Male Eating Disorders
Orthorexia,
Explained
When eating well stops being a preference and becomes a set of rules you are no longer free to break, something has changed. Orthorexia is one of the most common eating disorders in men, and one of the least often named.
Orthorexia, or orthorexia nervosa, is an obsessive preoccupation with eating food judged to be pure, clean or correct. The term was coined in 1997 by the physician Steven Bratman, from the Greek orthos, meaning right or straight. It is not yet a formal diagnosis in DSM-5 or ICD-11, which is a large part of why it goes unnamed and untreated, but it is widely recognised in clinical practice and it does real damage.
What orthorexia actually means
The confusion around orthorexia comes from a reasonable objection: surely wanting to eat well is a good thing?
It is. Orthorexia is not an interest in nutrition, and treating it does not mean persuading anybody to eat badly. The disorder is not in the content of the diet. It is in the relationship to it.
The clearest test is freedom. Someone who eats well can eat a slice of birthday cake at a party, enjoy it, and carry on as before. In orthorexia that is not available. The rules cannot be relaxed. Breaking them produces anxiety, guilt, or a compensatory response afterwards, and over time the list of acceptable foods narrows rather than broadens.
Symptoms of orthorexia
- A steadily narrowing list of permitted foods, with categories eliminated one after another
- Anxiety, guilt or shame when the rules are broken, out of proportion to what was eaten
- Increasing time spent researching, sourcing, weighing and preparing food
- Avoiding meals out, or at other people's homes, because the ingredients cannot be verified
- Moral language about eating: foods described as clean, dirty, pure, toxic, good or bad
- Self-worth that rises and falls with dietary adherence
- Social life contracting around the rules, rather than the rules bending around life
- Sometimes, though not always, unintended weight loss or nutritional deficiency
The last point matters. A person with orthorexia may be a perfectly ordinary weight. Waiting for visible thinness before taking it seriously is one of the reasons it runs for years.
Orthorexia and anorexia: what is different
The two overlap, and one can turn into the other, but the driving fear is not the same.
In anorexia nervosa the preoccupation is with quantity, weight and shape. In orthorexia it is with quality and purity. Where weight is lost in orthorexia it is usually a side effect rather than the goal, and the person will often say, accurately, that they were not trying to lose weight at all.
Underneath, however, the mechanism is frequently identical: the control of food is doing a job that has nothing to do with food. That is why the treatment approaches overlap so much, and why a purely nutritional intervention rarely holds.
Why it hides so well in men
Because it looks like discipline, and discipline in men is admired rather than questioned.
A man who weighs his food, tracks his macronutrients, refuses anything processed and organises his training around an eating window is called dedicated. He may be praised for it at work and at the gym. The same behaviour in a woman would more often prompt concern.
Men also present later, and are asked about eating far less often. In this practice orthorexia is frequently found not because a man came to talk about food, but because he came about his drinking, his exhaustion or his relationship, and the eating turned out to be underneath it.
It also travels. Orthorexia sits very close to bigorexia and to compulsive exercise, and the three often occur in the same person.
Treatment and recovery
Recovery does not mean giving up any interest in health. It means restoring flexibility, so that food becomes something you eat rather than something you administer.
Practically, that means two things happening at once. The behaviour is loosened gradually, deliberately and with support, because the rules are doing a job and removing them abruptly tends to produce something worse. And the job itself is addressed: what the control has been managing, what it protects against, and what would have to be felt if it stopped.
Where orthorexia sits alongside compulsive exercise, addiction or unprocessed trauma, treating them together rather than in sequence is what makes recovery hold. That combination is the particular specialism of this practice.
Getting help
Dr Philippe Jacquet is a UKCP registered psychotherapist, a Jungian analyst and an HCPC registered art psychotherapist, with twenty-five years of clinical practice. His doctorate at the University of Essex examined male eating disorders from the perspective of analytical psychology.
Work is available in Central London and online, in English or French.
If you are struggling with an eating disorder, Beat runs a free adult helpline on 0808 801 0677. Anyone medically unwell as a result of an eating disorder should also be assessed by a GP or a specialist medical eating disorder service.