, S., Ananías, N., Vergara-Barra, P., & Leonario- Rodriguez, M. (2022). Orthorexia nervosa risk and associated factors among chilean nutrition students: A pilot study. Journal of Eating Disorders, 10(1), 6-6. https://doi.org/10.1186/s40337-022-00529-6
2) Hul, M. (2022). Orthorexia facts sheet and statistics. The Recovery Village. Web accessed on July 7, 2022, from https://www.therecoveryvillage.com/mental-
health/orthorexia/orthorexia-statistics

3) The Refuge (2022). Orthorexia: Statistics, causes, signs, & symptoms. The Refuge, A Healing Place. Web accessed on July 7, 2022, from https://www.therefuge-
ahealingplace.com/eating-disorders/orthorexia/effects-symptoms-signs
Thomas, L. (2019). Diagnostic criteria for orthorexia. News-Medical.Net Life Sciences. Web
accessed on July 7, 2022, from https://www.news-medical.net/health/Diagnostic-Criteria-for-Orthorexia.aspx
4) Center For Discovery (2021). What causes orthorexia nervosa and why did I develop this disorder? Center for Discovery Eating Disorder Recovery. Web accessed on July 7, 2022, from https://centerfordiscovery.com/blog/what-causes-orthorexia-nervosa-and-why-did-i-develop-this-disorder