How To Heal From Orthorexia, Part 1: Uncovering Obsession
I run the site Paleo In The UK - where we are fairly used to the criticism that Paleo encourages Orthorexia. For all the conversation on why that is possibly true, but how that accusation cannot solely be reserved for a Paleo Diet, head over to Paleo In The UK’s latest article on How Paleo Can Become Orthorexia.
Orthorexia, simply defined, is an obsession with only eating and doing things that can be considered ‘healthy’. What is construed as ‘healthy’ will differ between individuals, but the universal characteristic in Orthorexia is that health obsession takes over people's thoughts, lives, decisions, activities and their every waking moment. Straying away from the ‘health’ template fills them with fear, dread and/or huge resistance. All of this is done with the belief that they are doing a ‘good thing’ or ‘the right thing’.
From the above description it is perhaps obvious why adhering to any dietary regimen, Paleo included, can cross close to Orthorexia territory.
To understand the distinction between ‘health’ and ‘health obsession’ revolves entirely around nuance and the subtle underpinnings of your psychology. In this article I discuss how you might identify whether your health aspirations are actually a damaging and paralysing obsession… and, if they are, how you can work to bring your attempts at wellbeing back into a more balanced state.
1 - Identifying Whether You Have Orthorexia
The reason Orthorexia is challenging to identify is because health, pursued to a moderate level, is seen merely as an aspirational desire for self-improvement. As such, it is applauded.
The difference between aspiration and unhealthy obsession is simply one of degree. Of course, we cannot and should not pathologise a very normal desire to be healthy and feel well.
However, Orthorexia is not just a desire to be your best self - it can manifest more as a desperation NOT to do anything UNHEALTHY. Sometimes just digging into the direction of someone’s goals is enough to clue you in as to whether their desire is a perfectly natural attempt to better themselves, OR suffocating and all-consuming fixation with AVOIDING anything they deem ‘unhealthy’.
A fixation on avoiding everything that is unhealthy adds complexity into life. It transforms workouts into obligations (because rest is lethargy) and meals into minefields of calculations and rules based on whatever diet is being followed. “Optimal Wellness” becomes a high bar of perfection - and every moment presents a test at which you can pass or fail in your attempt to achieve said perfection.
Orthorexia also makes wellness - in particular food and exercise - into a huge preoccupation which takes up time, requiring preparation and extensive planning. More often than not, Orthorexia will mean that you take yourself out of social situations, avoid environments where you feel you cannot make healthy choices and completely removes spontaneity in your decisions. This can lead to self-imposed isolation.
Orthorexia is often accompanied by the ‘glow’ of supercilious wellness one upmanship. In our society, health practices are so linked to worth and value that we tend to associate avoiding ‘indulgences’ as being virtuous and good. Our society is, in fact, built to encourage the obsessions inherent in Orthorexia - we label foods pejoratively, as ‘good’ and ‘bad’, and we praise those who ‘take care of their bodies’ by working out and eating ‘well’. This can mean that those with Orthorexia feel they are passing societies test for being a person worthy of praise.
Another key question to ask to identify whether practices are orthorexic is to think about whether it’s actually working. If - hand on heart - the practices you obsess about make you feel healthier, more well in yourself, completely secure in your behaviours and choices and are things that you actually derive pleasure from then it is possible that, even if they are extreme, these are not classifiable as Orthorexia.
However, this is unlikely to be the case. And if you cannot say you feel massively healthier based on the efforts you put in, it is possible your judgement has been clouded regarding whether the amount of effort being put in is being met with an equal reward.
And if you feel better because you feel like you’re doing the ‘right thing’ but you haven’t actually stopped to check whether your body is thanking you for it (think about healthy digestion, hormones, libido, hair, nails, how much you laugh in a day etc.) then we suggest you tune in and really try to ascertain how healthy your body feels, rather than just how healthy your head tells you you must be.
And lastly, to understand whether your health focus and goals have become obsessional, it is always worth asking how you would feel if someone took your ability to behave in this way away from you.
Could you be spontaneous? What are you not eating for ‘health reasons’ that you have actually become so threatened by that you are frightened of consuming again?
And if you don’t have a genuine allergy to this food, how much of your avoidance of it is based on the physical reactions you have personally had versus the information you have read about it online?
For my clients and in my work, all of the above come with grey areas and huge swathes of doubt. In chronic illness we are taught that nutrition can play a huge role in the pursuit of health and re-regulation of our bodies. In autoimmune conditions we are trained to avoid a whole slew of ingredients based on textbooks, not physical experiences. There is so much attention paid to diet in modern, Functional Medicine that it, in fact, can breed the very paralysis that would be diagnosed as Orthorexia in someone without a chronic illness.
