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© 2017 Ed Freedom Coach, Damara Miller, ACC

  • Damara

Three reasons it's so hard to identify Orthorexia.

Updated: Aug 29, 2019

In our diet-steeped culture it isn't always obvious (not even to ourselves) whether we are just dieting or have an eating disorder. There is a difference. Eating disorders are mental illnesses. Dieting is generally a choice. Yet both can feel out of control. Whether or not we have an eating disorder, if our disdain for our bodies or our obsession with food and/or exercise feels out of our control, it's time to get help. Here are three reasons why it's hard to identify Orthorexia.


But first! A super important side note. If you think you might have an unhealthy relationship with food I encourage you to trust that gut feeling. That nagging suspicion. It might even be Holy Spirit getting your attention. If you feel like you're not as free as God wants you to be where your body, food and exercise are concerned then hear me when I say, "There is more!"


Creating awareness is an important first step. Both for ourselves and others. There are plenty of good self-assessments out there. HERE is a screening tool from the National Eating Disorders Association and ONE from the Eating Recovery Center. These are good for providing a reality check, validating and helping us to discern. Taking one or both of these is an easy first step. Still, it's best to also talk with an eating disorder specialist. You can find free in-person or phone assessments at most treatment centers.


As great as these initial assessments are they don't necessarily catch everything. Which is why paying attention to that gut feeling and talking with a specialist are both so important. For example, you might be more concerned with avoiding "unhealthy" foods than your weight. You might exercise a lot because you're in a competitive sport, but you might also have an underlying anxiety that feels more like exercise compulsion.


Quick self-check... while considering all this, have you thought something like "I don't want to pay attention to this gut feeling and I don't want to talk to a specialist because then I'm going to have to do something about it."? If so, I cannot encourage you enough to follow up on it.


Take an honest self-assessment, talk to a safe person about it, even schedule a free 30-minute phone call with me. On that call I can help you figure out the next best steps for you to get treatment, pick a safe person to talk to about it and come up with a plan that you are comfortable with. If that sounds like you, I just want to encourage you that there is SO much more freedom ahead of you then you could ever imagine.


So why's it so hard to know whether Orthorexia is in the picture?


It's hard to identify Orthorexia without a clear definition and agreed upon working assessment.


Orthorexia is one eating disorder that may not be evident on a self-assessment. Hopefully questions about binging, pre-occupation with food or over-exercising might throw up some red flags. Without official defining criteria practitioners generally use a mix of the traditional eating disorder assessments and anxiety assessments to identify Orthorexia 1. Thankfully there are some simple self-assessments specifically for Orthorexia. Like Dr. Bratman's simple self-assessment here 2:


1. I spend so much of my life thinking about, choosing and preparing healthy food that it interferes with other dimensions of my life, such as love, creativity, family, friendship, work and school.


2. When I eat any food I regard to be unhealthy, I feel anxious, guilty, impure, unclean and/or defiled; even to be near such foods disturbs me, and I feel judgmental of others who eat such foods.


3. My personal sense of peace, happiness, joy, safety and self-esteem is excessively dependent on the purity and rightness of what I eat.


4. Sometimes I would like to relax my self-imposed “good food” rules for a special occasion, such as a wedding or a meal with family or friends, but I find that I cannot. (Note: If you have a medical condition in which it is unsafe for you to make ANY exception to your diet, then this item does not apply.)


5. Over time, I have steadily eliminated more foods and expanded my list of food rules in an attempt to maintain or enhance health benefits; sometimes, I may take an existing food theory and add to it with beliefs of my own.


6. Following my theory of healthy eating has caused me to lose more weight than most people would say is good for me, or has caused other signs of malnutrition such as hair loss, loss of menstruation or skin problems.


Orthorexia is hard to identify because it is

Ego-syntonic.


Ego-syntonic means "relating to aspects of a people’s thoughts, behavior, attitudes, feelings viewed as acceptable and consistent with the self-conception" 3. In other words, it seems like an appropriate avenue to pursue personally and socially accepted values. Orthorexia can look like the cultural ideals of eating "perfectly" and exercising a TON. It can be difficult to recognize Orthorexia when the people around us tell us they admire our discipline and self-control.


It's hard to identify Orthorexia when we don't have the language for it.


If you take the next step and speak to an eating disorder specialist it may be helpful to have some basic language under your belt. We may answer questions inaccurately and be misdiagnosed if we don't know what these terms mean.


Restricting or Restrictive Eating Limiting food intake to a certain number of calories or to certain foods or food groups. That means you might never miss a meal (you might even constantly be eating something) and still be restricting. If there are food items, types, groups or quality of foods that are considered "off limits" then that's restricting. If there are set rules determining certain times of day that you don't eat, set amounts of food, etc. then that's restricting.


Purging This does not just mean vomiting. It means any intentional effort to expend or expel calories. So using laxatives, diuretics or exercise can also be considered purging.


Over Exercising What is considered over exercising can vary from person to person, but be very clear and specific about how much you exercise. Take into account any health issues that you push through in order to exercise (i.e. frequent migraines, joint pain, muscle strains, exhaustion, a cold or flu, etc).


Compulsive Exercising Compulsive exercise is a compulsion to exercise to excessive, unhealthy levels despite physical and emotional consequences. 4 It might be helpful to mention if you experience any anxiety around not being able to exercise according to self-imposed workout schedules. For example, if you have a regular rhythm of exercising four times a week, but you get very disturbed and anxious if you have to miss one of those days.


Compulsive exercise might also look like the immediate coping response to feelings of anxiety. If the anxiety is great enough and goes unchecked, this could look like somebody exercising in random places or unusual times and even turning every daily task into an exercise. All of that and it still may never feel like enough to stem the anxiety.


Binge Eating or Bingeing Defined as eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is noticeably larger than what most people would eat in a similar period of time under similar circumstances. These episodes usually feel out of our control. If binging is around "healthy" foods, some clinicians might not immediately consider it bingeing. However, in Orthorexia, binging on any "unhealthy" foods might not feel like an option. So binging looks more like eating a whole tray of bran muffins. In this case pointing out the "out of control feeling" is key. Check out the DSM 5 criteria in greater detail from the National Eating Disorders Association HERE.


Fear Foods These are foods that are self-prescribed "off limits". We might not realize that we are afraid of these "fear foods". We might just deem them too "unhealthy" for us or just plain "unsuitable". It is helpful to think whether there are any foods that would make you really anxious to eat (especially if you couldn't exercise for the next 72 hours).





1 Eating Disorder Hope, "Raising Awareness for Orthorexia".

2 Steven Bratman, MD "The Authorized Bratman Orthorexia Self-Test".

3 Brytek-Matera et al., "Orthorexia Nervosa and self-attitudinal aspects of body image in female and male Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students", Journal of Eating Disorders (2015) 3:2

4 Addiction.com "Compulsive Exercise"