By Valerie Martin

You’ve met them at various points in your life:

• The friend who brings her own food everywhere she goes (or skips out on eating at social gatherings altogether)
• The co-worker who never partakes in the office birthday cake
• The family member who gets anxious at the thought of travel outside of large food-conscious cities
• The health food store evangelist who wouldn’t dream of ingesting anything with high-fructose corn syrup on the label

Diagnosed food allergies aside, the above examples all describe people who may have orthorexic eating patterns.

What is orthorexia?

In 1997, Dr. Steven Bratman coined the term “orthorexia” to describe a rigid devotion to healthy eating that becomes obsessive to the point of actually creating health risks and interfering with a person’s quality of life.

“Orthorexia starts out with a true intention of wanting to be healthier, but it’s taken to an extreme,” says eating disorder specialist and Academy of Nutrition and Dietetics Spokesperson Marjorie Nolan, MS, RDN. “If someone is orthorexic, they typically avoid anything processed, like white flour or sugar. A food is virtually untouchable unless it’s certified organic or a whole food. Even something like whole-grain bread – which is a very healthy, high-fiber food – is off limits because it’s been processed in some way.”

Though still sorely misunderstood, anorexia nervosa and bulimia nervosa are well-known disorders, and binge eating disorder has now finally made it into the DSM-V, the diagnostic manual for mental disorders. Orthorexia, on the other hand, is newer to the scene, not included in the DSM-V, and less behaviorally clear-cut than the aforementioned eating disorders.

So, is orthorexia a real eating disorder?

The answer will certainly depend on whom you ask, but for many in the mental health field including myself, an eating disorder therapist, it’s a definite “yes.” While anorexia involves restricting the amount of food, orthorexia similarly involves restriction of the type of food or ingredient. Often, the restriction can start off more or less benign, such as simply adopting a vegetarian, vegan, gluten-free or dairy-free diet, but can develop into orthorexia when someone continues to restrict and their list of “allowed” foods gets smaller and smaller.

The topic of orthorexia was buzzing online earlier this year when popular Blogger Jordan Younger of The Balanced Blonde (formerly The Blonde Vegan) publicly announced that she realized her quest for healthy eating had gone from healthy to obsessive to a full-blown eating disorder (orthorexia), and began the process of recovery including transitioning away from a vegan diet. (Of course, not all people following a vegan diet are or will ever become orthorexic, but in Younger’s case, her diet became dangerously restrictive over time.) As she told People magazine, “I was following thousands of rules in my head that were making me sick.” After a talk with a concerned friend and recognizing that her body was trying to tell her via recent health issues that something was wrong, Younger sought treatment.

Although it may not be recognized by the DSM-V, the National Eating Disorders Association (NEDA) recognizes the physical and psychological risks of orthorexic eating patterns:

“The diet of orthorexics can actually be unhealthy, with nutritional deficits specific to the diet they have imposed upon themselves. These nutritional issues may not always be apparent. Social problems are more obvious. Orthorexics may be socially isolated, often because they plan their life around food. They may have little room in life for anything other than thinking about and planning food intake. Orthorexics lose the ability to eat intuitively – to know when they are hungry, how much they need, and when they are full. Instead of eating naturally they are destined to keep ‘falling off the wagon,’ resulting in a feeling of failure familiar to followers of any diet.”

“Healthy” means balanced

We already know that diets don’t work. And as an eating disorder therapist and a person in recovery, I’ve seen many times how food rigidity backlashes. So, if dieting isn’t the solution and even “healthy eating” can become just as rigid as a diet, where do we go?

The answer – as with pretty much anything in life – is balance. (Hence Jordan Younger’s choice for her blog’s new name.) Trying to eat mostly nutritious foods does not mean that you’re going to become orthorexic, and the ability to be flexible with yourself is just as important. I know, I know, balance is much easier said than done. But let’s be real – everything worth doing is easier said than done.

Do I have a problem?

Not sure if your healthy eating patterns might be problematic, or worried about someone you know? According to NEDA, there’s no cause for concern with healthy eating unless:

1) it is taking up an inordinate amount of time and attention in your life;

2) deviating from that diet is met with guilt and self-loathing; and/or

3) it is used to avoid life issues and leaves you separate and alone.

Thomas Dunn, PhD, an associate professor of psychology at the University of Northern Colorado and co-author of a recent paper in Psychosomatics createda helpful list of traits that outlines suggested diagnostic criteria for the disorder. Dunn advises that people who identify with two or more of the following traits may want to reach out to a therapist or dietitian (with eating disorder experience) for help:

• “You consume a nutritionally unbalanced diet because of concerns about ‘food purity.’
• You’re preoccupied about how eating impure or unhealthy foods will affect your physical or emotional health.
• You rigidly avoid any food you deem to be ‘unhealthy,’ such as those containing fat, preservatives, additives or animal products.
• You spend three or more hours per day reading about, acquiring or preparing certain kinds of food you believe to be ‘pure.’
• You feel guilty if you eat foods you believe to be ‘impure.’
• You’re intolerant of other’s food beliefs.
• You spend an excessive proportion of your income on ‘pure’ foods.”

Most importantly, listen to the people who care about you. Don’t brush off their concerns “because they don’t ‘get’ nutrition.” Healthy eating is great, but extreme *anything* is going to have repercussions.