Next week I will discuss this in great depth - but for the remainder of this article I want to share how I work with those for whom health obsession does not begin with an illness, per se. If you have a chronic illness, however, do read the rest of this article. Everything that can fuel orthorexia in those who are healthy can also be contributing to the way those with chronic illness are approaching the tools they are using to heal. And yes, especially in chronic illness, diets can become obsessional rather than healing.
2 - Understanding Why Your Orthorexia Developed
Understanding what role or purpose the obsession with health is having in each individual case is vital to being able to unwrap the ties that Orthorexia can have over people.
For those with chronic illness, Orthorexia can develop because they are literally told that food is dangerous to their body and they must avoid certain things at all costs or risk deterioration. This makes me utterly incensed - but I will cover this in full next week.
What about those for whom Orthorexia does not begin with chronic illness? Well, the reasons are actually quite similar. In our modern world we are filled with messages that certain things are good and bad, and we are human - it is natural to want to fall on the ‘good’ side of this spectrum.
Whereas for some individuals this means that sometimes they have ‘guilty pleasures’ from the ‘bad’ side of spectrum, in certain psyches the whole notion of ‘good’ and ‘bad’ provides them with their paralysing framework for Orthorexia. The key is working out the background in that individual to understand why they feel such overwhelming need to be ‘good’.
The precise reasons will be completely individual, but some of the most common reasons for the development of Orthorexia are as follows:
For some their Orthorexia stems from witnessing (typically when they are young and/or at an impressionable stage) someone close to them develop a health condition that is either very traumatic and/or takes their life. This implants an early comprehension of how fragile and impermanent life is. In order to try and control one’s own life, an excessive attention is placed on managing everything possible in order to pursue wellness and stay healthy.
This can be a particularly powerful push towards Orthorexia if it is a parent or loved one who dies of a preventable, chronic health condition such as a heart condition, diabetes etc. and/or if a relative has developed neurodegeneration. An attempt to stave off a similar fate for themselves can lead someone who is predisposed to obsessional qualities to spiral down the path of becoming paralysed by the amount of things they are trying to maintain in order to stay healthy and stop themselves from following in their relatives’ footsteps.
For others, Orthorexia provides them with a sense of personal achievement and fulfilment - where being ‘good’ and being ‘virtuous’ confers an aura of superiority. This isn’t just for show, however. It is similar to any situation where someone seeks this superiority - it is typically related to seeking external validation or approval.
Sometimes this stems from a lack of internal self-worth. This can be due to a lack of outwardly expressed love in childhood and/or a competitive sibling environment during youth which made obtaining expressions of love feel like a battle. Sometimes it is the early parenting environment which simply didn’t foster an internal sense of self-worth or self-regulatory behaviour (also known as self-soothing).
It is also possible that outward attention/approval seeking manifest for those from divorced parents where a child feels (most likely, completely unconsciously) that their parents’ divorce was somehow a reflection on them as a child - that the parent that left did not love them enough to want to stay. Seeking external approval by being ‘good’ (by being obsessed with doing ‘good’ health and wellness practices) is founded on an early psychological imprinting that they weren’t ‘enough’. It could almost be said that these individuals are still trying to impress the parent that didn’t love them enough to stick around*.
*Of course, this is entirely subjective and more often than not utterly untrue - however this impression is acquired through a child’s eyes. It is not about fact, it is about what a child can understand at a young age.
Orthorexia can also emerge when there is a desperation to feel a sense of belonging: to a group, to a movement, to an ideology or to a tribe. As humans we are still tribal in nature - and nutrition or health practices can become almost like religions in their fervour. Finding a group that you can belong to is a powerful motivation. If it is a group with rules around nutrition, those who act according to those rules are granted admission, those who fall off the wagon are expelled from the group. This is a powerful incentive to behave and can easily lead to obsessional tendencies with health.
Again, this may just be a surface representation of a deeper emotional or psychological need to feel accepted and supported within a group of like-minded people. This too can stem from childhood experiences or be a reflection of a sense of isolation through the formation of early friendship groups.
Lastly, Orthorexia can arise as a slightly more legitimised form of another eating disorder. The obsession with becoming as thin as possible is “anorexia”. Within anorexia the attempt is to eat as little as possible and/or to push weight as low as possible.
Orthorexia is categorically not this. It does not have to have anything to do with a concern over ‘losing weight’. And yet, because in modern society we are indoctrinated with the sense that a lower weight correlates with health, where anorexia is an obsession with losing weight (and often is all to do with image and not to do with health), Orthorexia is an obsession with regulating body weight and body composition - and the aspired to image is one that the sufferer believes (subjectively) reflects ‘optimal health’. Typically this image is overly thin but with defined muscles.
