While not formally recognized under DSM-5, orthorexia is an excessive preoccupation with healthy eating that escalates into rigid, self-imposed food restrictions with negative health consequences.
“Orthorexia is a form of dietary perfectionism that can take over nearly every aspect of life,” says Najeeb Riaz, MD, Medical Director of Princeton Center for Eating Disorders. “It may start by eliminating categories like dairy, meat, or gluten, but eventually the list of acceptable food options becomes dangerously narrow.”
Those with perfectionist tendencies or obsessive-compulsive disorder (OCD) may be at increased risk for developing orthorexia, according to Dr. Riaz. Many become intensely preoccupied with determining the origins of what they consume, which can lead to social impairments.
“It becomes nearly impossible for those with orthorexia to go to a restaurant or social gathering when they don’t know the sources of food ingredients,” explains Dr. Riaz. “They also may have a condescending attitude toward those who are not practicing the same rigid approach to eating.”
The Physical Impact
The body needs a full range of food groups for various purposes, including maintaining strong muscles and bones, providing energy, and boosting the immune system, according to Dr. Riaz. When one area is not functioning appropriately, it can impact all other systems. As such, the limitations imposed by those with orthorexia can result in:
- Vital sign changes
- Dizziness and weakness
- Metabolic changes, such as low potassium levels, which can impact nerve and muscle cells, or low calcium levels that can lead to osteopenia or osteoporosis
- Orthostatic (postural) hypotension and low blood oxygen levels that can lead to cardiac complications like congestive heart failure
- Weight loss and malnutrition that can evolve into anorexia nervosa
Patients with orthorexia who are below 85 percent of their ideal body weight are candidates for inpatient treatment at Princeton Center for Eating Disorders. Comprehensive treatment includes individual and group psychoeducation and psychotherapy, daily medical monitoring, and psychopharmacology when needed to address issues like anxiety or obsessive-compulsive disorder.
"Education, support, and the establishment of a therapeutic relationship are vital in treating patients with orthorexia, and they provide a baseline for our care here,” adds Dr. Riaz. “Their belief system about foods is very strong, so trust must first be established to enable work toward positive long-term outcomes.”