"I thought I was just being healthy," said Sandra H., a 23-year-old who recently completed treatment for her obsession with dietary perfection. What began as a pursuit she felt passionate about gradually consumed her every waking hour. Because of her early recovery stage, she requested anonymity.
"I started by cutting [out] meat," she continued. "Then sugar, then all processed foods. Eventually, I was only eating raw fruits and vegetables and a few sprouted grains. Then one day at work, I fainted."
Sandra's doctor diagnosed her with severe iron-deficient anemia and referred her to a psychologist who specializes in eating disorders.
"I was shocked," Sandra said. "But once my therapist started asking me questions ... like how often do you think about food and if I prioritized eating healthy over happiness, it became pretty obvious. My lifestyle wasn't normal or remotely healthy. I was really hurting myself."
Some professionals use the term orthorexia nervosa to describe Sandra's condition, which literally means a "fixation on righteous eating." Dr. Steven Bratman coined the phrase in 1996. Orthorexia refers to an unhealthy obsession with eating healthy food, and it is a serious condition. The obsession can cause severe physical health ramifications.
I started by cutting [out] meat, then sugar, then all processed foods. Eventually, I was only eating raw fruits and vegetables and a few sprouted grains. Then one day at work, I fainted.
Sandra H., recovering disordered eater
What's in a Name?
The "Diagnostic and Statistical Manual of Mental Disorders" does not consider orthorexia an official mental disorder, and opinions within the psychiatric and dietary industries are mixed as to whether it should be.
Registered dietitian Mary Barbour described orthorexia as an "eating disorder much like anorexia nervosa, except instead of obsessing about being thin, [those with the condition] are fixated on eating foods that make themselves feel pure, healthy and natural."
You might, for example, limit your diet to organic foods. And should an unorganic food meet your plate, you can experience panic or partake in juice cleanses, which involve fasting and the use of herbal laxatives, to "detoxify" your body. Although the specifics vary, it is the extreme nature of your beliefs, thoughts and behaviors that pose a danger.
"Personally, I'm not much for diagnosable labels," said psychotherapist and former world-class athlete Diane Israel, whose own obsession with healthfulness once robbed her of emotional and physical wellness. Even so, she believes that orthorexia is a legitimate condition. Making it diagnosable may help ensure effective, timely treatment and guard against serious complications.
Elizabeth Shaw-Draves, a limited license clinical psychologist, uses other terminology.
"I do see clients who are obsessed with healthy eating, but I tend to work with them through an understanding of their healthy-food obsession as a manifestation of anxiety and OCD symptoms that are food focused," she explained. "A term that I sometimes use to describe food-focused obsessions that are subclinical, not serious enough to be diagnosable, is disordered eating."
Regardless of what you call it, most industry professionals agree that the condition's primary symptoms, such as severe dietary restriction, an obsession with eating "perfectly" and unnecessary weight loss, are worth addressing. In severe cases, they threaten lives.
From a nutritional standpoint, a fixation with healthy eating can lead to deficiencies of vitamins, minerals, protein, carbohydrates and fats necessary for everyday functioning.
In extreme cases, said Barbour, "there is a risk of undernourishing and eventually dying. Orthorexics may cut out so many foods that they convince themselves are impure that they limit themselves [in] what they can eat."
Dietary extremes also affect your emotions. As your fixation deepens, you may feel intense anxiety if your eating ritual is somehow altered or delayed, experience guilt after eating "imperfectly," or find yourself skipping out on social or work functions involving food outside of your comfort zone. Over time, these symptoms can lead to depression, sleep difficulties and hindered interpersonal relationships.
The three markers that your health-food interest has become an obsession are extreme rigidity in your eating patterns, in your allowed foods and in the amount of food you consume.
"Unwillingness to stray from carefully planned meals or mealtimes, as well as obvious stress and irritability when presented with impromptu eating -- i.e., dining out, grabbing food on the go -- are the behavioral manifestations of these issues," Shaw-Draves explained.
