Orthorexia: When "Clean Eating" Becomes Dangerous

Having some knowledge about healthy eating habits is generally helpful. Implementing such knowledge is even more helpful – to a point. When a person spends an excessive amount of time thinking about the quality of one’s diet and taking great measures to eat in a “healthy” way, this can be termed orthorexia. Although orthorexia hasn’t yet been added to the Diagnostic Statistical Manual (DSM) V as an official disorder, it can still significantly interfere with one’s quality of life, with serious medical, emotional, social, and spiritual consequences.

Orthorexia is in large part a situation where a person’s focus on the quality of her food and the extent to which she adheres to “clean eating” determines her self-identity and life purpose. Over time, focusing on clean eating becomes the only way she knows how to define herself. She may not acknowledge or may lose contact with important qualities she may possess, such as kindness, humor, a wonderful smile, and wisdom. Her personal relationships, career, spirituality, and self-care may suffer due to her not being emotionally present, due to obsessing about macronutrients, weighing and measuring food, or berating herself about “having a bad day” food-wise. Her life and future can be put on hold while she chases the mirage of achieving the “perfect” food plan and the associated accolades and immunity to life’s inevitable challenges.

There are scenarios in which people eat in a particular way or omit certain foods for medical, religious, or ethical reasons. For instance, if someone has celiac disease they are generally advised by their medical doctor or nutritionist to avoid gluten. Catholics avoid meat on Fridays. Jewish dietary rules prohibit shellfish and pork. Those practicing Buddhism generally follow vegetarian diets. Adhering to such dietary boundaries does not necessarily mean that a person suffers from orthorexia. The crucial difference is how much mental and emotional energy is invested in following such dietary guidelines and whether other areas of one’s life suffer.

For example, let’s take Sally, a 19-year-old woman, who is in her freshman year of college. Living away from home for the first time in her life and faced with the increased amount of freedom over (and responsibility for) her course curriculum, homework schedule, and social life, Sally struggles with some anxiety and depression. She feels insecure about fitting in with her peers and unsure about her major in college and career direction.

By her second semester at college, Sally has developed the belief that she should eliminate fruit, grains, and starchy vegetables from her diet. Sally’s weight is within the normal range and she hasn’t been diagnosed with any medical problems, but she feels that these dietary restrictions will help her with “clean eating”.

She begins to implement these changes and initially feels more in control of her life and proud of herself for “taking charge” of her nutrition. Cutting out these food groups limits her menu choices, but she doesn’t mind. In fact, she enjoys traveling miles to stores that stock foods on her “approved” list, planning such trips, reading about nutrition, poring over recipes, and preparing her meals.

However, after a few months Sally’s involvement in social activities, attendance at her classes, and studying have taken a back seat to her focus on clean eating. Her thoughts are primarily about obtaining, preparing, and eating the “right” foods, and there isn’t much energy left for other areas of her life. Sally’s primary relationship is now with food – not the quantity (which would be characteristic of binge eating or anorexia nervosa) but the quality. Sally begins to equate her self-worth with how “clean” her food is. If she stays on her self-prescribed diet, she feels increased self-esteem, but if she eats food not on her personal “green-light” list, she feels intense guilt or shame.

She loses connection with her intuition, social circle, academic studies, and interest in other activities. Her friends have trouble connecting with Sally, due to her preoccupation with planning, procuring, preparing, and reading about healthy or “pure” food. Sally’s emotional, spiritual, and social growth are all impeded, if not arrested. Her ideas about what she would like to do with her life are put aside. Sally becomes increasingly unsure about who she is and what her values are (outside of her food choices). In fact, she’s now not sure that she ever knew who she was to begin with.

This is a dangerous situation – yet it is not uncommon. Orthorexia often flies under the radar, since being “healthy eating” can seem admirable to oneself and others. Due to social media, we are bombarded with ads for products and programs for this supplement or that diet and the implied associated happiness, success in life, and freedom from anxiety or other uncomfortable feelings. The ability to stick with “clean eating” can result in admiration from others (“You have so much willpower!”). It can be very alluring to believe that eating in a particular way will solve all of our problems.

People with orthorexia can also struggle with mental health challenges such as anxiety, obsessive-compulsive disorder, or depression. There may be a history of trauma or unmet needs. The preoccupation with food quality may be an attempt to compensate for low self-esteem, loneliness, or social anxiety. One may have trouble with interpersonal communication.

Addressing underlying issues with the help of a psychotherapist, psychiatrist, or vocational counselor can go a long way towards loosening the grip of orthorexia. After all, orthorexia is ultimately not about the food. Clarifying your values in life and acting in line with these values can take effort but will shine a light on what “healthy” really means for you in the bigger picture.

Some helpful guidelines for recovery from orthorexia:

Practice being more flexible. Relinquish rigidity. Accept that making this shift may provoke some anxiety as you grieve the idea that there is one right way to eat. Life is not that simple.
Notice when you’re engaging in black and white (all-or-nothing) thinking. Develop a more nuanced statement to view the situation in a more realistic light.
Relinquish the pursuit of perfection and focus instead on balance and progress. Also, remember that progress is a long and winding road, and be gentle with yourself when you encounter twists and turns.
Be open-minded and curious. Be willing to let go of everything you think you know, so you can see the situation with new eyes. Keep in mind that any valid belief will not be lost if in fact your initial belief was accurate. In other words, you will not lose anything worthwhile.
Trust your intuition. This may initially be a foreign concept, but gradually you’ll hone your ability to discern what feels healthy and “right” for you in all situations, rather than turning to rules (dietary and otherwise) to determine your worth and path.

In addition, it’s important to recognize that as human beings, we are tribal in nature. No type of dietary regime or nutritional supplementation can substitute for social connection. Strengthening our social support system, allowing ourselves to be more vulnerable with others, and feeling a sense of belonging can be invaluable in developing a balanced relationship with food and our bodies.