By Joanna Townsend

US based licensed Psychotherapist

Dr. Steven Bratman, an American physician, invented the term “orthorexia” more than twenty years ago to describe eating behaviors among his health-obsessed patients. Deriving from the Greek word “orthos,” for right” or “correct,” orthorexia literally means a fixation on righteous eating. Though most lifestyle approaches to eating healthy are initiated with the best intentions, purist dietary rules can have detrimental implications.

Just as some people in their quest to avoid weight develop avoidant and restrictive eating behaviors like those seen in anorexia, Dr. Bratman views the unhealthy preoccupation with healthy eating seen in orthorexia as a parallel. And while it is not yet an official diagnosis in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), orthorexia is slowly being accepted and treated as an eating disorder by clinicians and mental health professionals.

What are some of the indicators?

• Elimination of entire food groups in attempt for a “clean” or “perfect” diet
• Severe anxiety, guilt, shame when eating food not regarded to be “healthy”
• Preoccupation with how food is prepared
• Avoidance of social events due to fear of not being able to follow one's “diet”
• Thinking critically or judgmentally about those who eat “forbidden” foods
• Positive self-worth being dependent on compliance with “healthy” eating behaviour
• Overexercise and exercise that is as much a primary focus as eating “pure” foods

What makes orthorexia tricky is that as the health and wellness movement spreads, clean eating is increasingly regarded as socially acceptable, if not the norm. "Orthorexia is often even heralded as a great statement of self-control and doing the right thing for your health,” says Amanda Mellowspring, a registered dietician and eating disorder specialist. But choosing to eat real, whole, nutritious food does not mean you have orthorexia. There’s a tipping point. It’s rational to be concerned about additives and preservatives, GMOs, hormones, antibiotics, and pesticides. But it comes down to how your lifestyle and engagement in health-promoting behaviours impacts you as a person.

A healthy balanced lifestyle is a conscious choice, with room for flexibility and fulfilment beyond body and food, whereas orthorexia is a psychological fixation that impairs daily functioning—affecting but not limited to one’s emotional well being, physical health, and social/interpersonal life. “In most cases, the underlying diet is itself reasonably healthy. It’s in the obsessive approach to diet taken by an orthorexic that the disorder lies,” says Dr. Bratman. So, be mindful if in the pursuit of wellness, your relationship with food is becoming excessive, psychologically limiting, and is impairing essential aspects of an otherwise healthy life.

The psychology of orthorexia

Much like other eating disorders, orthorexia thrives upon “all-or-nothing” thinking. Also called “black-and-white” thinking, this thought pattern is rooted in a distorted cognitive process where there is no space between perfection and failure. For instance, when food is labeled rigidly as “good” or “bad,” an intrinsic value is placed on the food, and on its consumer. For someone struggling with orthorexia, “good foods” are usually in the form of nutrient-dense, organic, pure foods. The problem is that with this binary, there is no grey area, and no room for balance. And because anxiety, guilt, and shame usually follow any deviation from “good” foods, orthorexic beliefs and behaviours are reinforced―a pure diet must be upheld 100% of the time in order to avoid failure and maintain self-control, discipline, and optimal health.

You can see how this distorted thinking style can actually perpetuate an unhealthy relationship with food and sabotage recovery.

Why balance matters

Balance is key because it means granting oneself unconditional permission to eat all types of foods. It releases self-judgment and allows for a life where healthy nutrient-dense foods exist right along playful indulgences. Balance also means having a healthy dose of passions and interests beyond food and exercise. Feeding our hunger for nurturing relationships, meaningful connections, a fulfilling career, and a deep spiritual practice, are just as important for maintaining good health. Food anxiety out of fear of ill-health is far more detrimental to one’s psychological state than any food is to one’s physical health.

We are surely destined for a life full of joy, meaning, and creativity beyond a perfect diet. So, if you've seen these indicators in yourself or in a friend, recovery is attainable. It’s possible to be healthy, well, vibrant AND make peace with food. But it requires being open to exploring and restructuring one’s thoughts, behaviours, and emotions around food. In fact, food freedom is an essential part of mental health and wellbeing. But if we dismiss orthorexia, we are dismissing those silently suffering.

There is help:

USA NEDA Helpline 1 800 931 2237

UK National Centre for Eating Disorders +44 084 5838 2040

Canada NEDIC 1 866 633 4220

AUS The Butterfly Foundation 1 800 33 4673

Find out more about Joanna Townsend who is US based licensed psychotherapist in our Featured Writers section. For more from Joanna, follow her along on Instagram or read more about Joanna’s coaching programs here.

Any information on this blog is not a substitute for personalised professional advice. If you are in crisis, go to your nearest emergency room, call lifeline on 13 11 14 or dial 000. If you live outside Australia, link to worldwide crisis numbers can be found in the sidebar.