Eating Disorder or Disordered Eating
People who are diagnosed with Eating Disorders most certainly experience disordered eating, though there lots of us who exhibit disordered eating behaviors and patterns, yet do not qualify for an official diagnosis according to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a manual for assessment and diagnosis of mental disorders.
It is important to note that Eating Disorders have greater symptom severity than non-clinical disordered eating and always meet criteria for a clinical diagnosis. Disordered eating includes some of the behaviors we see in people with Eating Disorders, however these behaviors occur much less intensely. Disordered eating behaviors are important to recognize and there is treatment that can help people who show such patterns.
What is Orthorexia?
Orthorexia Nervosa, literally meaning ‘proper appetite’, is best described as an obsession with healthy eating with associated restrictive behaviors. These restrictive behaviors can result in an overall severely restricted diet and avoidance of food believed to be unhealthy (Walker-Swanton et al., 2020).
While Orthorexia Nervosa is not a diagnosis within the DSM-5, it is observed to have similarities to other eating disorders such as Anorexia Nervosa due to the problematic eating habits and negative impacts on functioning to physical and mental health (Walker-Swanton et al., 2020). In addition to the behavioral overlap with eating disorders, Orthorexia has behavioral overlap with other psychiatric disorders such as Obsessive Compulsive Disorder, which can lead to malnourishment, loss of relationships, and poor quality of life (Missbach et al., 2017; Koven & Abry, 2015).
Can Orthorexia be treated?
Due to the overlapping symptoms and pathology of Orthorexia Nervosa with Anorexia Nervosa and Obsessive Compulsive Disorder, there are treatments available. Currently, the recommended treatment for Orthorexia involves a multidisciplinary team that includes a combination of medication management, cognitive-behavioral therapy, and psycho-education can be applied with close monitoring in outpatient settings (Scarff, 2017).
Why is Cognitive Behavioral Therapy a good therapy for Orthorexia?
Cognitive behavioral therapy is an evidence-based treatment for many mental health conditions, including eating disorders (Linardon et al., 2017). Some cognitive behavioral techniques which have been found useful in the treatment of Orthorexia include the following interventions:
Exposure and response prevention is a therapeutic intervention that involves exposure to a feared stimuli in a safe space, in which the patient eventually becomes accustomed to it, and over time the fear attached to it is reduced. This type of treatment would be used after rapport has been developed, the client has been educated on the treatment, and the client has consented to the treatment. This type of technique may be most successful for treating obsessive and compulsive aspects of Orthorexia (Koven & Abry, 2015).
Cognitive restructuring is a technique used to help a client learn how to identify their maladaptive thought patterns, challenge these thought patterns, and replace them with constructive thoughts and in return, more adaptive behaviors. This technique has been shown to be beneficial to address perfectionism and cognitive distortions surrounding food such as dichotomous thinking, overgeneralization, and catastrophization (Koven & Abry, 2015).
Relaxation training is used to reduce anxiety surrounding blood sugar levels prior and post meal, mealtime anxiety, and other anxieties related to food and eating (Koven & Abry, 2015; Niedzielski & Kaźmierczak-Wojtaś, 2021; Scarff, 2017).
Psychoeducation is used to provide the client education and information about their condition. This can help debunk inaccurate food beliefs in reference to food groups, purity, and preparation (Scarff, 2017). For example, the thought that carbohydrates are unhealthy or cause weight gain is actually a myth. Carbohydrates are used to fuel your body and give you energy. Your body can benefit from carbohydrates, fats, and protein eaten in moderation.
Cognitive behavioral therapy for the treatment of eating disorders typically consists of 19-40 sessions (Linardon et al., 2017). When considering psychotherapy, interventions should be designed to meet the individual’s needs based on the prominent symptoms (Koven & Abry, 2015). Your therapist will determine what specific interventions and length of treatment is appropriate for you after conducting an assessment.
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Where to Find Treatment for Orthorexia Nervosa in New York City
If you are looking for treatment for Orthorexia Nervosa in NYC, it is best to first know what type of treatment you seek. If you are curious about medication management, you should schedule an appointment with a psychiatrist or psychiatric nurse practitioner who prescribes and manages medication. If you are curious about education on nutrition, it may be best to schedule an appointment to consult with a dietician.
If you are looking for psychotherapy, you will want to look for therapists who practice cognitive behavioral therapy and have experience working with eating disorders. Finding a therapist can be a lengthy and often intimidating task. You may have to try a couple therapists until you find the right one for you.
All therapists and coaches here at New York Behavioral Health are trained in cognitive behavioral therapy. Finally, the cost of therapy will vary. However, there are great therapists at all price ranges. If you’re looking for these great therapists on the lower price scale, check out practices with intern programs (like New York Behavioral Health), sliding scale options, or who take insurance.
Barthels, F., Barrada, J. R., & Roncero, M. (2019). Orthorexia nervosa and healthy orthorexia as new eating styles. PLOS ONE, 14(7). https://doi.org/10.1371/journal.pone.0219609
Koven, N., & Abry, A. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease and Treatment, 385. https://doi.org/10.2147/ndt.s61665
Linardon, J., Wade, T. D., de la Piedad Garcia, X., & Brennan, L. (2017). The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85(11), 1080–1094. https://doi.org/10.1037/ccp0000245
Missbach, B., Dunn, T. M., & König, J. S. (2017). We need new tools to assess orthorexia nervosa. A commentary on “prevalence of orthorexia nervosa among college students based on Bratman’s Test and associated tendencies.” Appetite, 108, 521–524. https://doi.org/10.1016/j.appet.2016.07.010
Niedzielski, A., & Kaźmierczak-Wojtaś, N. (2021). Prevalence of orthorexia nervosa and its diagnostic tools—a literature review. International Journal of Environmental Research and Public Health, 18(10), 5488. https://doi.org/10.3390/ijerph18105488
Scarff J. R. (2017). Orthorexia Nervosa: An Obsession With Healthy Eating. Federal practitioner : for the health care professionals of the VA, DoD, and PHS, 34(6), 36–39.
Thomas, J. J., Wons, O. B., & Eddy, K. T. (2018). Cognitive–behavioral treatment of avoidant/restrictive food intake disorder. Current Opinion in Psychiatry, 31(6), 425–430. https://doi.org/10.1097/yco.0000000000000454
Thomas, J. J., Lawson, E. A., Micali, N., Misra, M., Deckersbach, T., & Eddy, K. T. (2017). Avoidant/Restrictive Food Intake disorder: A three-dimensional model of neurobiology with implications for etiology and treatment. Current Psychiatry Reports, 19(8). https://doi.org/10.1007/s11920-017-0795-5
Walker-Swanton, F. E., Hay, P., & Conti, J. E. (2020). Perceived need for treatment associated with orthorexia nervosa symptoms. Eating Behaviors, 38, 101415. https://doi.org/10.1016/j.eatbeh.2020.101415