Obsessed with Healthy Eating?

Does this sound familiar

• You avoid certain foods, fearing they aren’t “pure” or “healthy” enough.
• You have feelings of guilt, shame or anxiety after eating something outside your strict food rules.
• Planning meals or measuring nutrient content consumes your thoughts, leaving little room for anything else.
• Your social media has a large focus on food and dietary information.This may be a sign of orthorexia – an often-overlooked eating disorder. But you are not alone, and support is available. Read on to find out more.

Orthorexia is a term that has gained traction in recent years, reflecting a growing awareness of the fine line between healthy eating and an unhealthy fixation on food purity. Additionally, “the proportion of orthorexia nervosa symptoms [also] seems to be increasing”.

To help understand the issue, this blog will explore orthorexia through multiple lenses: defining the condition, examining its psychological underpinnings, assessing cultural and social media influences, comparing it with other eating disorders, and reviewing treatment approaches.

Our aim is to provide a balanced, research-informed perspective that can help both professionals and the wider public understand this emerging phenomenon in the realm of psychiatry and mental health care.

Orthorexia refers to an unhealthy obsession with eating foods that one considers healthy or pure. Unlike traditional eating disorders that centre on weight loss or body image, orthorexia is characterised by an excessive focus on the quality and purity of food. Individuals with orthorexia may rigidly adhere to specific dietary rules, often to the detriment of their physical, emotional, and social well-being.

Despite increasing recognition in popular discourse, orthorexia is not yet formally recognised in diagnostic manuals such as the DSM-5, which presents challenges for clinical assessment and treatment. This lack of formal recognition has sparked debate among researchers and clinicians, with some arguing that the focus on food quality, rather than quantity, makes orthorexia distinct from disorders like anorexia nervosa or bulimia.

As we continue to refine our understanding of mental health conditions, it becomes clear that recognising orthorexia is essential for developing tailored interventions that address both the psychological and behavioural components of this complex condition

The roots of orthorexia often lie in deep-seated psychological factors. As found in ‘Orthorexia and Orthorexia Nervosa: A Comprehensive Examination of Prevalence, Risk Factors, Diagnosis, and Treatment’

“Perfectionism, high levels of neuroticism, and a tendency towards obsessive-compulsive traits may predispose individuals to engage in rigid and extreme dietary behaviors.”

This makes sense when we think of things like the drive for perfection, which can manifest in an overwhelming need to control one’s diet as a means of achieving an ideal state of health, purity, or self-worth.
Anxiety plays a significant role, too; the fear of contamination or illness may propel an individual to adhere strictly to ‘clean’ eating regimes, sometimes to an extreme degree. In this context, food becomes not just nourishment but also a symbol of control and safety in an unpredictable world.

Understanding these mental factors is crucial for both clinicians and individuals alike, as it shifts the narrative from one of moral judgement to one of psychological complexity. Recognising that orthorexia may be an expression of deeper emotional or cognitive issues helps pave the way for more compassionate, targeted therapeutic interventions that address the underlying causes rather than merely the symptoms.

Primary Focus:

• Orthorexia: Centres on the quality and purity of food, with an obsession for ‘clean’ or ‘healthy’ eating.
• Anorexia Nervosa & Bulimia: Primarily focus on body image, weight control, and calorie restriction.

Underlying Motivation:

• Orthorexia: Driven by a desire to achieve an ideal state of health or purity, rather than weight loss.
• Anorexia Nervosa & Bulimia: Motivated by a fear of weight gain or a drive to lose weight.

Behavioural Patterns:

• Orthorexia: Involves rigid dietary restrictions focused on food quality.
• Anorexia Nervosa & Bulimia: Often involve restrictive eating patterns, sometimes combined with bingeing and compensatory behaviours (especially in bulimia).

Common Overlaps:

• Both can feature strict dietary rules that lead to social isolation and nutritional deficiencies.
• In all cases, these behaviours can result in significant stress in both social and professional contexts.

Implications for Treatment:
Misdiagnosis or oversimplification of orthorexia can lead to inappropriate treatment strategies. Recognising that orthorexia is as much about an unhealthy mindset as it is about dietary choices is essential for developing holistic, effective therapeutic interventions.

In today’s digital age, cultural trends and social media play a pivotal role in shaping our perceptions of health and wellness. The surge in “clean eating” trends, championed by influencers and wellness gurus, has led many to adopt rigid dietary regimes under the guise of health optimisation. While a focus on nutrition can be beneficial, the obsession with food purity promoted online can blur the line between healthy eating and orthorexia. Social media platforms are replete with images and testimonials that idealise perfection in dietary habits, often without acknowledging the potential psychological toll such standards can take. This constant bombardment of ‘ideal’ lifestyles can fuel feelings of inadequacy and pressure, especially among vulnerable individuals.

It is essential for us to recognise that these cultural influences are not just about food—they reflect broader societal pressures to achieve an unattainable standard of perfection, especially as an impact on young people. By critically examining these influences, we can better understand how misinformation and unrealistic expectations contribute to the development of orthorexic behaviours, thereby informing more balanced public health messaging and individual awareness.

The following case study comes from ‘The various facets of orthorexic eating behavior: five case reports of individuals with supposed orthorexia nervosa.’ Barthels, F., Fischer, M., Keskini, R. et al.

Ms. A described her eating behavior as “very healthy, very disciplined and quite monotonous”.

She paid close attention to only eating unprocessed, fresh foods and to the composition of her diet. She kept track of her nutrient intake, especially of her protein intake which she has defined to be at least 1.5 g per kg of her ideal weight. Furthermore, she has determined to not eat more than 1,700 to 1,800 kilocalories per day.

Her main motivation for her keeping up with her healthy eating behavior was to prevent diseases and to promote her health.
She said that her eating behavior was often detrimental to her mental well-being, because she had to ruminate a lot about her eating behavior and that this took up very much time.

What’s interesting here is that we can see that her behaviour comes from good intentions. There are certain things which are entirely reasonable – eating fresh foods for example – but when taken as a whole (and noticing the obsessive nature of it) we see the orthorexic eating trends emerge.

Addressing orthorexia requires a multifaceted treatment approach that goes beyond conventional nutritional advice. Cognitive Behavioural Therapy (CBT) has shown promise in helping individuals identify and challenge rigid thought patterns associated with eating disorders. By reframing negative beliefs about food and health, CBT can enable individuals to develop a more flexible and balanced approach to eating.

Mindfulness-based interventions are another effective strategy encouraging individuals to become more aware of their eating habits and the underlying emotions driving their behaviours.

Such therapies help cultivate a non-judgemental awareness of food choices, reducing the anxiety associated with dietary perfectionism. In some cases, a combination of therapeutic approaches may be necessary to address the complex interplay of psychological factors involved in orthorexia. The success of these interventions often hinges on a collaborative, patient-centred approach that values progress over perfection, ultimately empowering individuals to reclaim a healthier, more sustainable relationship with food.

Improving our understanding of orthorexia is a crucial step towards fostering healthier relationships with food and promoting overall mental well-being. By delving into the definition, psychological underpinnings, cultural influences, and treatment strategies associated with orthorexia, we can better support those who struggle with this condition. At Positive Mind Works, we are dedicated to advancing mental health care through research-informed practices and compassionate support. If you or someone you know is facing challenges related to orthorexia or any other eating disorder, we invite you to explore our services, resources and get support.