It is a Thursday morning around 8:30 AM. This is the time that you always have breakfast; no earlier, no later. You prepare the same meal that you have every day at 8:30 AM. You feel comfort in this meal. It is “pure,” it is “clean” and it is “perfect.” The rest of the meals and snacks that you have planned for the day are just the same – they are also “pure, clean and perfect.”
While eating non-processed foods and being cognizant of where your food is coming from is by no means disordered eating (in and of itself), there can certainly come a point where an individual can indeed become “too healthy.”
The term Orthorexia Nervosa (ON) was first coined by Bratman and Knight in the late 1990’s in an article in Yoga Journal and is defined as an obsession with “healthy” eating choices, or the thought that eating certain foods will have harmful effects (1). There is a marked concern with the quality of food—including the source, processing, and packaging of foods to be consumed. This type of rigid thinking with regard to food choices, can lead to nutritional deficiencies, impacted relationships, decreased quality of life and other medical complications such as weight loss and malnutrition. Individuals with orthorexia typically do not have a primary focus on weight (unlike many individuals with other eating disorder diagnoses), rather, the quality and value of the food itself takes precedence. Though ON is not yet recognized as a psychiatric disorder in the DSM-5, significant research around diagnostic criteria has been reviewed by Bratman and fellow researcher Thomas Dunn, (3) and is described below:
Criterion A: Obsessive focus on “healthy food” as evidenced by:
• Preoccupation with dietary restrictions
• Violation of restrictions causes anxiety and distress with fear of disease or other negative impacts
• Dietary restrictions increase over time
Criterion B: Compulsive behavior causes clinical impairments:
• Malnutrition, weight loss, or other medical complications
• Impairment of social or academic functioning due to beliefs about dietary restrictions
• Body image concerns, self-worth and confidence are contingent on meeting “healthy” eating guidelines
Do any of the above criterion sound familiar? Do you think that you might have ON? Ask yourself these few questions, (4).
Do you choose foods based on your health status? Are you choosing foods based on the thought that it will improve your health and wellbeing? Does the thought of eating something that does not necessarily have this immediate effect make you apprehensive?
Do your thoughts about food preoccupy more than three hours of your day? You may be finding yourself thinking of things such as: planning your next meal, timing out meals, researching restaurant menus, thinking of ways to avoid eating with others, etc.
Does eating a certain way impact your typical lifestyle? Have you been isolating around meal times? Ask yourself, what does it look like when going out to eat with family or friends– are you having trouble tolerating the menu or maybe even attending? Are the obsessive thoughts about food quality impacting your day-to-day functioning and concentration?
Do you allow yourself to eat food items that are outside of categories that you’ve deemed as “healthy?” This may include foods that you once used to enjoy. It may seem like the list of these foods has decreased quite a bit recently.
Does the quality of food take precedent over taste preferences? When picking out food at the grocery store, wonder to yourself – are you choosing intuitively? Intuitive Eating: the philosophy of listening to one’s natural body cues, (hunger, fullness, cravings) rather than solely focusing on the nutrient contents, (i.e. macronutrients and micronutrients) in foods.
How do we get from “pure,” “clean” and “perfect” to “balance,” “variety” and “intuitive?” This process is not easy. To help stabilize these intrusive thoughts, clinical complications and related behaviors, adequate support from experienced professionals is the first step. If you or a loved one answered yes to one or more of these questions listed, please seek help and support through Walden Behavioral Care.
1. Koven NS, Abry AW. The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat. 2015;11:385-394.
2. Moroze RM, Dunn TM, Craig Holland J, Yager J, Weintraub Psychosomatics. 2015 Jul-Aug; 56(4):397-403.
3. T.M. Dunn, S. Bratman / Eating Behaviors 21 (2016) 11–17
4. Donini, L.M., et al. “Orthorexia Nervosa: Validation of a Diagnosis Questionnaire.” Eating Weight Disorders, vol. 10, 2005. “Homepage.” Intuitive Eating, www.intuitiveeating.org/.
Emily Schwarz, RD, LDN is the adolescent dietitian for the Walden’s residential eating disorders program and began her career with Walden Behavioral Care in October, 2017. Emily earned her Bachelor’s degree in Nutrition and Dietetics at the University of Massachusetts Amherst and completed her dietetic internship at Hunter College City University of New York in May 2017, where she worked at multiple sites to address the unique health needs of New York City. During her internship, Emily began her interest in eating disorders while completing an extensive rotation at the Renfrew Center of New York. She can be reached at firstname.lastname@example.org or at 781-693-9970.