How is orthorexia diagnosed?

While orthorexia is not included in the Diagnostic and Statistical Manual of Mental Disorders, edition 5 (DSM-5), most healthcare providers regard it as an important and serious illness that requires proper treatment.

As with eating disorders like anorexia, bulimia, and binge eating disorder, orthorexia can present with several serious symptoms that negatively affect mental and physical health. The following are some common orthorexia symptoms that healthcare providers look for (Koven & Abry, 2015):

  • Rigid eating patterns and diet rules that avoid foods that they categorize as “unhealthy”, sometimes extending to entire food groups (these food groups often include: processed foods, sugar, meat, dairy products, carbohydrates and/or gluten). The rigidity can lead to social isolation and anxiety about dining out.
  • An intense preoccupation with the nutritional content of foods, often driven by a desire for physical health and wellbeing.
  • Guilt or self-punishment when straying from a “clean” or “healthy” diet. When individuals stray from their self-imposed diet, severe anxiety, distress and self-punishment behaviors commonly associated with other eating disorders like restriction, purging or excessive exercise can result.
  • Obsessive thoughts about food and health that can interfere with daily life, relationships and overall well being.

Who is affected by orthorexia?

Just like other eating disorders, orthorexia does not discriminate and can affect anyone regardless of their body size, sex, age, demographic or socioeconomic status. It is still unclear how prevalent orthorexia is, and current research studies find prevalences between 6.9-90% in the general population (Niedzielski & Kaźmierczak-Wojtaś, 2021). More studies are needed before we can make any conclusions.

While there is no way to predict exactly who will or won’t struggle with orthorexia, there are some orthorexia risk factors that can cause an individual to be more apt to suffer from orthorexia at some point in their lifetime. Some common orthorexia risk factors include:

  1. Perfectionism: Individuals with high levels of perfectionism may be more prone to developing orthorexic behaviors. They may set strict dietary standards and become fixated on adhering to them, often striving for an unattainable level of dietary purity.
    History of an eating disorder or mental health issues: A history of other eating disorders or mental health conditions, such as obsessive-compulsive disorder (OCD), anxiety disorders, or depression, may increase the risk of orthorexic tendencies. These conditions can contribute to rigid thought patterns and behaviors related to food. It is also not uncommon for people who are recovering from another eating disorder to develop orthorexia to compensate for their increased food intake/reduced purging (Segura-Garcia et al., 2014).
  2. Extreme interest in health and wellness: An interest in health and wellness can be a positive pursuit, but when taken to an extreme, it can lead to orthorexic behaviors. An individual's desire to optimize their health can evolve into an obsession with clean eating and an avoidance of certain foods.
  3. Social and cultural influences: Societal trends and cultural ideals that emphasize healthy eating, weight loss, and dietary purity can contribute to orthorexic tendencies. Pressure to conform to these ideals can push individuals toward extreme dietary restrictions.
  4. Negative life events or stress: Significant life changes, stressful events, or traumatic experiences may trigger the development of orthorexic behaviors as individuals seek control and order in their lives through strict dietary rules.

It's important to remember that not everyone with these risk factors will develop orthorexia, and some individuals may have other risk factors not mentioned here. Additionally, orthorexia may overlap with other eating disorders or mental health conditions, making diagnosis and treatment complex.

What are the health risks of orthorexia?

Since a focus on health or clean eating is often normalized, it can be easy to see orthorexia as a less serious problem than more commonly known eating disorders like anorexia and bulimia, but orthorexia can pose equally serious risk to overall physical and mental wellbeing. Some orthorexia health risks include:

  • Malnutrition
  • Depression
  • Severe anxiety
  • Irritability
  • In rare cases, death

While those with orthorexia often begin following certain rigid eating patterns with improved overall health as their goal, the extreme measures start to have the opposite effect over time. Sometimes the condition becomes so intense, one experiences severe weight loss and malnutrition. Damage to personal relationships and a general lack of interest in other activities or hobbies are also common.

It is common for individuals who suffer from orthorexia to also have anxiety disorders or other eating disorders, especially anorexia and bulimia. While it is not officially recognized as a stand-alone eating disorder, orthorexia should be cause for concern and specialized treatment for orthorexia is recommended.

Treatment Orthorexia Athlete

What are the treatment prognostics for orthorexia?

While more research is needed, the studies conducted so far suggest that people with orthorexia benefit from a similar treatment approach as other eating disorders (Niedzielski & Kaźmierczak-Wojtaś, 2021), Current best practices for orthorexia treatment involves cognitive-behavioral therapy (CBT), psychoeducation and medication (Koven et al., 2015).

Athletes are two to three times more likely than the average person to develop an eating disorder. Those impacted by disordered eating or nutritional deficiencies will become less competitive in sport, more prone to injury and risk permanent physical damage that, in some cases, can be life threatening. Walden’s GOALS Intensive Outpatient Eating Disorder Treatment Program is designed specifically for adult athletes (18+) who need guidance on how best to optimize the balance between nutritional needs and performance goals.

Learn more about our specialty virtual program for athletes

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Koven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015 Feb 18;11:385-94. doi: 10.2147/NDT.S61665. PMID: 25733839; PMCID: PMC4340368.

Niedzielski A, Kaźmierczak-Wojtaś N. Prevalence of Orthorexia Nervosa and Its Diagnostic Tools-A Literature Review. Int J Environ Res Public Health. 2021 May 20;18(10):5488. doi: 10.3390/ijerph18105488. PMID: 34065506; PMCID: PMC8160773.

Segura-Garcia C, Ramacciotti C, Rania M, Aloi M, Caroleo M, Bruni A, Gazzarrini D, Sinopoli F, De Fazio P. The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Weight Disord. 2015 Jun;20(2):161-6. doi: 10.1007/s40519-014-0171-y. Epub 2014 Dec 28. PMID: 25543324.

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