Taking “Healthy Eating” Too Far: Understanding Orthorexia and Food Anxiety
A New Eating Disorder Diagnosis
I was chatting with another therapist, one who also treats eating disorders, when she said something that startled me. We were discussing the importance of carbohydrates and how to respond to clients who insisted on following a low-carb diet. “I tell them to just eat the three healthy carbs,” she told me, ticking them off on her fingers: “Sweet potatoes, brown rice, and quinoa. Those are the only ones I eat because they’re the only ones that are safe.” Red flags were waving in all directions. While I’d seen no signs that this therapist struggled with the more well-known eating disorders (ED), like anorexia or bulimia, I wondered if she might qualify for the “newer” ED: orthorexia. Most people have never heard the name orthorexia, but living in modern society, they definitely would recognize the symptoms.
The Signs and Symptoms of Orthorexia
People with orthorexia are obsessively concerned with the healthfulness of food. They spend hours each day planning meals and snacks, studying the nutritional content of foods, and researching how each food was grown and processed. These individuals may fixate on specific nutritional qualities of food, such as calories, fat, sugar, high fructose corn syrup, carbohydrates, salt, and more. They may overwhelmingly fixate on finding foods that are whole, organic, vegan, vegetarian, not genetically modified, etc.
The Effects of Orthorexia and Eating Disorders Over Time
Orthorexia doesn’t stop with the mental preoccupation. Individuals actively and compulsively avoid any food they feel is unhealthy or impure. Over time, they cut out an increasing number of foods until the list from which they are “allowed” to eat is very short and limited in variety. Some develop rituals such as eating at the same time every day and refusing to vary by even five minutes, convinced their body will experience weight gain or heart disease if they do.
As you can imagine, such restriction can lead to other eating disorders, including the most deadly – anorexia nervosa. When a client who is already predisposed to this self-starvation disease begins decreasing food intake, her brain’s reward circuitry changes. Where before, her brain would release dopamine due to a reward, such as enjoying a meal, it now releases it due to a punishment, like skipping a meal.
The feeling of reward occurs with other harmful behaviors as well, such as keeping detailed notes on nutrition facts or refusing to eat snacks during Bible study groups because the crackers may contain refined white flour. Freedom around food slowly slips away, followed by freedom when grocery shopping, when spending time with friends, and finally, when simply living daily life. The world grows steadily smaller and feels more and more threatening.
What began with an interest in “healthy eating” and self-discipline turns into severe anxiety and regimens that can negatively impact physical, social, and mental health. It can lead to issues like malnutrition, extreme weight loss or overeating, and problems with bone density and the reproductive system. Socializing is avoided, relationships are strained, and isolation grows as the sufferer becomes increasingly overwhelmed by obsessive thoughts and compulsive behaviors.
Orthorexia, Anxiety, and OCD
If the word “compulsive” sticks out to you, there is a reason: Orthorexia and obsessive-compulsive disorder (OCD) are connected and sometimes overlap. A qualified mental health professional trained in treating both eating disorders and OCD can tease out the difference and determine if a person qualifies for one or both diagnoses.
So why is caring about the health content of food so bad? Let’s look closer at what part of this can be harmful. We read headlines about the newest scientific discovery every day: This food changes your gut microbiome, that food increases cholesterol, and an entire group of foods increases the risk of cancer. Shouldn’t we try to avoid these foods altogether?
We should indeed be mindful of what we eat. It would be unwise to consume nothing but chocolate chip cookies seven days a week – just as it would be unwise to consume nothing but broccoli or grilled chicken or chia seeds. At the same time, no single food, eaten when you have a craving for it, will lead to immediate catastrophic results. This type of “black and white” thinking appears frequently in anxiety and eating disorders and must be challenged with an examination of the facts.
Yes, science has shown that consuming too much of one food can affect your health – when combined with many other factors. But the fear of eating this food can cause just as much damage. The consequences of high anxiety around food, obsessive thoughts about nutritional content, and highly restrictive eating can cause just as much or even more harm than food consumption.
Is Orthorexia Treatable? 4 Tips from a Therapist
So what’s the answer? While there is no one right answer to treating eating disorders, here are a few suggestions from a therapist who specializes in treating them:
Step back and question your automatic beliefs about food. Do you have a rigid way of looking at foods, placing them in strict categories labeled “good” and “bad?” Do you panic at the thought of eating anything in the latter category and strive to make perfect choices at every meal and snack?
Identify errors in thinking and challenge them with facts. Maybe you believe eating a certain food will immediately harm your health, even when no evidence supports this belief. Or maybe you think, “If I eat what my mom is serving tonight, I will get cancer.” Work toward replacing rigid views of food and meal routines with a more flexible, realistic approach.
Welcome old and new favorites back into your meal plan while finding healthy ways to manage anxiety. If you follow a raw, vegan diet but once enjoyed fish, allow yourself to start eating it again. If you’ve always wanted to try a cinnamon raisin bagel, buy one the next time you’re out and plan to eat it for breakfast the next day. Start small, and use techniques like deep breathing and journaling to cope with anxious thoughts as you move forward.
Recognize that food is a gift from God. Psalm 136:25 tells us “He gives food to every creature” and His love endures forever as the sustainer of life (Psalm 136:1). He does not want us to live in fear of this gift but rather use it to nourish our bodies and fellowship with Him.
If your anxiety and behaviors make these actions seem impossible, find a therapist and a dietitian who can assist you in your healing journey. And if you need help finding a therapist who can help you manage your eating habits and heal the wounds that contribute to your unhealthy patterns, all without compromising your faith in God who continues to provide hope even when you want to despair, I would love to work with you. You can click here to schedule a free consult (if you live in NC) and take the next step toward the life you desire.
By the way, I did gently steer my therapist friend to several instructional courses on eating disorder treatment. She took every class. Afterward, with an understanding that all foods fit and that we, as counselors, should never perpetuate fear of food, her approach to ED care radically changed. She also sought her own treatment for orthorexia and now eats the widest variety of foods of anyone I know. Trust her story. Learn from it. Recovery is within reach, and it’s possible for you, too.
Author: Jessie Tucker Mitchell, MA, LCMHCA, NCC
Jessie is a clinical therapist who specializes in eating disorders and anxiety. If you’re interested in working with Jessie or have questions about next steps, don’t hesitate to reach out and book a free intro call now!
