I’ve got a weird one here for you and it’s about the human relationship toward food and how humans can turn just about any behavior into an obsessive-compulsion.
Disordered eating behaviors cross a wide spectrum of irregular eating attitudes which significantly affect a person’s physical, psychological, and social well-being. What we now consider basic eating disorders–anorexia nervosa, bulimia nervosa, and binge eating—are still on the rise and can be life-threatening if left untreated. Two new conditions have entered the eating disorder lexicon in the past twenty years: orthorexia and orthorexia nervosa. These are two different yet related concepts in disordered eating. Orthorexia is a subclinical condition marked by the obsessive fixation on eating only “pure” and “healthy” foods or what is also termed, “clean eating.” People with orthorexia follow a set of strict dietary rules—often dismissing entire food groups—while behaving obsessively over where the food came from, how it is prepared, and its nutritional content. Orthorexia nervosa is orthorexia taken to a pathological extreme marked by intense anxiety, distress, and dysfunction in daily living. The concept is contradictory: healthy eating becomes self-harming or self-defeating behaviors (Horovitz & Argyrides, 2023). The worldwide prevalence of normative discontent with one’s body form and size along with the continued media images of perfect bodies, diet industry promises, and the relentless influence of social media all contribute to unhealthy obsessions with food and body image disturbance (Horovitz & Argyrides, 2023).
Typical dysfunctional behaviors would be:
- Spending large amounts of time planning menus and buying food
- Coming into conflict with those who do not share the same healthy-eating attitude
- Avoiding social situations where food may be served
- Preparing one’s own food when away from home
- Lecturing others on the benefits of clean eating
- Feeling stressed, shamed, guilty, and impure if rigid behaviors are not followed
- Negative physical sensations when failing to maintain “healthy” behaviors (Elias, Gomes, & Paracampo, 2022).
A Brazilian study showed that females are more vulnerable to orthorexia along with severe body image disturbance and that women on average are about 1.83 times more likely to engage in orthorexic behaviors than are men. This is consistent with the long-established fact that women are more likely to develop eating disorders in general (Elias, Gomes, & Paracampo, 2022).
One personality characteristic of orthorexia is behavioral rigidity which is found in people who are more compliant with authority and social rules. Another driving factor is that the intensity of unhealthy beliefs about food mirror the level of body image disturbance (Elias, Gomes, & Pararcampo, 2022). Other personality traits that support orthorexia are a need for control along with perfectionism and an intense sense of guilt if rules are not followed (Lieu et al., 2024).
The good news here is that orthorexia and orthorexia nervosa are treatable with education, behavioral interventions, and, most importantly, the development of body appreciation (Liu et al., 2024).
Closing Thoughts
Orthorexia is a strange disorder in that it is contradictory. On the one hand, a person is obsessed with “clean food” but to realize this goal they eventually fall into dysfunctional behaviors which bring distress to themselves and others.
Next, any intervention will need to enhance behavioral flexibility over rigidity while reforming negative beliefs about food and nutrition. Women in particular, as they are more likely to present orthorexic complaints, should be given special attention.
And, as has been established in the research literature over the past twenty years, the teaching and practice of body appreciation is nearly a universal panacea for normative discontent and body image disturbance.
Lastly, disturbed body image and orthorexic dysfunction need to be explored more fully as body image is a very powerful diagnostic tool to identify the condition and with which to design treatment strategies (. Further studies regarding the relationship between ON and body image could be helpful to better understand the relevance of body image as a transdiagnostic factor and its potential value as target for treatment interventions (Brytek-Matera et al., 2018).
So there is some encouraging news here amidst the odd madness.
Paul Shane, Ph.D., LMT
Director, Academic Content
References
Brytek-Matera, A., Gramaglia, C., Gambaro, E., Delicato, C., & Zeppegno, P. (2018). The psychopathology of body image in orthorexia nervosa. Journal of Psychopathology 24(3), p. 133–140.
Elias, M., Gomes, D., & Paracampo, C. (2022). Associations between orthorexia nervosa, body self-Image, nutritional beliefs, and behavioral rigidity. Nutrients 14(21), 4578. doi: 10.3390/nu14214578.
Horovitz, O. & Argyrides, M. (2023). Orthorexia and orthorexia nervosa: A comprehensive examination of prevalence, risk factors, diagnosis, and treatment. Nutrients 15, 3851, https://doi.org/10.3390/nu15173851.
Liu, C., Messer, M., Anderson, C., McClure, Z., Linardon, J. (2024). Body appreciation predicts lower levels of orthorexia nervosa symptoms: Prospective findings. Body Image 40, 101684, https://doi.org/10.1016/j.bodyim.2024.101684.