What Is Orthorexia? Exploring Connections With OCD

Orthorexia and OCD

Healthy eating is important for overall wellness. But individuals who hyperfocus on clean or super-healthy foods may develop Orthorexia Nervosa (ON), a condition based on anxiety-provoking, restrictive eating patterns. Though the emerging condition has not been formally recognized by the American Psychiatric Association’s (APA’s) official disorders manual, it has recently gotten more attention in research studies. These discoveries have revealed links between orthorexia and other closely-related disorders, such as anorexia nervosa (AN) and obsessive-compulsive disorder (OCD).

Read on to review the signs and symptoms of orthorexia. Then understand risk factors and potential causes. Finally, explore comparisons to two other disorders with many overlapping elements: anorexia and OCD.

Orthorexia and OCD

What Is Orthorexia?

Orthorexia Nervosa (ON) is a condition centered on healthy eating where individuals feel excessive emotional distress from food choices perceived as unhealthy. This distress may lead to restrictive eating that causes unintended weight loss, malnourishment, and problems with relationships. While orthorexia is not a recognized eating disorder, clinicians have observed and studied the condition for several years.

What Are the Five Warning Signs of Orthorexia?

Researchers and clinical experts have proposed diagnostic criteria including several key signs and symptoms of orthorexia.

  • Obsessive Focus on Rigid Dietary Rules: Individuals are preoccupied by rigid beliefs about a healthy diet, resulting in compulsive restrictive eating behaviors.
  • Escalation of Dietary Restriction: Restrictions increase over time, potentially eliminating entire food groups. Fasting and cleansing sessions may become more frequent.
  • Psychological Distress: Not following strict rules results in shame, poor self-worth, feeling impure, and exaggerated fears about personal health.
  • Impacting Major Life Areas: Psychological distress interferes with major life activities, such as relationships, career, school, and daily functioning.
  • Medical Complications: Severe or unintended weight loss, malnutrition, or other consequences occur because of a restricted diet.

How Common Is Orthorexia?

Studies show that orthorexia affects 1%-6.9% of the U.S. adult population, though other eating disorders occur at around 1%, indicating that 1% may be a more realistic estimate. Prevalence may also vary among populations in different countries, especially since there is some debate about the potential impact of cultural influence on this disorder.

Also, studies have revealed greater vulnerability to orthorexia among different population groups. For example, athletes, doctors, dieticians, and individuals who follow veganism tend to focus closely on food and its impact on the body. Since a key behavior in orthorexia is dietary restriction, this focused perspective may be associated with increased risk.

What Are the Causes and Risk Factors of Orthorexia?

The exact causes of orthorexia are not yet known. However, research has revealed several risk factors common to other conditions involving rigid thinking, obsessive thoughts, and compulsive behaviors, such as eating disorders and obsessive-compulsive disorder (OCD).

Neurocognitive Deficits

Researchers have observed that individuals with orthorexia have similar neurocognitive deficits as those with anorexia nervosa. These include problems with flexible problem solving, external attention, and working memory. Brain scans have also revealed several irregularities, such as poorly regulated activity in brain regions associated with food-related reward, obsessions, and compulsive behavior.

Risk Factors

Multiple research studies have found the orthorexia risk factors that do not directly cause the disorder may nevertheless contribute to its development. It was additionally discovered that many risk factors for orthorexia and anorexia overlap.

Common Risk Factors of Orthorexia Include:

  • Food pickiness and preferences
  • Obesity
  • History of parental eating disorders
  • Perfectionism, appearance orientation
  • Overweight preoccupation

Comparing Orthorexia Nervosa and Anorexia Nervosa

Debate continues as to whether orthorexia is a part of a continuum of eating disorder risks and patterns, a precursor to anorexia nervosa (AN), or if it stands alone as a distinct condition. Regardless, orthorexia’s focus on restrictive eating patterns and emotional disturbance lends itself to a comparison with anorexia.

Similarities Between Orthorexia and Anorexia Include:

  • Striving for perfection.
  • Need for control.
  • High anxiety levels.
  • Rigid selection of acceptable foods.
  • Alignment between symptoms and personal beliefs, meaning that individuals do not see symptoms as problematic.

