The difference between following a healthy diet and orthorexia

Are you constantly faced with nutritional and health advice from the media about what you should and should not be eating?


In today's society, we are all inundated with health choices that are changing our relationship with food. There is media advice about reducing saturated fats, salt and sugar, limiting red meat and increasing fruit and vegetables. Debates are ongoing about whether margarine is better than butter, sweetener better than sugar, skimmed milk better than semi-skimmed. Food choices are influenced by ethical responsibilities; Fair Trade, locally sourced food.

What does a healthy diet involve?

A healthy diet involves:

1. Eating food that provides adequate amounts of calories for your activity level.  This means having a balance between the energy you consume in the food and the energy you use up. If you eat or drink more than your body needs, you put on weight. If you eat and drink less than your body needs you lose weight.

2. Eating a wide range of foods so the diet is balanced and your body is having all the nutrients it needs.

In pursuit of a healthy diet some people make dietary choices based on misguided and confusing dietary advice which could lead to damaging consequences. Obsessive striving to become healthy could end up with people spiralling out of control causing them severe harm.

What is orthorexia?

Eating healthily is commendable. It improves overall health, aims to safeguard against ill-health and helps recovery from illness. Some people, however, get an obsessive fixation with healthy eating with an extreme focus on the quality and purity of the food they eat. The term 'orthorexia' was coined for this condition by Dr Steven Bratman. 

It is as yet unrecognised as an eating disorder in the DSM-V and may not be clinically diagnosed by medical professionals but it does prevail as a serious medical problem. It differs from eating disorders like anorexia nervosa and bulimia nervosa in that the foremost aim in orthorexia is not to be thin but to be healthy; the focus being on the quality of the food rather than the quantity.

Signs and progression

It is a progressive condition initially starting off with having a dietary preference or choice. At this point people are still in control. Misguided by advice on nutritional claims they perceive and therefore categorise food as good and bad, clean or dirty, safe or unsafe. They seek quality and purity in food as this is viewed as healthy. As a result, they avoid 'unclean' foods which are deemed unhealthy and eat only 'clean' foods.

The underlying meaning is that eating 'clean' food equates to being worthy and good while eating 'dirty' food makes them unworthy, bad and impure. This soon leads to the variety of foods becoming more and more restrictive followed by whole food groups being left out. The number of 'safe' food they allow themselves by now is very limited. 

People impose rigid obsessive rules and there is a compulsion to adhere to them to maintain the perfect diet. Thinking is 'black and white' and they would rather go hungry than break their food rules. Sadly there is no enjoyment in food only fear and anxiety. They constantly worry about whether they have eaten the 'right' food. Suddenly food seems to have started to take control.

The diet can become dangerously unbalanced and nutritionally deficient with serious complications. The calorie intake too is insufficient by now to sustain normal activity. Additional concerns arise due to claims of intolerance to certain foods, the existence of food allergies, adopting a vegan style of eating, use of detoxing and going on liquid diets which further complicate their relationship with food.

Family and friends, in general, tend to praise healthy eating viewing it as a means of improving lifestyle, being healthy and showing discipline. This validates and makes people feel good at what they do. They strive to do better so they can feel valued.  

People with orthorexia want to feel good about themselves and believe they are looking after themselves by eating the best way possible. They cannot believe that others are not doing the same and wonder why other people do not share the same views as them.

There is a sense of righteousness and feeling special which improves their self-esteem and self-worth.  However it does not stop here as due to their perfectionist traits they feel that they could always do better, it is never enough, they could be healthier and so their rules become more and more rigid. They do not control food but food controls them.

Changes to watch out for

There are some behavioural changes to watch out for:

  • obsessions over food and health such as digestive problems, asthma, allergies, skin conditions
  • self-diagnosis of having a food intolerance and food allergies
  • cutting out foods, entire food groups, eating raw/fresh/liquid only
  • increased use of supplements
  • use of laxatives to cleanse the body
  • irrational concern about food preparation, food shopping and checking of food labels for ingredients
  • unable to relax restrictive rules

There are also a number of personality changes to look out for, such as:

  • guilt and anxiety at any deviations from your restrictive rules
  • constant thinking of food
  • regular advanced planning of food and meals
  • emotional well-being is dependent on eating the 'right' food
  • critical thoughts of others who do not eat healthily
  • fear of eating out, eating food not prepared by them but prepared or bought by others
  • loneliness
  • low levels of energy
  • depression, mood swings, anxiety

The obsessive fixation on healthy eating soon starts affecting other areas of life such as withdrawing from family and friends, social isolation, problems with relationships and in work. Could it be that food is used as a means to fend off anxiety and all the other many emotions that life presents you? Perhaps the search for absolute purity is a rejection of your natural self?

Othorexia is a serious disorder which negatively impacts daily life, has severe and far-reaching health consequences and requires professional help. Find an experienced counsellor near you.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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London W1W & NW11
Written by Dr Sharmaline Attygalle, BACP (Accred) Integrative Therapist, MBBS, BSc Psychology
London W1W & NW11

Sharmaline Attygalle is an integrative counsellor working with children, young people and adults. She works in Cambridge. Sharmaline has an interest in eating disorders and believes in exploring the person as a whole.

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