Orthorexia vs ARFID: Understanding the Differences

When it comes to eating disorders, most people have heard of anorexia nervosa, bulimia nervosa, and binge-eating disorder. However, these are not the only eating disorders in existence. Two eating disorders that do not receive as much attention in society or popular culture are orthorexia nervosa and Avoidant/Restrictive Food Intake Disorder, or ARFID. Below is a basic explanation of these two disorders, their effects on patients and the primary differences between them. 

What Is Orthorexia Nervosa?

Orthorexia nervosa is an eating disorder characterized by an unreasonable concern with eating “healthy.” While other eating disorders usually focus on the amount of food consumed, orthorexia nervosa is more focused on the quality and type of food the individual eats. 

In most cases, worrying about food quality is a desirable behavior that improves the individual’s overall health and quality of life. However, in an individual with orthorexia nervosa, healthy eating becomes an obsession that has the opposite effect. Like other eating disorders, orthorexia nervosa can lead to serious complications if it is left untreated. 

Recognizing Orthorexia Nervosa 

Because of its nature, orthorexia nervosa can be difficult to recognize. However, some of the signs and symptoms of this eating disorder include:

  • An obsessive focus on eating “healthy” foods – Most people with orthorexia nervosa become so obsessed with eating healthy that it begins to have a significant negative impact on their life. The individual may become anxious about healthy eating, severely restrict their intake of different types of food and/or engage in compulsive behaviors related to making healthy dietary choices. 
  • Fluctuating body image, self-esteem, and identity – Someone who has orthorexia nervosa may experience fluctuations in their self-image and identity based on how well they are able to adhere to the “healthy eating” guidelines they impose on themselves. When the individual is adhering to all guidelines well, they will feel more confident and have a more positive self-image. On the other hand, if the individual breaks any of their self-imposed rules, self-esteem and self-image will decline rapidly. 
  • Social disruptions – In many cases, people with orthorexia nervosa will experience problems with social interactions, academic functions, and other similar issues because of their disorder. For example, someone who is battling orthorexia nervosa may be resistant to spend time with people in settings that require exposure to “restricted” foods. The individual may also deal with interpersonal issues as a result of the distress and anxiety the disorder causes. 
  • Physical consequences – Orthorexia nervosa that involves severe restrictions of certain types of foods often leads to physical complications, such as malnutrition, extreme weight loss, anemia and menstrual disturbances in women. In the worst cases, these consequences can develop into a medical emergency. 

What Is ARFID?

ARFID differs from orthorexia nervosa. This disorder is characterized by extremely “picky” eating habits and/or disturbed eating patterns. In most cases, people with ARFID are not concerned about gaining weight. Instead, they are picky about the foods they eat for other reasons. People with ARFID may dislike certain smells, textures and/or colors of food. They may also eat very slowly or have a low appetite. In many cases, someone with ARFID will have digestive problems as well, further complicating their ability to take in proper nourishment. This eating disorder is most common in infants and children. 

An individual with ARFID may experience multiple issues as a result of the disorder. Common complications of ARFID include weight loss or failure to gain weight, nutritional deficiencies, dependence on nutritional supplements and/or psychological or social problems. 

Orthorexia Nervosa vs ARFID

Both orthorexia nervosa and ARFID involve restricted eating behaviors. In both disorders, affected individuals may avoid entire categories of food, leading to nutritional deficiencies and other complications. However, with orthorexia nervosa, the motivation behind restricted eating is related to the individual’s body image. People with ARFID, on the other hand, do not have a distorted body image. Instead, their restricted eating behaviors are related to the individual’s relationship with the food itself. 

Eating Disorder Treatment for Orthorexia Nervosa and ARFID

Both orthorexia nervosa and ARFID require treatment in most cases. Without the proper treatment, patients who have these disorders may suffer from multiple complications that put their health at risk. In the worst cases, these complications may even become life-threatening. 