Differences Between Orthorexia and Anorexia:

  • Restrictive Eating: The focus is on the quality of food for orthorexia vs. the amount of food for anorexia.
  • Social Acceptability: Orthorexia can be perceived and promoted as a healthier lifestyle, whereas individuals with anorexia may feel more shame about their condition.
  • Eating Patterns: Individuals with orthorexia tend not to skip meals and gravitate toward food they believe is extremely healthy. But those with anorexia will avoid any food, even healthy options, to achieve weight loss.

Connections Between Orthorexia and Obsessive-Compulsive Disorder (OCD)

Research has revealed many compelling connections between orthorexia and obsessive-compulsive disorder (OCD), and understanding these links begins with reviewing the elements of OCD.

signs of orthorexia

What Is OCD?

Obsessive-compulsive disorder (OCD) is an anxiety-inducing condition featuring patterns of intrusive, unwanted thoughts (obsessions) that lead individuals to perform repetitive behaviors (compulsions). OCD affects individuals of all ages, disrupting daily functioning and social interactions. Obsessions, emotions, and behaviors become a distressing self-feeding loop as explained below.

Signs and Symptoms of OCD Include:

  • Cognitive Symptoms

Obsessions are disruptive thoughts, beliefs, and urges that individuals cannot prevent or control. These unwanted thoughts are distressing and often the first OCD symptoms individuals perceive. Obsessions are typically centered around one of the following themes:

  • Cleanliness and contamination.
  • Preoccupation with harmful events.
  • Focus on symmetry, extreme orderliness with “correct” object placement.
  • Taboo subjects such as aggression, sex, morality, and religion.
  • Emotional Symptoms

Individuals are distressed by these obsessions, reacting with emotions such as disgust, anxiety, and fear. Shame is also common among individuals with mental conditions, especially for those who have observable symptoms, such as OCD-related checking or handwashing behaviors. Because individuals cannot control their obsessions, individuals with OCD often feel ongoing frustration and emotional exhaustion.

  • Behavioral Symptoms

In an attempt to reduce these unpleasant emotions and prevent their most feared outcome, individuals perform compulsive ritualistic behaviors. These can include excessive cleaning, checking, arranging objects, tapping, and counting. Despite their initial purpose of reducing anxiety, relief is short-lived. Performing compulsive behaviors induces more anxiety as individuals fail to reach self-imposed perfectionist standards. And a failure to perform compulsions in the ideal way provokes fears of a worst-case outcome. For example, a failure to perfectly perform the checking ritual for the appliance switches in the kitchen will provoke a fear of fire.

The Relationship Between Orthorexia and OCD

Orthorexia more closely resembles other eating disorders than OCD, and its presence is not a predictor of OCD symptoms. Nevertheless, a comparison between orthorexia and OCD is meaningful, and can promote a better understanding of both disorders.

Similarities Between Orthorexia and OCD

  • Neurocognitive Deficits

Evidence suggests that orthorexia and OCD negatively impact similar types of brain activity, resulting in disordered thoughts and emotional responses. Expanding on these findings may provide important insights on the development and treatment of each disorder.

  • Obsessive Thoughts

Individuals with orthorexia obsessively think about healthy food, food planning, and the associated rituals. The obsessions are intrusive and disruptive, evoking anxiety and negatively affecting quality of life. This obsessional anxiety leads to creating ritualistic behavior in an attempt to gain control and reduce distress.

  • Ritualistic Behaviors

Much like compulsive behavior patterns associated with OCD, individuals with orthorexia may develop rigid rituals for meal prep and planning to preserve the purity of their food. Ensuring the perfect preparation of food may become time consuming, especially when these patterns involve specific utensils and procedures. Failure to strictly follow these or other rules about their diet can be perceived as a threat to their health. This resembles how a failure to perform OCD compulsive behaviors can provoke fears of disastrous outcome, such as the kitchen fire example above.

One Key Difference Between Orthorexia and OCD

  • Perception of Symptoms

One significant difference between orthorexia and OCD is how individuals perceive their symptoms. As is the case with anorexia nervosa, individuals with orthorexia strive toward perfect performance of their compulsive behaviors, even though they are a critical element of their disorder. With OCD, the compulsive behaviors are viewed as unacceptable, causing additional shame and distress.

Exploring Connections Orthorexia and OCD

A comparison between orthorexia and OCD reveals important connections, including irregularities in brain functioning, obsessive thought content, and compulsive behaviors. This exploration expands the base of knowledge about how orthorexia develops, how it can be treated effectively, and its place on the spectrum of mental health conditions.