Orthorexia: the “healthy” eating disorder

undefined The idea seems surprising. How can trying to eat well become a health problem? How can wanting to take care of your body by adopting a healthy diet lead to a behavioural disorder?

The answer is that “healthy eating” can become a problem when this well-meaning quest falls into excess and eating “pure” meals becomes the day’s sole preoccupation. This disorder is known as orthorexia. Doctissimo gives you the lowdown on this quest for the perfect diet.

What is orthorexia?

Orthorexia is a recently identified problem which Dr Steven Bratman was the first to describe in 1997¹. The term comes from the Greek “orthos” meaning right or correct, and “orexis” which means appetite.²   This eating disorder is characterised by a pathological obsession with eating healthily and ends up with numerous food restrictions. Orthorexics will often exclude any food from their diet which contains pesticides, herbicides or other chemical products from their diet.

Bulimics, anorexics and orthorexics all have a distorted attitude towards their food. But where anorexics begin to under-nourish themselves in order to lose weight and bulimics eat excessively without feeling either hunger or satisfaction; orthorexics put emphasis on the quality of food rather than the quantity. “For orthorexics, the objective is to be in good health. They fear the effects of the environment on the body and seek to reduce these by eating healthy, good quality food,” explains Catherine Dijuste, therapist and specialist in eating disorders.

Another big difference between these three food-related problems is that there is no “physiological” aspect to orthorexia, as there is in cases of anorexia and bulimia. “This is one of the reasons why orthorexia is not considered an illness”, the specialist adds.

Orthorexia: what are the risks?

Since orthorexics refuse all food which they judge to be “impure,” and sufferers spend most of their time developing different meals according to their special rules, their social lives can gradually disintegrate. It is difficult to dine at friends’ houses or to go to restaurants when not knowing where the food has come from and how it was prepared is an issue. It is exactly this social isolation which is the most serious consequence of this obsession. 

Catherine Dijuste is more reassuring on the subject of the health risks associated with orthorexia: “Orthorexia is all about wanting to be healthy. As a result, the sufferer will eat “well”, not wanting to risk developing any kind of deficiency,” except for in certain, extreme cases where orthorexia becomes too restrictive and leads to weight loss and serious nutritional deficiencies. Dr Bratman describes this rarer, more serious, and sometimes fatal version as orthorexia nervosa.

According to the specialist, the main problem is dietary education given to children by orthorexic parents: “Orthorexic parents try to transfer their fear of “poisonous” foods to their children and there is a risk that the children might then become anorexic or bulimic in adolescence. The risk of obsessional disorders becomes greater, because eating becomes a source of worry and guilt for them.”

Profile of an orthorexic

Not considered as ill, and therefore not treated by medical professionals, it is difficult to estimate the number of orthorexics. However, thanks to certain studies, it has been shown that orthorexia mostly affects adults, with women and people who play sport regularly being the most at risk. For adolescents, “It can be a way of hiding another problem, like anorexia,” Catherine Dijuste speculates. Young girls will explain their new diet by affecting a concern for eating well and staying healthy.

People suffering from orthorexia are often very fastidious and organised, with a keen eye for detail. They want to stay in perfect health above anything else, warding off illness and staying slim (synonymous with good health for them) and will develop their own strict dieting rules, which they will force themselves to follow.

Fatty foods, sugar, salt, chemicals... Orthorexics flee from everything they consider to be poison for the body. They generally consume organic products, and in some cases may become vegetarian or vegan.

If the rules of the diet are ever broken, orthorexics are seized by a strong feeling of guilt and will try to do everything they can to “re-purify” their body: diet, detox and deprivation...

Are we all would-be orthorexics?

At a time when health warnings urge us not to eat too much sugar or salt, and to eat five portions of fruit and vegetables a day or risk endangering our health, are we all condemned to become orthorexic?

No according to Catherine Dijuste: “We do not all become orthorexic as the development of this disorder requires certain pre-existing conditions.” Conditions that the specialist defines as a certain fragility: “People with fluctuating self-esteem and who are slightly paranoid, always in control and trying to forget certain problems in their lives by projecting them onto food are more likely to suffer from orthorexia than others.”

The Bratman Test: Steven Bratman designed a test in order to attempt to identify people who are orthorexic. If you respond “yes” to four or five of the questions, you should try to adopt a more flexible attitude towards your diet. If you respond “yes” to all the questions, you could potentially be suffering from orthorexia, and it could be worthwhile consulting a nutritional specialist to find out more.

• Do you spend more than three hours a day thinking about your diet?
• Do you plan your meals a few days in advance?
• Is the nutritional value of a meal, in your eyes, more important than the taste and the pleasure of eating it?
• Is your quality of life affected negatively when the quality of your diet improves?
• Have you recently become more demanding of yourself?
• Is your other half forced to eat healthily because of you?
• Have you given up foods which you previously liked in favour of “healthy” foods?
• Does your diet prevent you from going out, distancing you from your family and friends?
• Do you feel guilty when you stray from your regime?
• Do you feel at peace with yourself and feel in control when you eat healthily?

1. Dr Steven Bratman’s Orthorexia Home Page
2. "Orthorexia nervosa. A new eating behaviour disorder?" Actas Esp Psiquiatr. 2005 Jan-Feb;33(1):66-8  

Sources :

• Interview with Catherine Dijuste, therapist, eating disorder specialist, member of French study group on obesity and overwieght (GROS)
• Orthorexia Nervosa – US National Eating Disorders Association 
• The European Food Information Council

Jessica Xavier

More information:
Anorexia nervosa
Bulimia
Nutrition discussions