When I first heard the term orthorexia—a fixation with healthful food that results in a rigidly restrictive diet—I immediately thought of two people I know to whom the term might apply. One is a grandmother who eats little more than raw vegetables and fruits…the other is a college student who consumes mostly unsweetened oatmeal, skim milk and egg whites.

Given the myriad health problems associated with junk food and obesity, it may seem silly to worry about a diet that’s too healthy. But orthorexia can wreak havoc with a person’s psychological and social well-being…in extreme cases, it involves severe nutritional deficiencies that can seriously damage physical health—or even lead to death.

Despite these alarming facts, many mental health professionals and physicians are unaware of this disorder. To discuss the problem, I contacted Sondra Kronberg, RD, a certified eating disorder registered dietitian, a spokesperson for the National Eating Disorders Association and founder and nutritional director of the Eating Disorder Treatment Collaborative headquartered in Westbury, New York. She told me, “Unlike anorexia, in which a person is obsessed with being thin, orthorexia involves an all-consuming obsession with dietary ‘purity.’ Typically, the goal is to enhance quality of life and extend longevity, but what starts as a desire to control your health ends up controlling you.”

Recognizing the problem. Most people who are careful about their diets—cutting back on fat and refined carbs, eliminating processed foods, going organic or vegetarian—do not have an eating disorder, of course. While it is tough to pinpoint exactly when conscientiousness crosses the line, certain warning signs do suggest orthorexia. These include…

  • Strong motivation to achieve dietary purity…and a resulting sense of righteousness or superiority over others.
  • Preoccupation with food, often involving many hours spent each day planning and preparing “perfect” meals…and loss of interest in other activities not related to diet.
  • Social isolation (for instance, refusal to go to parties or restaurants) brought on by inflexible eating habits.
  • Guilt, anxiety or self-loathing upon straying (or even thinking of straying) from self-imposed dietary restrictions.
  • Elimination of so many entire food groups or nutrient categories that only a few “acceptable” foods are left. Deprived of needed nutrients, orthorexics may suffer severe malnutrition and excessive weight loss leading to cardiac problems and other complications—or even death.

Who gets orthorexia? Research on orthorexia is limited, and there is no official data on its prevalence—in fact, some health professionals consider it a form of anorexia or obsessive-compulsive disorder rather than a distinct condition. According to Kronberg, though, both women and men can develop orthorexia…the disorder is more common among adults than adolescents…and sufferers tend to be detail-oriented, perfectionistic and rigid in other areas of their lives.

For someone with orthorexia, recognizing when dietary restrictions have gone too far can be difficult because eating healthfully generally makes good sense. The person also may be reluctant to acknowledge the truth because her obsessive focus on food allows her to avoid thinking about other problems, such as arguments with her spouse or loss of her job, Kronberg said.

Getting help. To test yourself, review the warning signs listed above…the more that apply to you, the more important it is to seek professional help. Another clue: Expressions of concern from family members or friends. If you suspect that you may have orthorexia, visit the Web site of the International Association of Eating Disorders Professionals (www.iaedp.com) or the National Eating Disorders Association (www.NationalEatingDisorders.org) for referrals to professional practitioners who can help.

A common approach used to treat orthorexia is cognitive behavioral therapy (CBT), in which a therapist helps the patient identify the faulty thinking, distorted beliefs and underlying fears that drive her harmful actions…then guides changes in these thought processes to bring about healthful changes in behavior. For instance: With CBT, a patient can come to recognize that a few French fries are unlikely to lead to a heart attack and that her fear of even being near blacklisted foods has left her isolated and lonely. Kronberg said, “I try to help patients see that an overly restrictive diet needlessly saps joy, and that by being a little more flexible about what they eat, they can restore health, balance, well-being and joy to their lives.”