The amount of time you spend thinking about food is another factor, including time spent planning meals, calculating your caloric intake and reprimanding yourself for eating foods you've banned from your diet. Your dreams and first thoughts upon waking may also involve food.
Investigating the Roots
Understanding where the healthy-eating obsession comes from may help prevent or reduce its repercussions.
Although health is a common motivating factor, according to Karin Kratina, a registered dietitian affiliated with the National Eating Disorders Association, fear of poor health, a compulsion for complete control, a desire for thinness, spiritual factors and the use of food to establish a unique identity may also contribute. Other risk factors include having loved ones who diet; having low body image or self-esteem; partaking in body-focused activities such as gymnastics, bodybuilding or beauty pageantry; and, possibly, genetics.
If you have these risk factors, steps can be taken to prevent a full-blown obsession from holding you captive. Barbour suggests allowing for "wiggle room" in your diet.
"When we completely deprive ourselves of the things we love, we put ourselves in a state of imbalance," she explained. "I'm not saying go eat an entire batch of chocolate chip cookies. The thing that everyone wants to achieve is balance. One way to get there is by indulging once in a while, in moderation. Some people put the percentage at 80/20 or 90/10. It's really whatever makes you comfortable."
In other words, making healthy choices most of the time and occasionally allowing modest amounts of sweets, fried food or other low-nutrient fare you desire may be the optimum road to wellness.
"I knew I was in recovery when I could eat a Snickers and enjoy it," said Sandra. "I practically called my therapist the moment after." She now allows herself one or two mini Snickers almost every day.
Shaw-Draves suggests making a conscious effort to acknowledge the fixations and emotions you experience in relation to food, such as anxiety, then committing to continual small changes.
Each change should "challenge the food rigidity that is hallmark with maladaptive eating patterns," she explained. "Journaling about the feelings associated with food intake and trying to alter patterns is helpful because it encourages reflection and can be reread at a later date. These simple things -- when done with steps that can be taken slowly -- begin to change one's perception of and relationship with food."
Media and society often praise dieting and thinness, so a fixation on healthy eating may be easily overlooked or deemed normal or commendable. If your dietary regime seems like a job you feel desperately obligated to manage perfectly, it's time to seek help.
A therapist with a specialization in eating disorders or with your primary symptom, such as anxiety, can help you address and change your thoughts and behaviors. And fear not: The goal of treatment is not to "make you fat" or take away all control you currently have, but to shift your focus and improve your emotional and physical well-being. You can control your diet in another way -- by eliminating strictness and rules and aiming for balance and emotional fulfillment.
"I believe it is never too early in the process to seek treatment," said Shaw-Draves. "Once a person notices that their preoccupation with healthy eating is adversely affecting their relationships and ability to function normally, then treatment is warranted. In general, the earlier a person seeks treatment, the easier and more short term the treatment will be."
Working with a therapist you feel comfortable with is key, so you may need to shop around a bit before you settle on one.
Additionally, once you recognize your need for help, Shaw-Draves recommends not panicking. "I see many clients who realize they have a problem and then simply shut down emotionally because they are so overwhelmed and unsure about how to proceed. A relationship with food is like any other relationship; it wasn't created overnight, and it will not be changed overnight."
And it's important to remember that when it comes to adjusting your diet, too much information from multiple sources can be harmful. Rather than scanning the Internet and paging through diet books and magazines for guidance, Barbour recommends talking to a nutrition professional, preferably a registered dietitian with expertise in eating disorders.
"If you notice, the majority of diet books pretty much come to the same conclusion: lean proteins, vegetables, fruits ... grains/starches, " Barbour said. "And keep the white stuff to a minimum -- rice, bread, processed foods."
Because diet books, many of which present themselves as "healthy lifestyle" books, often impose additional rules and gimmicks, choose your resources wisely. Your dietitian can likely provide the materials you need or refer you to valid books and websites.
"If someone out there is struggling like I did, I would say get help," said Sandra. "People used to tell me I had so much discipline. I hated that! It's not about having willpower. My problems totally took my personal power away. With my therapist's help, I'm getting it back."