It started with loosely-defined "junk food." Then it was refined sugar. Next, alcohol was banished, followed by carbs. Before long, I had whittled my once-diverse diet down to a tiny number of foods. Any unexpected divergencea glass of champagne or bite of cake at a party, a failure to double-check the ingredients listed on the wrapper of a protein barwould send me spiraling into a total panic, followed by a compulsive workout-and-cleanse routine to rid my body of the intruders. My rigid adherence to diet and exercise had become an all-consuming obsession.
Yet, I (and my friends and family) considered my lifestyle to be healthy. I received constant praise for my discipline.
Whats trendier, after all, than an elimination diet or "eating clean?" It's easy to find ourselves seduced by alluring pseudo-scientific theories and the moralizing of our eating choices: bad food will harm you, good food will heal you.
For Americans, and especially for women, healthy eating has become practically synonymous with deprivation. Maybe that's why the red flagsdistressing and compulsive thoughts or behaviors, self-created rules around foodoften go unnoticed or even praised, despite the fact that restrictive diets can be precursors to clinical eating disorders, Kamryn T. Eddy, Ph.D, an associate professor of psychology at Harvard Medical School and co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, tells SELF. In a culture that's already hyper-fixated on our bodies, we're also constantly reminded that there are ways to improve and "purify" it every time we see a celebrity hawking cleanses and detox teas on Instagram (spoiler: they're mostly laxatives).
Too much or too little of any one thing is generally problematic, and strict food rules in any form can set the stage for eating disorders, says Eddy. She emphasizes that when we are as inflexible around food as I had become, physical and mental health is greatly compromised. According to the National Eating Disorders Association (NEDA), food inflexibility can lead to guilt or self-loathing if a "bad" food is consumed, as well as anxiety about food planning and isolation from social events with food and drinks. It can also cause nutritional deficiencies when entire food groups are removed from a person's diet.
This type of ultra-controlled healthy eating, known as orthorexia, can take many forms. According to NEDA, orthorexia signs and symptoms include compulsively checking nutrition labels, an inability to eat any food that isn't designated "pure," obsessively following "healthy lifestyle" bloggers or social media figures, and showing an "unusual interest" in what others are eating. Of course, you can check nutrition labels and follow fitness experts on Instagram without being orthorexic. It's the compulsivity and obsession (reading labels every time, even multiple times, that you eat something and feeling anxious if you don't, for example) that define orthorexia.
Orthorexia can often lead to anorexia, registered dietitian Christy Harrison, certified eating counselor and host of the popular podcast Food Psych, tells SELF. I've seen many clients who get so afraid of foods they see as processed and unclean that they end up eating hardly anything. Then, even if the orthorexia didn't have anything to do with weight at the beginning, they end up extremely fearful of, and resistant to, gaining weight.
By restricting my diet in an attempt to make it pure, all I ended up doing was imposing nutritional deficits on my body (a body which, by the way, is already full of organs meant to filter what I eat, and which is perfectly capable of digesting pretty much any kind of food I could throw at it).
I opted out of so many celebrations and social gatherings in fear of the food that Id be expected to eat or the cocktails Id be expected to drink. I missed out on friends birthdays and fun nights out, and on the rare occasions when I would show up, my obvious discomfort (and my transparent lies about having already eaten or just wanting water) made everyone else uncomfortable, too. Friends and dates gradually drifted away, preferring the company of someone who could share a beer after work or go for tacos and margaritas without obsessing over the "unhealthiness" of what I was eating or drinking. My family walked on eggshells around me, buying my separate, special groceries from the health food store when I was home and watching me agonize over our holiday meals. I lived in the prison that orthorexia had built around me, isolated in a life devoid of joy and connection with others.
Eventually, deprived of adequate nutrition and rest over the course of a year, my body and brain suffered. I experienced heart irregularities, dizziness and exhaustion, an inability to focus, and the loss of my period, all symptoms of anorexia, according to the Mayo Clinic. My best friend, deeply worried by all of these symptoms (and tired of watching me self-destruct in the pursuit of the perfect, "healthy" body) stepped in. With my approval, she made a consultation appointment for me at a local treatment center. The admitting counselor confirmed it: my orthorexia had morphed into anorexia nervosa. If I didnt learn how to find balance, my restrictive diet could end up killing me.
Eating disorders are rooted in compulsivity and obsession surrounding food, though they may present in different ways. According to NEDA, orthorexia is characterized by being consumed with "good vs. bad" or "healthy vs. unhealthy" food, while anorexia is characterized by obsessive caloric restriction and weight loss.
Thankfully, doctors and therapists who specialize in nutrition, such as those at the Cambridge Eating Disorder Center (CEDC) in Massachusetts, are growing more aware of orthorexias prevalence, risks, and why it so often goes ignored, untreated, or even rewarded. This is especially true in patients who do not lose a large amount of weight, who continue to function normally in their day-to-day lives, or whose symptoms may not yet be apparent.
Since individuals with orthorexia may maintain an outwardly healthy appearance, they may be reluctant to see (it) as a problem, Seda Ebrahimi, Ph.D., director of the CEDC, tells SELF. Still, she says, the consequences of such restrictive eating may lead to significant nutritional deficiencies and health problems.
Orthorexia is not yet recognized by the DSM-5 and thus, not medically diagnosable. However, practitioners skilled at recognizing eating disorders will know what orthorexia is and can connect patients with the appropriate therapists, nutritionists, and medical doctors.
"For anyone reading this who has had disturbing symptoms arise since they started 'eating clean,' like bingeing or emotional eating, constant thoughts about food, low energy, dry skin, abnormal blood work, or stress fractures, consider that overly restrictive eating," Harrison says. "Orthorexia may be at the root of these symptoms. Don't take them as a sign that you need to 'eat cleaner,' because that could just make the problems worse." She says that treatment will vary by individual and depend on how far the orthorexia has progressed (or if it overlaps with any other clinical disorders).
I didn't see my orthorexia for what it was until it had transformed into anorexiawhich is what I was officially treated for. But my therapist and nutritionist both helped me to deal with those orthorexic thought patterns and habits. They also helped me to reject elimination diets, which I am still doing in my recovery. Through talk therapy and learned coping mechanisms, I was able to walk back my rigid thinking around what I'm "allowed" to eat, eating and exercising on a certain schedule, and defining healthy as being thin, toned, and free of "bad" food in my body.
Eating mindfully is good for you, and changing your diet to focus on minimally processed foods is generally recommended across the board. But if you find yourself with an ever-shrinking list of permissible foods, if deviating from that list makes you feel anxious and guilty, if you control your food choices so strictly that it interferes with other plans and activities, and if your relationship with food takes up a large amount of space in your life, it might be time to ask what your devotion to that diet is costing you.
Socially, I've had to step away from friends who engage in orthorexic lifestyles or restrictive diets, both on social media and in real life. Many people don't understand that I had a real disorder; they just think I "took my diet and exercise too far." I've accepted this, and while I try to clarify widespread misconceptions about the bad science of detoxes, cleanses, and elimination diets, I try not to preach at my loved ones.
With weekly therapy appointments, weigh-ins, and nutrition appointments, along with a meal plan designed to help me regain weight and relearn unstructured eating, my treatment team helped me find my way back to a balanced lifewhich, for me, includes regular doses of ice cream, pizza, and pinot noir.
The social messaging around what healthy looks like and the aggressive promotion of virtuous eating still creep in and create the occasional urge to diet. They probably will for the rest of my life. But now I know first-hand that banning certain foods won't always solve your problemsfor some of us, it can cause them.
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Orthorexia: How My 'Clean Eating' Turned Into Anorexia - SELF
