For Ashley Bailey, everything was fine until she put on her "skinny" jeans. They were falling off. Something was wrong.
"It was so super obvious," she said. "I wouldn't eat anything with more than seven ingredients. I tried every diet — vegan, raw, Paleo, fruitarian. People kept asking me if I was OK. I just thought they were over concerned."
Controlling some digestive issues turned into a massively restrictive diet for Bailey. She might eat a bushel of grapes and a mango for dinner, but legumes, meat, and eggs were out. It was never about losing weight for her, but if she did gain any her restriction cycle started all over again. She thought she was being healthy.
"I'd flip about the scale," said Bailey, who has blogged about her condition. "Then, I'd just latch on to another diet."
What Is Orthorexia?
Bailey is now about a year and a half into her recovery from orthorexia. While not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), it is considered an eating disorder. Those who have it remove whole food groups from their diet and only eat foods they consider "pure."
That "pure" food is often referred to as "clean eating," a term you might find on a magazine cover or online article about organic, minimally processed food without preservatives, chemicals, dyes, or GMOs. When taken to an extreme, this can lead to an obsession with consuming the "right" kind of foods, inadvertently excluding vitamins and minerals necessary for a balanced diet.
Studies show orthorexics spend considerable time focused on the quality of their food. If unhealthy foods are consumed, guilt, anxiety, depression, and shame linger like a nosy neighbor.
Maddy Moon, a life coach who also blogs about her recovery from orthorexia, talked about how she first started with veganism. After a while, she got hooked on having others acknowledge her slim appearance. But then she took things a little too far.
"In the pursuit of a perfect body," she explained, "I lost friends. I lost my period. I lost my sex drive. I developed IBS. I had no social life and I was starving all the time."
Dr. Steven Bratman, an occupational health physician at California's NorthBay Healthcare, coined the term "orthorexia" in 1997, when it applied to people who embraced alternative healing, or unconventional therapies not based in modern medicine like homeopathy. But now, he said it's more like anorexia. He sees mostly women and male athletes with it, many of whom equate "low calorie" with "healthy."
"Most [orthorexics] can't stop thinking about food. They become obsessed. Life has turned into a menu," said Bratman. "Most people with that kind of psychological issue don't seek help because they think it's working for them."
Orthorexia vs. Anorexia
While people with orthorexia and anorexia share an obsessive focus on food and how it affects their bodies, orthorexics are concerned more with perceived health, and anorexics are concerned more with weight and image. Essentially, people with orthoreixa fear eating something "unhealthy," while people with anorexia restrict food to lose weight.
An Eating Disorder on the Rise
Joanna Imse, assistant program director of Walden Behavioral Care in Massachusetts, a facility targeting eating disorders, said orthorexia is clearly on the rise. She estimates about one client a week comes to her as a referral.
"It's definitely an increasing phenomenon," she said. "It's part of the greater culture shift in knowing where your food comes from — clean, healthy eating that's organic or farm-to-table."
Matt Stranberg, a nutritionist at Walden who often works with Imse, said orthorexia clearly takes an emotional toll. But, many people don't realize it's a problem until they see the physical effects — malnutrition, hair loss, bad skin quality, gastrointestinal problems, disrupted sleep, and even a weakened immune system.
"There's nothing wrong with having a better relationship with food," he said. "But when the line between you and food becomes blurry, it affects your mental health and well-being independent of weight loss."
Sondra Kronberg, a New York-based clinical nutrition therapist and National Eating Disorder Association spokesperson, said 20 years ago eating "diet" anything — from soup to soda — was the key to weight loss. Today, American culture seeks out unadulterated and chemical-free superfoods. Think kale, the "It Girl" of green, leafy vegetables.
Orthorexia and Exercise
Orthorexic perfectionist tendencies get rewarded by feeling in control of their food. That sense of control often extends to exercise. Kronberg said an exercise addiction is a frequently co-occurring disorder. If you're focused on your body's purity, then workouts become compulsive.
"I was also an exercise addict," said Bisciello. "That was one of the things I learned to cope with. I can't run 20 miles after not eating. You've got to have energy and you can't do it by destroying yourself."
Orthorexia and Social Media
Among those interviewed, there was universal agreement that social media has a lot to do with the spread of orthorexia. Research published last year showed a strong prevalence of orthorexia in the healthy eating community online. Every time someone posts a picture of their açai bowl or their last sweaty yoga class, it's hard not to feel sheepish when you just had a beer and a cookie. In a world of comparison, we feel bad if we don't measure up.
"Open up Instagram and all you see are what people are eating," said Aleah MacKay, who started her recovery process at Walden. "You see that person's successful and beautiful. It's one big comparison game."
Moon agreed that it affects your self-esteem.
"At the root of it, it's just not feeling worthy," she said about her own emotional struggle. "Now, I only do what feels good or has some enjoyment to it."
Cora Poage, who has written about orthorexia's stranglehold, explained her own moment of clarity.
"Eventually, I started to recognize I didn't love my body at any weight," she said. "There wasn't going to be a weight that would give me the gift of acceptance."
There's nothing wrong with wanting to eat more healthfully, whether it's for weight loss or just feeling better about yourself. There is something wrong, however, if you can't be flexible with it. If food takes center stage to the exclusion of everything else in your life, it might be time to seek help.