When Healthy Eating Becomes an Uncontrollable Obsession

Eating healthy food is usually considered a good thing, but sometimes so-called healthy behavior can take a dangerous and compulsive turn. There’s a word for this phenomenon: orthorexia. The term was coined by Steven Bratman, M.D., and it refers to an obsessive fixation with righteous eating. While orthorexia is not an official clinical term—unlike anorexia and bulimia, it’s not included in the “Diagnostic and Statistical Manual of Mental Disorders,” published by the American Psychiatric Association—it is a form of disordered eating that can lead to more serious conditions.

“Orthorexia is often a precursor to anorexia, but it’s also possible to see orthorexia on its own, though it’s not as common as you would think,” says Ellen Astrachan-Fletcher, vice president of clinical operations for Insight Behavioral Health Centers and licensed clinical psychologist. “It starts out as a general focus on health—eating foods that don’t have sugar or white flour in them, for instance—and such rules become more and more extreme. It can be difficult to see where the lines are crossed, from healthy eating to orthorexia, and then, perhaps, to anorexia.”

Warning Signs

So, how do you know when a loved one’s “healthy” behavior has crossed the line?

Andrea Goldschmidt, Ph.D., director of the Eating Disorders Program at University of Chicago, says that healthy eating crosses the line when it becomes inflexible—”more like a rule rather than a guideline”—and starts to interfere with a person’s day-to-day life and social activities. A person should be able to relax healthy eating standards from time to time, for holidays and other special occasions, for example. If not, and if the person feels extreme guilt after eating “unhealthy” foods or foregoes eating entirely when no “acceptable” foods are available, then there’s a problem emerging.

Astrachan-Fletcher agrees, saying to look out for when healthy eating becomes rigid and extreme, to the point that it’s dictating a person’s life.

If you think your focus on healthy eating is becoming problematic, Bethany Doerfler, a registered dietitian at Northwestern Memorial Hospital, recommends considering the following questions:

  • Do you wish that occasionally you could just eat and not worry about food quality?
  • Do you ever wish you could spend less time on food and more time living and loving?
  • Does it seem beyond your ability to eat a meal prepared with love by someone else—one single meal—and not try to control what is served?
  • Are you constantly looking for ways foods are unhealthy for you?
  • Do love, joy, play and creativity take a back seat to following the perfect diet?
  • Do you feel guilt or self-loathing when you stray from your diet?
  • Do you feel in control when you stick to the “correct” diet?
  • Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?

The more you answered yes about yourself or someone you care about, the more likely you are dealing with orthorexia, Doerfler says.

Orthorexia Versus Anorexia

Orthorexia and anorexia share an unhealthy preoccupation with food eating. However, Doerfler says, individuals with orthorexia can maintain a healthy weight, and so, “this form of disordered eating is often missed,” she says. The National Eating Disorders Association (NEDA) has a helpful quiz online that can help you or a loved one evaluate whether or not it’s time to seek help.

Getting Treatment

Individuals with orthorexia face emotional issues and could benefit from the help of both a licensed mental health provider and a registered dietitian. The emotional issues that lie at the root of both orthorexia and anorexia can be related to, for example, experiences in a person’s past. Astrachan-Fletcher says that a person with orthorexia is “decreasing his or her anxiety by restricting eating, and he or she needs a new way to deal with anxiety.” Therapy can help such a person develop new, less restrictive coping mechanisms.