Going vegan, eating organic, or simply cutting sugar can all be healthy lifestyle choices. But if doing so gives you anxiety about hanging out with friends (what if there's nothing I can eat?!) or makes you fear certain foods, it can actually be quite dangerous. Yep, being too healthy can actually be unhealthy.
Orthorexia is an obsession with eating a "pure" diet, which can mean avoiding foods with unhealthy fats, added sugar or salt, genetic modifications, artificial colors, or flavors and preservatives. And it's becoming increasingly common—in part due to the way #cleaneating is glorified on Instagram.
When Healthy Eating Becomes an Obsession
While it’s smart to care about what goes into your body, it can become a problem if the restrictions start taking over your life. “If a behavior is so disruptive that it interferes with work and personal relationships, it could be a sign of a psychological disorder," says clinical psychologist Sherry Pagoto. "Social life is a huge factor in health because it’s a buffer for stress."
Extreme orthorexics will often turn down social invitations, fearing that “healthy” food won’t be available. Or—if they opt to risk it—will refuse to touch even a morsel of "impure" food (anything processed, refined, or unhealthy), despite hunger pangs.
Some may even spend tons of time shopping for specific groceries and preparing meals, or hide their habits from friends and family to avoid criticism. The clinical basis of orthorexia nervosa: emerging perspectives. Koven NS, Abry AW. Neuropsychiatric disease and treatment, 2015, Feb.;11():1176-6328.
Though they sound similar, orthorexia is markedly different from anorexia: The goal is not necessarily to lose weight but instead to attain “perfect” physical health.
Someone who's anorexic might avoid healthy fats found in oils and nuts like the plague because they're afraid of the calories, while an orthorexic person is more likely to acknowledge fat’s health benefits and carefully portion out their organic almonds and expeller-pressed oils. They wouldn't fear weight gain so much as eating an imperfect diet.
Depending on the extremity of the diet, some health-food addicts can fall prey to chronic hunger and rapid weight loss as they blacklist “unhealthy” foods. Others don't lose any weight at all because they eat enough ultra-healthy foods to sustain themselves. So don't discount someone's disorder just because they're not stick thin.
Why It Matters
Orthorexia isn't currently recognized as an official medical condition in the DSM-5, the statistical manual of mental disorders. And the term itself has only been around since the late 90s, so there's not a ton of research on it.
Since orthorexia has less to do with poor body image or self-esteem, and more to do with a fear of illness and bad health, some classify it as a form of OCD, where a person satisfies unreasonable obsessions (like, say, eating a completely pure diet) with ritualistic behavior (meticulous calorie counting and nutrient tracking, refusal to eat certain foods, etc.). Obsessional and Eating Disorder-related Intrusive Thoughts: Differences and Similarities Within and Between Individuals Vulnerable to OCD or to EDs. Belloch A, Roncero M, Perpiñá C. European eating disorders review : the journal of the Eating Disorders Association, 2016, Jun.;24(6):1099-0968. [Eating disorders (ED) and obsessive-compulsive disorders (OCD): common factors]. Bertrand A, Bélanger C, O'Connor K. Sante mentale au Quebec, 2011, Dec.;36(1):0383-6320.
In this case, someone with orthorexia might undergo cognitive behavioral therapy to address the unhealthy rituals attached to their grocery shopping, food prep, and eating habits.
Some psychologists think a combination of CBT and mindfulness (which increases the awareness and acceptance of uncomfortable sensations) can train orthorexic patients to overcome anxiety related to their health.
Others think orthorexia should be treated like any other eating disorder and involve physicians and dietitians—and sometimes even the use of drugs that help to control mood by inhibiting serotonin receptors.
Because it's not an accepted medical term, there's no definitive classification, diagnosis, or treatment for orthorexia. But before you start diagnosing every health-fanatic friend, know there’s a fine line between health-conscious and health-obsessed. The term orthorexic does not apply to people with medical conditions that absolutely forbid certain food groups, such as those with celiac disease, lactose intolerance, or food allergies.
The distinguishing factor seems to be whether the behavior interferes with other obligations (especially social life). If your fear of unhealthy food is keeping you from grabbing a drink after work or taking a rest day, consider talking to a professional about those feelings.
One easy way to ward off unhealthy feelings is to take a break from social media—especially Instagram. A recent study found that heavy Instagram users, especially those who follow a lot of health-related accounts, are way more likely to have orthorexic tendencies than people who stay away from aspirational food accounts. Instagram use is linked to increased symptoms of orthorexia nervosa. Turner PG, Lefevre CE. Eating and weight disorders : EWD, 2017, Mar.;22(2):1590-1262.
This doesn't mean you should unfollow all your favorite food blogs; maybe just turn off post notifications, so you're not seeing their ultra-healthy pics all day every day. Another idea? Create a separate Instagram account where you follow your go-to foodies. That way, you can just check it when you're looking for recipe inspo or product reviews.
The most important question to ask yourself is: Am I happy? A health-conscious person cares about their body, but a health-obsessed person freaks out over it. Your diet and exercise shouldn't give you anxiety.
While some foods are healthier than others, there's no food that's going to kill you if you eat it once or even a few times.
Living a healthy life shouldn't require you to turn down people and experiences that make you happy. Even for the sake of “perfect” health, exclusively talking to your organic, homegrown tomato plant is not sufficient social interaction. Cutting down on junk food is great, but moderation is key to achieving both physical and mental health.