Orthorexia is an eating disorder characterized by an obsession with “healthy” eating through a restrictive, self-imposed diet. Currently, there are no clinical treatments that have been specifically designed for orthorexia.
This is because the condition is a newer eating disorder that does not currently have its own classification within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The DSM-5 is the handbook that mental health professionals use to diagnose and guide the treatment of mental health conditions.
Nevertheless, there are still treatments available for orthorexia, even though these have not been created specifically for the condition. Typically, healthcare providers use existing treatments for anorexia nervosa or obsessive-compulsive disorder to help treat orthorexia. This is due to the overlapping symptoms and pathology of these three conditions.
This article will cover the medications, therapies, medical monitoring, lifestyle, and alternative treatments used for orthorexia.
Prescription Medications
There is no existing research on the efficacy of psychotropic medication (drugs that affect the mental state) for people with orthorexia. However, certain medications may be given that are typically prescribed for people with anorexia nervosa due to the common symptoms of the two conditions.
Orthorexia is often treated as a subtype of anorexia nervosa or obsessive-compulsive disorder.
Selective serotonin reuptake inhibitors (SSRIs) are shown to reduce depression symptoms among people with anorexia nervosa and are often also prescribed to people with orthorexia for this reason. Researchers also state that SSRIs may be beneficial for people with orthorexia for reducing anxiety and obsessive-compulsive traits.
Prescription medications should not be the first-line treatment for people with orthorexia, though. People with orthorexia may be resistant to or noncompliant in using prescription medications because medication can be seen as an “unnatural substance” outside their restrictive diet.
Therapies
Similar to other eating disorders, various types of psychotherapy and therapeutic methods may be used to treat orthorexia. It can help an individual with orthorexia increase the types of foods in their diet.
This is done because one characteristic of orthorexia is severely limiting certain food categories (such as dairy, sugar, carbohydrates, GMO, etc.). Therapy can also help a person develop coping skills for the anxiety triggered by eating these previously restricted foods.
Although there is no research on the therapeutic outcomes of treatment for orthorexia, eating disorder professionals typically use a combination of psychoeducation and cognitive behavioral therapy.
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT) is a type of psychotherapy with a large evidence base as a treatment for many mental health conditions, including eating disorders. In CBT, a trained therapist teaches their patient how to identify negative thought patterns, challenge these thoughts, and replace them with constructive thoughts and behaviors.
The theory behind CBT for orthorexia is that it can help reduce perfectionism and cognitive distortions, which many people with orthorexia struggle with. By changing the underlying thought patterns that led to their disordered eating, a person can then change their diet as a result.
Exposure Therapy
Exposure therapy involves exposing a person to their feared stimuli in a controlled, supportive environment. It is used as a treatment for phobias, social anxiety, and obsessive-compulsive disorder, and there is some emerging evidence for its use in treating anorexia nervosa, as well.
Exposure therapy is based on the behavioral theory that avoidance reinforces fear. By exposing a person to their feared stimuli, they can habituate to it, and over time reduce their fear response.
A person with orthorexia may experience intense feelings of shame, guilt, and anxiety when they eat a food restricted from their diet. An example might be having something to eat at a work function when they are unsure if it is non-GMO (genetically modified organism) or not.
Through exposure therapy, they can habituate to eating food that induces distress and learn to expand their diet while limiting the fear, shame, and guilt associated with this.
Psychoeducation
Psychoeducation is another component of treatment for orthorexia. Therapists use psychoeducation to inform patients about their condition, raise awareness of their condition, and support the person with evidence-based resources.
In the context of orthorexia, a mental health professional might use psychoeducation to educate about the importance of eating a balanced diet, and correct inaccurate beliefs about certain food groups or food preparation methods.
However, this process will likely create emotional stress for a person with orthorexia, who has deeply ingrained beliefs and obsessions with their dietary restrictions. As a result, psychoeducation should be used in conjunction with other therapeutic tools.
Medical Monitoring
As with other eating disorders, medical monitoring may be necessary during orthorexia recovery and treatment. Although people with orthorexia are more focused on the quality of their food, rather than trying to alter their body composition or lose weight, they may still have malnutrition.
A case study of a man with orthorexia found that his condition caused hyponatremia, metabolic acidosis, subcutaneous emphysema, mediastinal emphysema, pneumothorax, and pancytopenia.
People with active orthorexia should be monitored for the emergence of any medical condition. Refeeding in a hospital setting may also be recommended for people who have experienced severe weight loss from their orthorexia.
Additionally, various blood tests should be taken at diagnosis and throughout orthorexia recovery to monitor any deficiencies or abnormalities that may result from a restricted diet. These tests include:
- Complete blood count
- Lipid profile
- Vitamin B12
- Electrolytes
- Folate
- Liver function tests
- Magnesium
- Manganese
- Phosphate
- Vitamin D
- Zinc
Alternative Treatments
During treatment, people with orthorexia may experience anxiety when eating meals that include foods outside their self-imposed diet. Various complementary and alternative treatments may help reduce this mealtime anxiety. These include:
- Relaxation therapyYogaMeditationDeep breathing techniques
Lifestyle
Some people with orthorexia may benefit from limiting or changing their social media use during orthorexia recovery. A 2017 study found an association between Instagram use and orthorexia. No other social media platforms were associated with an increased risk of developing orthorexia.
Some people with orthorexia might feel triggered by using Instagram or following certain “clean eating” accounts on the platform. During recovery, they might benefit from reducing their Instagram usage.
However, there is no research that specifically evaluates the cause-and-effect of Instagram use and orthorexia, and there could be other factors in this relationship.
A Word From Verywell
Unfortunately, there is currently no evidence on treatments specifically designed for an orthorexia population. As a result, the likelihood of recovery or response to interventions remains unknown.
If you have orthorexia, you may be aware that knowledge and research on your condition are still developing. However, despite this, there is help available for you. You deserve to eat a balanced diet full of foods you enjoy and to feel good while doing so.
If your restricted diet is getting in the way of your social commitments and relationships or creating anxiety or shame in your life, then it may be time to talk to your practitioner about your treatment options. Together, you and your healthcare provider will tailor a treatment plan that is unique to you.
Summary
Orthorexia does not have a specific treatment regimen. Currently, eating disorder professionals must choose from existing treatment options, primarily those used to treat anorexia nervosa or obsessive-compulsive disorder, to treat orthorexia. These include cognitive behavioral therapy, exposure therapy, and education about the condition and nutrition.
Antidepressants and other medications may be used. Medical monitoring may be done to look for signs of malnutrition. Alternative medicine practices may help with anxiety. If social media is a trigger, the person may be advised to stop using it.
