You may have heard the term "orthorexia" on social media or in the news. Orthorexia is an obsession with eating food that fits within the person’s criteria of acceptable. The behaviors become disordered and called orthorexia when they reach a level where they cause the person distress or impact the person's life negatively such as affecting family and friend relationships and other social interactions. It is characterized by a rigid and inflexible adherence to these self-imposed rules of acceptable eating. The acceptable eating is based on perceptions of what is healthy, not on weight or body size.
The behaviors by themselves do not indicate orthorexia. Two people can follow the same eating guideline, but for one person it is a rigid rule and impacts their life, and for the other person, it is more of a general practice, and adhering to it does not cause distress. Often times the motivation behind the behavior can help differentiate.
Same Behavior in Two People: Orthorexia in One, Normal in the Second
Here are a few example. First, we have two people who eat organic. One is afraid non-organic food will give him cancer. He spends hours at the supermarket reading food labels and choosing foods, and he avoid eating out with friends who want to eat at non-organic places. The other person buys organic food, but if he mistakenly buys or eat something non-organic, it causes him no distress. If he is eating out with friends, he eats whatever is available, whether or not there are organic options.
In a second example, we have two people who avoid white flour. One person avoids white wheat for general stomach issues. She would rather not eat anything and remain hungry if all options are white wheat. When her friend surprises her for her birthday with a white wheat cake, she won't eat it. All her friends know her rules, and they work hard to accommodate her. The other person chooses whole wheat over white wheat because she has diabetes. When she goes to the grocery store, she gets whole wheat bread. When eating out, she chooses whole wheat if it is available, but will have white wheat if that is the only option.
Clearly, in both examples the first person's rule is rigid and inflexible. It impacts the person's social life and causes distress. The second's person was more flexible and saw their food preferences as guidelines and not rules.
Orthorexia, Eating Disorders, and OCD/OCPD
Although orthorexia itself is not a diagnosis in the DSM-5, the guideline of psychiatric diagnosis, it can be characterized under the umbrella of OCD or OCPD. That differentiation depends on how much distress or interference it causes the person versus the distress or interference it causes the family of the person. If the person is distressed by how much work it takes them to follow their food rules, it is likely OCD. This person may know that what they are doing is not logical, but they feel that they have to do it. If the person believes that their food rules are the correct way of living, that those who don't do what they are doing are wrong, they may have OCPD. These people may try to compel their family members to follow their rigid rules.
Orthorexia is discussed along with eating disorders, such as anorexia and bulimia. There is definitely overlap between some characteristics of these disorders, such as inaccurate perceptions of reality and needing to follow food rules. Additionally, people with eating disorders or disordered eating often have other psychiatric comorbidities, such as anxiety or OCD.
Disordered eating is a very broad topic. With any psychological disorder, there is always a spectrum from zero evidence of a disorder to enough symptoms to diagnose a severe disorder. All throughout the middle of the spectrum are disordered eating behaviors of increasing severity until they reach diagnostic threshold and beyond.
Here are examples of behaviors that could be orthorexia. These behaviors are only disordered when they are severe enough to cause significant impact to the person's life and cause distress to them or their family.
Behaviors that Can be Orthorexia
Only eats organic
Won’t eat MSG
Won’t eat GMOs
Won’t eat at takeout
Only eats at home or at homes of accepted individuals
Avoids situations that won’t have acceptable foods
Avoids certain foods that are “unhealthy”
Has rigid meal template
Follows a vegetarian or vegan diet
Does “Clean eating”
Checks ingredient lists
Very interested in what other people are eating
Spends a lot of time thinking about/planning future eating occasions
Follows wellness blogs, Twitter, or YouTube
Avoids nightshades
Avoids all white flour
Avoids all sugar
What to do About Orthorexia
If you have noticed in yourself food behaviors that are causing you distress, reach out to a mental health professional and registered dietitian who specializes in disordered eating.