Whilst the aspired-to physique may be slightly different between Orthorexia and anorexia - the desire which motivates both can be similar: a need to in some way have control over one’s body.
When this need for physiological self-control is the origin of an individual’s Orthorexia we have to dig a little deeper to understand why they seek such control. What are they trying to manipulate? What are they trying to avoid or attract by being a certain shape/weight? What is the body they aspire to going to give them - what do they think it will confer and why do they feel that self-control and self-restriction are the ways to achieve it?
Essentially, exceptional self-control and the ability to operate within extreme restrictions are the underpinnings of Orthorexia. Digging deeply into the reasons behind the need to maintain such restraint and control is essential for being able to work through the behaviours that have become your obsession.
3 - Letting Go Of Control
Once you establish why you started to grab onto control in the first place it is possible to unwind the controlling parts of your nature which have become Orthorexia. However, as you can see from how quickly we got into really deep psychology and emotions above - this is often best done alongside someone who can understand and have a real awareness of how to help you process the deeper issues behind the Orthorexia.
This means that healing from Orthorexia is not about lecturing yourself that you need to ‘lighten up’ and ‘let go of control’ and ‘you can’t control it all anyway, so why does it matter?’. Though these statements are sort-of true, all they do is encourage a harsh and toxic monologue inside yourself wherein you are basically chastising yourself for feeling the way that you do. This actually does nothing to help you address the core issues which gave rise to your Orthorexia. You aren’t flawed for being orthorexic. Far from it. You are using Orthorexia to try and overcome what you perceive as your flaws.
So instead of the self-judgement, I encourage clients not to focus on the behaviours and obsessions they want to change - certainly not to start with. I know that the way people behave around food typically has nothing to do with the food itself, and Orthorexia is no different.
If this is the case, changing the food behaviours as an attempted solution will be a temporary fix - and, if it works at all, the obsessional health-based behaviours will more than likely be replaced with other, similarly self-defeating ones.
Rather than piling in on the self-hatred trip, therefore, we take a step back - forget about the ‘how’ someone is behaving and really understand the ‘why’.
Then, if we uncover childhood trauma, emotional patterns which are imprinted from early life experiences, somatic memories which are hardwired into someone and affecting their nervous system etc. etc. I utilise a whole host of techniques from simple ‘talking through stuff’ to more nuanced NLP reframing practices to help my clients change their understanding of how to interact with the world around them.
The key to this, more often than not, is helping someone see the truth of why they are doing something. Often we have spent so long constructing behaviours and coping strategies that we have no idea of the latent issues which are pushing us to these strategies in the first place.
Simply by stopping all of the running around and the “COPING” we shine a light on what we’re trying to cope with. Seeing it in daylight is sometimes enough to make the feelings, the thoughts and the patterns evaporate - and slowly we learn that we have no use for the behaviour. In the case of Orthorexia, it is possible to learn that being only ‘good’ is not a route to fix the pain that was being felt internally.
And no, healing doesn’t always happen overnight. More often than not for Orthorexia it is a process of remembering that you’re allowed to forget to be so vigilant, slowly realising that the security blankets of health behaviours that you constructed were actually not necessary, were not serving you - and were themselves creating ill health.
It may take time, and reminders - but healing is possible. And this doesn’t automatically mean that you become unhealthy. Instead, it means that you hold the pursuit of health and wellness in the right perspective, balanced with the notion that a large part of health is being happy - and that a large part of happiness comes from freedom, not restrictions.
But what about those for whom a certain degree of nutritional specificity or care and attention towards their health is absolutely necessary: those with chronic illnesses?
If you are reading this site then you must be aware of how important good nutrition, lowering inflammation, healthy lifestyle practices and focusing on wellbeing is to getting better and to recovery from or management of a health condition.
But it is here where Orthorexia can become the most dangerous and much more difficult to tackle. Where an obsession and a need to follow ‘health practices’ is legitimised - as it is in chronic illness - how do you strike up a balance where your investment in wellbeing safeguards your health, rather than contributes to your stress, to your inflammation - and ultimately your illness?
I will discuss this next week, so SIGN UP FOR UPDATES in the toolbar at the top of this page so that you will be notified of NEXT WEEK’s ARTICLE HOW TO HEAL FROM ORTHOREXIA, PART 2: ORTHOREXIA IN CHRONIC ILLNESS - WHERE HEALTH IS A LEGITIMISED OBSESSION.