What are people’s experiences of orthorexia nervosa? A qualitative study of online blogs

Abstract

Purpose Orthorexia nervosa (ON) is a proposed new eating disorder, used to describe a pathological obsession with healthy or 'clean' eating. Although some quantitative research has been carried out in ON, very little qualitative work has been published to date to explore individual experiences of ON. Thus, this study aimed to explore individuals' personal experiences of ON, as described in online blogs. Methods Fifteen women bloggers, who self-identified as having ON, consented for their blog entries to be analysed in this study. Forty pre-existing blog entries describing the first-person experiences of ON were analysed using thematic analysis. Results Three key themes were discussed: (1) initial motivations for a healthier lifestyle, (2) fuelling the problem-social influences, and: (3) when healthy becomes unhealthy. Bloggers described the role of social messages, comparison with others around ideas of 'healthiness', as well as confusion around diagnosis as factors influencing their disordered eating. They also described the exacerbating impact of perfectionism and perceived control, as well as a confirmatory cycle of fear and avoidance. For some bloggers, increased physical symptoms in response to feared foods provided confirmation for these fears, further exacerbating food avoidance. Conclusion Whilst the debate around the diagnosis of ON continues, these bloggers' accounts suggest that ON is experienced as a legitimate, debilitating disorder, worthy of clinical and research investigation. This study provides evidence of some of the potential triggers and maintaining factors for this disordered eating style. Level of evidence Level V, qualitative descriptive study.

Identifying the Profile of Orthorexic Behavior and “Normal” Eating Behavior with Cluster Analysis: A Cross-Sectional Study among Polish Adults

“…Individuals with high ON tendencies had more difficulties identifying and accepting their feelings, and resisting impulses, engaging in goal-directed behaviors and finding the right strategies when upset compared to people with low ON tendencies. It has been hypothesized that ON behavior can be considered as a coping strategy in order to feel 'perfect' and in control [57] in these participants who have poor emotion regulation abilities [56]. It is possible that people with ON tendencies tend to perceive themselves to be more 'out of control' when experiencing negative emotions.…”

Orthorexic tendencies are linked with difficulties with emotion identification and regulation

“…In regards to the impulse subscale, which specifically looks at feeling out of control, many papers have indeed found that individuals with AN and BN show greater difficulties with controlling their behaviour during times of emotional distress compared with control groups [10,56,57]. Moreover, in our recent qualitative work exploring women's experiences of ON as described in their online blogs [42], restrictive dietary rules around healthy eating were described as a coping strategy to feel 'perfect' and in control. Exercise and food rules were described as serving the same purpose; increasing levels of perceived control, regardless of which food/ exercise rule was being adhered to.…”

“…While very little work has been conducted in ON, similar mechanisms may be in place. Indeed, in a recent qualitative study of 15 women bloggers who self-identified as having ON [42], restrictive dietary rules around healthy eating was described as a coping strategy in order to feel in control.…”

“It’s Healthy Because It’s Natural.” Perceptions of “Clean” Eating among U.S. Adolescents and Emerging Adults

“…Notably, very few participants identified weight loss or calorie reduction as key themes in their definition of “clean” eating, and although “clean” eating was frequently defined using language of dietary restriction, few respondents offered restrictive dietary behaviors as a potential harmful consequence of following “clean” diets. In a recent analysis of women bloggers’ experiences with orthorexia nervosa, participants reported that their diets were initially motivated by health problems (such as digestive issues) and a desire to be healthy, but that social influences (such as social comparisons of “healthiness”, and praise for pursuing “healthy” behaviors) and lack of awareness fueled their difficulties [ 22 ]. These data suggest that weight loss is likely not a defining feature for those who may eventually go on to pursue “clean” diets in an unhealthy manner, and that further research is needed to identify pathways that tip the balance from healthy to unhealthy pursuits.…”

“…Although not yet recognized as a standalone diagnosis, research suggests that orthorexia nervosa (ON) reflects an unhealthy preoccupation with healthy eating, one associated with substantial distress and functional impairment mirroring eating disorder psychopathology [ 18 , 19 ]. Moreover, the National Eating Disorder Association suggests that the “clean” eating trend may be associated with ON [ 20 ], and scholars often describe ON as an extreme variant of “clean” eating (e.g., [ 6 , 21 , 22 ]). Thus, “clean” eating may involve excessive dietary restriction resembling an eating disorder [ 23 ] and thereby increase risk for nutritional deficiencies [ 24 ].…”