The Relationship Between Orthorexia and Obsessive Compulsive Disorder (OCD)
Orthorexia is a fairly recent term that is used to describe a disordered eating pattern classified by the restriction of any foods that are subjectively deemed “unhealthy.” One’s definition of healthy foods can vary, however this disorder typically involves solely consuming foods that are organic, clean and unadulterated. This would include raw, whole and limited – ingredient foods. While individuals should spend SOME time thinking about making healthy food choices, allowing oneself to only consume foods that meet optimal standards – which is a pattern indicative of someone with orthorexia – feels depriving and unattainable, which can ultimately result in feelings of guilt and/or shame.
Often, we see orthorexia occurring co-morbidly with obsessive compulsive disorder (OCD). Just as individuals with OCD set standards for how they must perform rituals or compulsions, we are seeing individuals with orthorexia setting very high standards with regards to diet and food consumption. If foods considered “unhealthy” are consumed, thoughts can often become so distressing that individuals feel the need to perform a compulsion (which can often include over-exercising and/or fasting in order to relieve anxiety). Just as those with OCD experience impairment to psycho-social functioning, individuals with orthorexia often become isolated as day-to-day tasks can feel overwhelming. Navigating grocery shopping, dining halls/buffets, going to the mall or movies, going out to eat or simply enjoying time at a friend’s or family member’s home can be stressors for those with orthorexia, and so they are often avoided.
Here are some actual examples of orthorexia cases that I have seen in my work. You will be able to see how it mirrors thoughts and behaviors that are also associated with OCD. Please note: names and specific details have been changed as to protect confidentiality.
Susan needs to eat at the same exact time every day (not 5 minutes before or after) or else calories will be absorbed differently and therefore contribute to diabetes, heart disease and weight gain
Joe must have vegetables at every eating episode as they are the “epitome of health”
Ann will only shop at Whole Foods or farmer’s markets; other grocery stores are not an option
John specifically plans out the time he showers in the evening as a shower will help digest dinner. The shower needs to be between dinner and evening snack in order to aid in feelings of fullness/eating too close together
These are common signs and symptoms of orthorexia1 that have OCD characteristics:
Compulsive checking of ingredient lists and nutritional labels
An increase in concern about the health of ingredients
Cutting out an increasing number of food groups (all sugar, all carbohydrates, all dairy, all meat, all animal products, etc.)
An inability to eat anything but a narrow group of foods that are deemed “healthy” or “pure”
Unusual interest in the health of what others are eating
Spending hours per day thinking about what food might be served at upcoming events
Showing high levels of distress when “safe” or “healthy” foods aren’t available
Obsessive following of food and “healthy lifestyle” blogs on Twitter and Instagram
Body image concerns may or may not be present
Both orthorexia and OCD are serious conditions that can severely impede upon day-to-day functioning. I would recommend that anyone who is experiencing either or both of these conditions seek treatment from an OCD and eating disorder specialist or find providers that have experience with both.
Bridget Komosky MS, RD, CD-N is a Registered Dietitian Nutritionist. She completed her Bachelor of Science degree in Nutrition at Ithaca College and her Master of Science degree in Clinical Nutrition at New York University. She completed her dietetic internship at NewYork-Presbyterian Hospital in New York, NY. Her work in eating disorders includes a six-month fellowship at NewYork- Presbyterian Hospital and New York Psychiatric Institute, employment as a dietitian on the inpatient eating disorder unit at NewYork-Presbyterian Hospital, and now as a dietitian at Walden Behavioral Care since October 2013. Currently, Bridget is the Nutrition Coordinator for Walden Behavioral Care’s CT Region adult and adolescent Partial Hospitalization Programs and the Binge Eating Disorder Intensive Outpatient Program.