Chapter 2 - Treatment of pathologic healthy eating (orthorexia nervosa)

Abstract

Orthorexia nervosa (ON) is a proposed eating disorder diagnosis characterized by excessive preoccupation with health and rigid, compulsive adherence to often idiosyncratic healthy eating “rules.” ON bears many similarities to currently recognized diagnoses, including anorexia nervosa, obsessive-compulsive personality disorder, and obsessive-compulsive disorder. The phenomenological similarities among these diagnoses have led some to argue that ON, like anorexia nervosa, may be an eating disorder in the obsessive-compulsive spectrum. The ON research is in its very early stages. The construct was first described in 1997, and only since 2013, psychometrically sound symptom measures have been available to researchers. There is no evidence-based treatment for ON. In this chapter, ON is conceptualized as a manifestation of obsessive-compulsive disorder, with intrusive thoughts about health and food being managed through avoidance and ritualizing (e.g., eating only “healthy” foods, engaging in checking or safety behaviors to ensure food “quality”), which are negatively reinforced by temporary relief from anxiety. Exposure and response prevention treatment is recommended to help patients recognize and interrupt this cycle of anxiety and avoidance. Because ON can impact nutrition and weight, and because of the need for differential diagnosis with anorexia nervosa and other eating disorders, interventions and assessment strategies are informed by evidence-based practice for disordered eating.