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Orthorexia Causes, Symptoms and Treatment

The term orthorexia comes from the Greek “ortho  ” which means “correct” and ”  orexie  ” which means “appetite”. Dr. Steven Bratman was the first in 1997 to talk about orthorexia to describe a new deviant eating behavior.

Orthorexia is not considered scientifically as a eating disorder (TCA) , so statistics on orthorexia remain very rare. While an anorexic or bulimic person will exhibit a quantity-focused food obsession, an orthorexic person will focus on quality. She will adhere to a strict diet consisting of foods that she considers to be pure, healthy and good for health.

People with orthorexia are anxious about eating food they think is bad. This anxiety generates the setting up of rituals to select and prepare the best possible diet.

In Anglo – Saxon literature we speak of nervous orthorexia for the most severe forms of this disorder.

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The diagnosis of orthorexia

At present, there are no recognized diagnostic criteria for orthorexia.

Given the suspicion of an orthorexia-type non-specific eating disorder (TCA-NS), the health specialist (general practitioner, nutritionist, and psychiatrist) will question the person about his diet.

It will evaluate the person’s behaviorsthoughts and emotions related to the desire to eat pure and healthy foods.

He will look for the presence of other disorders (obsessive-compulsive disorder, depression, anxiety) and control the impact of the disorder on the body (BMI, deficiencies).

Finally, he will evaluate the impact of the disorder on daily life (number of hours spent per day to choose his diet) and on the social life of the person.

Only a healthcare professional can diagnose a food behavior disorder (TCA).

The Bratman test

Dr. Bratman has developed a practical and informative test that allows you to know the relationship that can be had to his diet.

Just answer “yes” or “no” to the following questions:

– Do you spend more than 3 hours a day thinking about your diet?

– Do you plan your meals several days in advance?

– Is the nutritional value of your meal in your eyes more important than the pleasure of tasting it?

– Has the quality of your life deteriorated while the quality of your food has improved?

– Have you recently become more demanding with yourself? –

– Is your self-esteem strengthened by your desire to eat healthy?

– Did you give up foods that you liked for “healthy” foods?

– Does your diet interfere with your outings, keeping you away from family and friends?

– Do you feel guilty as soon as you deviate from your diet?

– Do you feel at peace with yourself and do you feel comfortable controlling yourself when you eat healthy?

If you answered “yes” to 4 or 5 of the 10 questions above, you now know that you should adopt a more relaxed attitude to your diet.

If you answered “yes” to more than half you may be orthorexic. It is then advisable to turn to a health professional to discuss.

Source: The obsession with eating “healthy”: a new eating disorder – F. Le Thai – Daily Nutrition Paper of the Doctor of 25/11/2005

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Researchers are working on the scientific validation of a diagnostic tool (ORTO-11, ORTO-15) based on the Bratman questionnaire for the detection of orthorexia. However, since orthorexia does not benefit from international diagnostic criteria, few teams of researchers are working on this disorder.

Causes of Orthorexia

Orthorexia is characterized by an obsession with eating well. The American doctor Steven Bratmanwas the first to give a name to this phobia in 1997. He mentioned it in his book Orthorexia: Health Food Junkies Overcoming the Obsession with Healthful Eating. Since then, this obsession with healthy eating has evolved into a social phenomenon.

A true disorder, orthorexia is an atypical eating behavior. The principle is to have an extremely healthy diet without being constrained. For example, people with high cholesterol must follow a very strict diet to limit their lipid levels in the blood. The orthorexic person will impose a binding diet without medical reason.

Orthorexia responds to widespread concern about the potential for dangerous foods, even those known to be good for your health. Therefore, a person who suffers from orthorexia can decipher food labels obsessively.

 Associated disorders

The main disorder associated with orthorexia is the food obsession. Orthorexia is sometimes equated with obsessive-compulsive disorder (OCD). Indeed, the orthorexic person will be guided by his or her personal beliefs   towards the perfect diet. The result will be real rituals of choice and preparation of food. The orthorexic person has a need for permanent control over their diet, which will generate anxiety and depression.

People who suffer from orthorexia may have low self-esteem, especially when they “crack” and cannot constrain themselves strictly to their diet. The ulpability and a negative vision of themselves ensue.

People with other eating disorders, such as anorexia, may develop an associated orthorexia.

The complications of orthorexia

Sometimes a very excessive eating disorder, orthorexia can have serious consequences for the body and the mind. It is the obsession with healthy eating that takes control over the way of life and thought.

Complications will depend on the severity of the orthorexia and the diet that the person is forced into.

In the least severe cases, orthorexia would not cause more health risk than those incurred by people who follow a vegetarian diet (diet excluding the consumption of animal flesh) or vegan (diet excluding in addition to their flesh, foods derived and produced by animals such as eggs and gelatin).

