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These days, it's cool to be health-conscious. It's no longer weird to say you're vegan, gluten-free, or paleo. Your neighbors do CrossFit, run marathons, and take dance classes for fun. And then there's the fitness influencer phenomenon. Between having zero shortage of inspirational fit people to look up to and a steady stream of transformation photos popping up on our Instagram news feeds, it's virtually impossible to miss the fact that health is a big deal right now.
But there's a dark side to the current obsession with being healthy: Sometimes it goes too far. Take, for example, the story of Henya Perez, a 28-year-old vegan blogger who landed in the hospital after trying to cure her yeast infection with a mostly raw food diet. She became so fixated on consuming a specific amount of fruits and vegetables to make herself healthy that she ended up making herself sick instead. After her scary episode, she was diagnosed with a condition called orthorexia nervosa, an eating disorder that causes someone to have an "unhealthy" obsession with "healthy" food. (See: The Difference Between Picky Eating and an Eating Disorder) While Perez's story might seem extreme, this need to analyze the health factor of everything you eat probably sounds a little familiar to you, so we're answering some important questions—what exactly is this disorder, and where is the line between "eating healthy" and disordered eating?
What Is Orthorexia?
The term, coined by Steven Bratman, M.D., in 1996, is not officially recognized as a diagnosis in the Diagnostic and Statistical Manual of Psychiatric Disorders, 5th Edition (aka the DSM-5), which is the standard in diagnosing mental illness. That being said, mental health practitioners and doctors are becoming increasingly aware of its existence. "Orthorexia often starts out as an innocent attempt to eat more healthfully, but this attempt can take a turn to a fixation on food quality and purity," explains Neeru Bakshi, M.D., medical director of the Eating Recovery Center in Bellevue, Washington. The most common manifestations are an avoidance of substances like artificial colors, flavors, preservatives, pesticides, genetically modified products, fat, sugar, salt, and animal and dairy products, she says. Overall, people with the disorder become concerned with what and how much to eat for optimal health. (Related: Why an Elimination Diet Won't Help You Lose Weight)
"The main difference between orthorexia and other eating disorders is this idea that these behaviors are not for weight-loss purposes, but rather due to a belief that they are health-promoting," notes Rachel Goldman, Ph.D., a clinical psychologist who focuses on wellness and disordered eating. And the difference between this disorder and eating healthy? Goldman, who is also a clinical assistant professor of psychiatry at NYU School of Medicine, says that orthorexia is marked by physical and mental symptoms such as malnutrition, severe weight loss, or other medical complications due to such a restricted diet, as well as an impaired social, school, or work life.
For Lindsey Hall, 28, it all started when she decided to start focusing on healthy eating in her early 20s after struggling with disordered eating in her teens. "I thought if I just 'ate healthier,' all the eating disorder preoccupation would go away and give me some real direction," she explains. "I was still not eating enough because I was preoccupied, now, with being vegan and 'clean, raw eating.' The more I researched, the more I read of the horrors of meat, which led me down a rabbit hole of reading about chemicals and pesticides and processing and this and that. Everything was 'bad.' It evolved to a point where nothing I ate was acceptable." (Related: Lily Collins Shares How Suffering from an Eating Disorder Changed Her Definition of "Healthy")
Who Does It Affect?
Because orthorexia is only recently recognized by the medical community, there isn't reliable research available on who is most likely to get it or exactly how common it is. One of the biggest known risk factors for it (and other eating disorders), according to Goldman, is being on a strict diet. The more restrictive the diet is, the higher the risk becomes, which makes sense considering that designating certain foods as "off-limits" is a big part of the disorder. Interestingly, Goldman notes that "there is some evidence that shows individuals in health and nutrition fields could be at a higher risk."
That was the case for Kaila Prins, 30, who quit her graduate school program to become a personal trainer while suffering from orthorexia. "I wanted to be around people who 'got' me," she says. "Which meant withdrawing from everyone who didn't understand and rejecting anything that prevented me from cooking at home and getting the type of 'nutrition' I thought I needed."
Aside from the fact that research is limited, there's also the fact that the disorder often gets brushed under the rug by those suffering from it. "Many of these individuals are probably not seeing their symptoms or behaviors as problematic, so they are not going to a physician and either being diagnosed with problematic symptoms or with this condition," says Goldman. What's more, she thinks that the disorder could be on the rise. "With more and more people doing these elimination diets and participating in restrictive dieting, I am sad to say that the number of people with orthorexia may increase." In fact, based on her experience, she thinks that orthorexia, or the symptoms associated with it, might even be more common than often-discussed eating disorders like anorexia or bulimia. (P.S. Have you heard of exercise bulimia?)
How It Affects Lives
Like other eating disorders, orthorexia can affect all areas of a person's life, from their relationships to their job and everything in between. For Prins, she says it turned her entire life upside down. "I lost momentum in the one career that I've ever wanted and ended up in $30,000 of debt from the grad program I never finished." She even broke up with her boyfriend at the time so she could totally focus on her body and her eating.
Hall also saw her relationships suffer while she was dealing with the disorder. "People stop knowing how to talk to you or what to say. I became insufferable to be around—constantly checking food facts when out to dinner, asking questions about the food, not showing up to dinner events because I didn't want to be around food," she says. "I missed birthday parties and even when I was at events, I wasn't paying attention to anything going on around me."
And beyond all the external ways the disorder affects people's lives, it also causes a huge amount of internal anxiety. Prins recalls a time when she was panic-stricken when her mom was a mere five minutes late picking her up from the gym, which meant getting in her post-workout protein would be delayed.
The Progression of Orthorexia
While there is, of course, no easy answer to why more and more people are suffering from orthorexia, Dr. Bakshi thinks it may have something to do with the messages that are out there about health and fitness right now. "We are a celebrity and social media driven society, and we tend to want to emulate people that we admire and respect," she explains. "I do think that there may be some influence that social media stars have on how people choose to start out with clean eating and dieting, and there is going to be a subset of people who then continue past the point of health and will obsess over the details of dieting." Obviously, those influencers and social media stars aren't causing people to develop the disorder, but the focus on weight loss and "transformation" in general makes people more likely to try cutting certain foods out of their diets and then escalate into an eating disorder. But it's not all bad: "Thankfully, there are also many social media stars and celebrities who have spoken out about their own past struggles with disordered eating and their recovery," she adds.
The Road to Eating Disorder Recovery
Similar to other mental health issues, orthorexia is treated with therapy and sometimes medication. As for how to know when it's time to seek help? "With any mental disorder, when it starts interfering with someone's daily functioning, that is a sign that it is time to get help," says Goldman. And for those who may be currently struggling with the disorder, aside from getting professional help, Prins has this advice: "As soon as I learned how to let someone else cook my food (and not freak out about the kinds of oil they used in it), I felt like a whole portion of my brain got freed up to think about other things. You can still eat healthily while living."