In This Article
Editor's Note: This story discusses eating disorders and disordered eating. If you are struggling with an eating disorder or disordered eating and need help, visit NEDA to talk to someone via phone, chat, or text who can help.
Growing up, I viewed my obsession with "eating healthy" as a requirement for existing. This wasn't because I thought eating certain foods would help me live longer or be stronger, but because I disliked my body so intensely. I felt that food was the only way to change or control it. I remember being in middle school and feeling bitter that other girls (those I deemed "naturally thin") could eat a bag of chips with lunch without thinking twice or choose mayonnaise instead of mustard on their sandwich without considering the caloric difference. Still, I felt like this was just a fact of life. At my core, I felt that my body would never be good enough to not think about what I ate.
As I got older, this preoccupation with food took the form of diets and exercise. But with every diet and obsessive bout of exercise, I had an excuse that sounded a whole lot like, "I want to be healthy." I wasn’t running five miles a day because I was obsessed with being thinner. I was doing it because I was training for a half-marathon, and exercise helped me decompress. I wasn’t giving up dairy because it was an easy way to cut calories; I was doing it because of "gut health" (spoiler: my gut was fine). I wasn’t refusing to eat pasta and bread because I thought I couldn’t eat carbs without losing weight; I was doing it because they made me tired.
The truth—which I’d later discover and admit to myself in therapy—was I had to be constantly shrinking myself to be happy. "I’m being healthy" was a much easier thing to say to myself than "I have an eating disorder." Orthorexia is the exact term that my therapist used to diagnose my behaviors around healthy eating (many of which I still have today).
As Dr. Sid Khurana explains, orthorexia isn’t technically an established diagnosis in the diagnostic statistical manual (this is what health care professionals use to diagnose mental disorders), but it still very much exists. "Orthorexia Nervosa is a term used to describe people whose extreme diets—intended for health reasons—are leading to malnutrition or impairment of daily functioning, or in other words, a pathological obsession with healthy eating," he explains.
Jeana Cost says another common hallmark of orthorexia is that it frequently begins as a small thing. "It often starts with small changes and good intentions but turns into extreme dietary rules and restrictions," she notes.
Because orthorexia is so sneaky, it can be hard to identify it in yourself or others. But if you find yourself constantly preoccupied with "healthy eating," then it’s worth considering speaking to a professional. Not sure if you fall into this category or not? Here are seven other signs your obsession with health and wellness could be orthorexia, and what to do if they resonate.
Meet the Expert
Dr. Sid Khurana, M.D., is a board-certified general psychiatrist at Nevada Mental Health. He is certified in both general psychiatry and child/adolescent psychiatry, and he specializes in the treatment of bipolar disorder, PTSD, and anxiety.
Jeana Cost, MS, LPC, CEDS is the vice president of clinical services at Denver Health's ACUTE Center for Eating Disorders, the only intensive care unit dedicated specifically to helping patients with eating disorders and severe malnutrition.
Only Eating a Select Number of Foods
If you find yourself eating select types of food and only those foods (and you don’t have any physical condition or allergy that requires such dietary restrictions), this can be a sign of orthorexia. "In all eating disorders, the relationship with food is complicated," Khurana says. The most significant difference with orthorexia isn’t the quantity of food (a hallmark of eating disorders like anorexia) but the type of food.
For me, I used to substitute foods that were "acceptable" for foods that weren’t. I can remember telling myself I was allowed to eat 20 servings of a particular vegetable (regardless of whether I was hungry or not), but that a single cookie wasn’t OK.
Thinking Constantly About How "Clean" Your Food Is
Becoming obsessed with the "purity" of a food is another sign of orthorexia, says Khurana. This happened with me, too, always in the form of one diet or another. With many of the diets I went on, I became hyper-focused on the ingredients in food. Did it have artificial ingredients? Added sugar? Not enough protein? Was it "clean" enough? These were the things I asked myself before eating something to determine whether or not I could eat said food without shame.
This can also be something that occurs in both anorexia and bulimia, Khurana mentions. Notably, though, Cost points out that not everyone with orthorexia is driven by a desire for thinness.
Punishing Yourself if You Eat Something You Consider Unhealthy
People with orthorexia also often view eating something "unhealthy" as worthy of punishment, says Khurana. For many years of my life, I would tell myself I could only eat a bag of popcorn at the movie theater if I ran for three hours the next day. Or, I could only go out drinking with my friends if I spent three hours in the gym beforehand. If I didn’t punish myself with exercise, I felt intense shame about eating something that I had deemed "bad."
Believing You Eat Healthier Than Most Other People
Being convinced that how you eat is healthier than others is another common sign of orthorexia, according to Khurana. Cost also notes that being overly critical of how others eat is a sign of orthorexia.
Though I would have never admitted it at the time, I compared the way I ate to others constantly (and still do, sometimes, even post-diagnosis). I got a sense of pride that I ate "better" than other people, and I resented people who didn’t stick to strict diets and were thinner than me.
Spending a Lot of Time Finding and Acquiring "Acceptable" Foods
Khurana says spending an excessive amount of time food shopping, meal planning, and finding "acceptable" foods can be a sign of the condition. Of course, many people can shop for food, plan meals, and prep foods they like in a balanced way. But if this type of activity consumes your way of thinking, then it might be a sign of a bigger problem.
I can remember feeling anxious or panicked when I’d enter situations where I didn’t know what was "safe" to order at a restaurant. I spent hours checking menus and calorie counts online before meals to make sure I wouldn’t be unprepared and forced to eat something "bad." Little did I know, this was orthorexia.
Having Obsessive-Compulsive and Perfectionist Traits
Orthorexia also coincides with other psychiatric conditions, as Khurana points out. "Orthorexia has a correlation with perfectionism, obsessive-compulsive traits, psychopathology, disordered eating, history of an eating disorder, dieting, poor body image, and drive for thinness," he says.
Having a History of Anorexia or Bulimia
Like mentioned before, orthorexia can sometimes coincide with anorexia and bulimia, but Khurana points out it can also appear after treatment for an eating disorder. Cost says one of the most significant commonalities between all of the disorders is that they are all often centered around control, and using food as a way to exert this.
Because there can be so much overlap (for example, anorexia disguised as vegetarianism), it’s important to speak to a mental health professional and get an assessment. Khurana says this is key to finding out if someone is overvaluing healthy eating, struggling with orthorexia, or dealing with other conditions.
If any of the signs above sound familiar to you, it’s best to follow Khurana’s advice and seek advice from a mental health professional. Cost agrees and notes that anyone who has an eating disorder that disrupts their life should seek help from someone specializing in the area. "Getting an assessment is the first step, and then starting to work with a mental health professional (therapist) for the coexisting conditions can be a good place to start," Khurana adds. "Combination of therapy and appropriate medications can be appropriate for certain clinical situations."