Pushed to the extreme, neurorexia nervosa can cause malnutrition and death. The appearance of deficiencies (vitamins, minerals, and other nutrients) is common because of a diet too strict. These deficiencies can affect the muscles (including the heart), the bones (risk of weakening of the bones or even of early osteoporosis), the hormonal functioning and also the brainSignificant weight loss can also be observed.

Obsessed with his quest for perfect nutrition, an orthorexic person can isolate himself socially and lose his appetite for life. Food obsessions can lead to isolation, withdrawal, sometimes interruption of studies or professional activity, and aggravate eating disorders, creating a vicious circle.

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The symptoms of orthorexia

It is not easy to recognize an orthorexic person although the sickly desire to have a healthy diet is at the heart of his concerns.

The signs of orthorexia are similar to:

  • Follow restrictive dietary rules to minimize salt, sugar and fat intake;
  • Categorize foods as “good / healthy” or “bad / unhealthy”;
  • Be obsessed with the quality aspect of food. An orthorexic person may even go as far as providing emergency meals if she does not eat at home;
  • Consider food as a medicine to the detriment of taste or pleasure. Fatty or sweet dishes are considered to be poison;
  • Spend several hours a day thinking about optimizing your diet;
  • Abuse dietary supplements;
  • Decipher food labels with special reference to additives, preservatives and dyes. By logic, an orthorexic person relies on organic foods without pesticides;
  • See this obsession become almost spiritual. A person with orthorexia thinks to preserve his health and body purity by eating ideally;
  • Conduct a lot of research to find the ideal diet;
  • Forcing oneself into true rituals:chew food at least 50 times before swallowing, do not eat vegetables that have been harvested for more than a few hours, cook steamed beans for 12 minutes in order to keep them healthy;
  • Hold moralizing and rigid discourses on healthy eating.

People at risk for Orthorexia

The population of the industrialized countries would be more affected by orthorexia.

Many factors such as the abundance of food productsthe omnipresence of dietary advice and the hygienist theories would have an influence on the development of orthorexia in this population.

A study conducted on the Italian population found more orthorexia in men than in women. Conversely, the Turkish population has more orthorexic among its fellow citizens.

Finally, athletes concerned about the impact of their diet on their performance, would be more likely to develop orthorexia.

Risk factors

A study conducted in Turkey 4 shows that the presence of several conjugated factors would influence the occurrence of orthorexia. A body mass index  higher associated with the presence of obsessions related to a desire to eat healthy increase the risk of developing orthorexia.

Prevention of orthorexia

Orthorexia is the result of extreme food advice. The sugar, constantly pointed by health professionals, is seen as bad for health. For orthorexic, it should therefore not consume. On the other hand, the highly recommended fruits and vegetables will form the basis of many orthorexic foods.

The motivations of orthorexic people can be as follows:

  • Obsessive desire to be in good health, and to live in a healthy body;
  • Willingness to lose weight even if it is not necessary, not by decreasing the quantity, but by choosing quality foods. Obesity is perceived as a real scourge;
  • Achieving social standards of beauty, although this is not the main goal.

There is no prevention of orthorexia. Prevention ultimately involves early detection that allows it to be treated as soon as possible.

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Medical treatment of orthorexia

This disorder is not considered scientifically as a disease. In our society, healthy eating is seen positively, especially because of the explosion in the number of cases of obesity. However, in orthorexia, eating healthy is pushed to the extreme and turns to obsession. Orthorexia brings real suffering and impacts the daily lives of people affected.

There are no specific recommendations for the treatment of orthorexia. The treatment is similar to that proposed to treat other eating disorders (anorexia, bulimia). It would consist in setting up a multidisciplinary follow-up including various forms of interventions: complete medical evaluation, support, medical follow-up, psychotherapy and in some cases medication.


The psychotherapy aim in part to reinstate the concept of pleasure from eating. The interest of the therapy is to manage to no longer be governed by his obsession to eat healthy and pure to regain self-control by letting his desires speak without feeling guilty.

The treatment of eating disorders usually involves behavioral and cognitive therapy similar to that used to reduce obsessive-compulsive disorder (OCD). This therapy aims to reduce the anxiety related to food obsessions and reduce the compulsions (rituals of choice and preparation of food) caused by these obsessions. The sessions can be composed of practical exercises, the person being confronted with situations that she fears, with relaxation or with role plays.

Group therapy and family systemic therapy may be offered.


The use of the drugs will be reserved for the relief of the symptoms associated with orthorexia (obsessive-compulsive , depression, anxiety), not to intervene on the disorder itself.

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