Orthorexia: Understanding the warning signs

Updated January 2023 | 6 min read
Expert contributor Dr Tania Nichols, clinical psychologist
Words by Lucy E Cousins

Is your need to eat healthily negatively affecting your mood, body and lifestyle? Then you may be suffering from this little-known condition.

Sophie was a teenager when she began showing signs of orthorexia. 

“I was about 15 when I started to watch what I was eating and [began] doing YouTube workouts in my room after school,” she says. 

Now 24, the Perth woman says as a student, she wasn’t taught that gaining weight during puberty was normal and necessary, especially as a female. Instead, she believed gaining weight was associated with obesity. 

“I thought if I kept putting on weight, I was going to be unhealthy, which is a ‘bad thing’,” she remembers. “So I started focusing on maintaining a thin, ‘healthy’ body.”

In addition, her class was made to weigh themselves regularly during PE lessons from Year 7 onwards. That, she says, was a “real trigger” for her disordered eating. As she progressed through puberty, Sophie began restricting her diet to the point where she was too scared to eat her own birthday cake.

“I do naturally have quite a sweet tooth, so I would try to deceive myself into thinking that I didn't like cake or desserts,” she says. “I kept up this false pretence with friends, so they didn’t ask questions.”

Sophie would also get anxious if she missed a workout, and she had a target for the number of calories her workout needed to burn each day. This obsession took hold of Sophie’s life for the next four-and-a-half years.

“I was known as the ‘healthy’ one in the family, and I thought what I was doing was normal,” she says. “I thought everyone restricted food and had to force themselves to work out.”

However, her disordered eating progressed into strict food restrictions, binge episodes and severe digestive issues. She was also diagnosed with a chronic bowel condition. So, when she was 19, she reached out to a psychologist and dietitian for help, learning about orthorexia for the first time.

What is orthorexia?

According to the Butterfly Foundation, which specialises in eating disorders, orthorexia –  also known as orthorexia nervosa –  involves an “obsession with healthy or ‘clean’ eating”, and the benefits of healthy foods but not necessarily food quantity. However, as clinical psychologist Dr Tania Nichols explains, orthorexia isn’t classified as an eating disorder.

“There's a lack of consensus [by medical professionals] around whether it's a standalone eating disorder or a subtype perhaps of an existing well-known eating disorder, or even perhaps an obsessive-compulsive type illness,” she says. 

Instead, clinicians look at orthorexia as ‘disordered eating’, where the symptoms might include behaviours that are typical of eating disorders, like restrictive eating, compulsive eating, irregular or inflexible eating patterns, but they happen less frequently or are lower in severity.

Warning signs of orthorexia

Although there are some clear indications that someone might be in the later stages of disordered eating, the challenge with orthorexia is how easily related behaviours can fly under the radar.  

“It can start off with someone seemingly doing something pretty healthy and socially acceptable,” says Dr Nichols. “[A person might say] ‘Oh, I'm going to sort my diet out and introduce more vegetables, stop drinking so much alcohol and cut out lollies’.”

This, she explains, can then turn into cutting out dairy, cutting out carbohydrates and foods that might have artificial additives, or sugar and salt. In orthorexia, these habits can become extreme to the extent that the dietary changes become dietary deficiencies and can be harmful. In the short term, this can lead to nutritional deficiencies, low mood, irritability, depressive symptoms, muscle cramps, headaches, gastrointestinal problems and fatigue. In the long term, it may increase the risk of osteoporosis and osteopenia – which is a loss of bone mineral density – as well as nutritional and metabolic problems.  

People suffering from orthorexia can also present with increased anxiety around not being able to prepare food or do exercise.

“They might feel like going to a restaurant is stressful because they don't know what's in the meal, therefore it might not be ‘clean’,” says Dr Nichols. “They might start to withdraw from social activities, or not be able to go to a friend's birthday party because they can't be sure the food will meet their dietary requirements.”

Sophie admits she suffered from this way of thinking. Her focus on living healthily had a huge impact on her life and it prevented her from doing things she wanted to do. She says she was a “difficult person” to be around.

“My ‘healthy lifestyle’ was the number one priority in my life, even above my relationships,” she says. “I didn’t have the mental space or the time to devote to even my sister and mum; I couldn’t justify not exercising or meal planning.” 

How to help someone showing signs of orthorexia 

If you think a friend or family member may be suffering from orthorexia, you may notice them really struggling with making decisions around what to eat or making lengthy requests to avoid certain food groups at restaurants. Or perhaps they don’t go out with friends and family as much, and they show increased tension and discomfort in certain social situations. 

They might be spending a considerable amount of time thinking about and planning meals or compulsively checking nutrition labels when they're at the supermarket. 

If that’s the case, according to the National Eating Disorder Collaboration, there’s no right or wrong way to talk to someone experiencing disordered eating. A good idea would be to learn as much as you can about disordered eating from a trusted source, like Butterfly Foundation. Then, choose a caring environment for your chat, avoiding mealtimes, and understand that the person may respond with anger or denial. 

Try to use “I” statements, like “I’m worried about you”, instead of “You’re worrying me”, and avoid talking directly about their appearance or food. Focus on their health, how they’re feeling, and their behaviour. Listen to their responses thoughtfully and suggest seeking help to talk more about what they’re going through. Let them know you’re there to help.  

What does recovery from orthorexia involve?

Treatment for orthorexia can start with visiting a GP to run blood tests for nutritional deficits, like low iron and low levels of vitamins. Other health checks might be needed to check for issues related to restricted eating, like digestive issues. A GP can put together a mental health care plan, which may include a visit to a psychologist and a dietitian. 

“The treatment depends on the patient, but it would be similar to what we do with other eating disorders,” explains Dr Nichols. “For example, psychoeducation about eating disorders, behavioural skills to increase irregularity and flexibility around eating, and asking people to do behavioural experiments to try some of the foods that have become fearful for them.”

Re-training the brain to address underlying beliefs about certain foods is important, she says, as patients can have “black and white thinking”, where some food is seen as ‘good’ and some is seen as ‘bad’.  

“We try to get to the bottom of that and what that kind of thinking means for them, as well as what role this control around eating is having in their lives,” says Dr Nichols. 

For Sophie, throwing away her scales and learning to love food again was a huge part of her recovery, which took about two years. It was also helpful understanding what was affecting her condition. 

“My recovery process just involved a lot of learning and unlearning the belief that my eating was based on. Like, I thought you had to be thin to be healthy,” she explains. “I had to also challenge my fears around certain foods.”

Now a practising peer support worker in eating disorders and an eating disorders recovery coach, Sophie’s advice to those in a position like hers is to shift your mindset and expand your definition of health.

“Educate yourself more about what health really is and how it's actually quite individual and personal,” she says. “Social media and even health guidelines are not necessarily designed for everyone. Trust in yourself and trust that only you know your body the best.” 

If you're struggling with depression or anxiety, and need to speak to someone now, call Lifeline on 13 11 14.

Do you, or does someone you know need support?

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