Both orthorexia nervosa treatment and ARFID treatment programs focus on dealing with the issues underlying the disorder and improving eating behaviors. However, because these disorders don’t stem from the same causes, the exact approaches to treatment will be different. For this reason, it is important to have an accurate diagnosis so you can get the most effective treatment available. 

Orthorexia Nervosa Treatment 

Orthorexia nervosa treatments are similar to the treatments used for anorexia nervosa and other eating disorders that stem from a distorted body image. Some of the treatment approaches that may be used in these programs include:

  • Psychotherapy – Psychotherapy focuses on helping patients discover the psychological issues that led to the development of their eating disorders, such as a negative body image, low self-esteem, anxiety and/or past traumas. Psychotherapy sessions may also seek to help patients overcome each of these issues so they won’t be as likely to engage in disordered eating behaviors in the future. 
  • Support group sessions – Interacting with other people who are struggling with similar issues can be helpful for people who have any type of eating disorder, including orthorexia nervosa. For this reason, many eating disorder treatment centers include support group sessions as part of their treatment protocols. During group meetings, patients will spend time seeking support from peers and providing support as needed. 
  • Behavioral therapy – Behavioral therapy is an evidence-based treatment used to treat behavioral issues in patients with eating disorders of all types. Depending on the needs of the patient and the philosophy of the treatment facility, dialectical behavioral therapy and/or cognitive behavioral therapy may be used to treat patients with orthorexia nervosa. 
  • Education – Patients who have been diagnosed with orthorexia nervosa must learn how to eat healthy without becoming obsessed. For this reason, many treatment programs will include nutrition education, meal coaching and other services designed to help patients learn how to choose healthy foods while still getting all the nutrition they need. 
  • Medical care – In cases where a patient with orthorexia nervosa is suffering from physical complications of the disorder, medical care may be included in the treatment program. The goal of medical care is to improve the nutritional status and overall health of the patient as they work to overcome their eating disorder. 

Every individual’s experience with orthorexia is different, and treatment programs should always be tailored to the patient’s specific characteristics. 

ARFID Treatment

ARFID treatment is similar to treatment for orthorexia nervosa. However, in most cases, psychotherapy is not necessary. Because patients with this disorder are not usually struggling with a distorted body image or low self-esteem, they don’t need to explore these deeper issues. Instead, the focus of treatment is changing the individual’s behavior so they can tolerate a greater variety of foods, thus improving nutritional status. Most ARFID treatment programs will include behavioral therapy, and food exposure therapy is often used as well. Depending on the age of the patient, education may also be provided to help the patient gain a better understanding of their nutritional needs. If the patient has medical issues related to malnutrition or other effects of the disorder, these issues may be addressed in treatment as well. 

Choosing the Right Eating Disorder Treatment Center

Not every eating disorder treatment center provides the same quality of services. In addition, while some eating disorder treatment centers offer customized treatment programs designed specifically for orthorexia nervosa or ARFID, others do not. For this reason, it is important to consider your options carefully when selecting an eating disorder treatment center. Below are some tips to help you choose the right treatment center for a patient with orthorexia nervosa or ARFID. 

1. Look for a center that specializes in these issues. 

One of the best ways to ensure you are receiving the best possible treatment is to look for a facility that offers programs and treatments targeted to orthorexia nervosa and ARFID. Facilities that understand these specific disorders and offer targeted treatments are more likely to be effective than those that do not. 

2. Consider whether you need inpatient or outpatient treatment. 

Orthorexia nervosa and ARFID can both be treated with either an inpatient or an outpatient treatment program, depending on the needs and preferences of the client. Each of these treatment structures offers different advantages and disadvantages that should be considered when you are making a choice. For example, while inpatient treatment programs require more time and a greater level of commitment, they are more intensive and tend to be more effective than outpatient treatment. 

3. Research the treatment program’s reputation and success rates. 

Before you select an eating disorder treatment program, take some time to research the program’s reputation by reading reviews from past patients, reading testimonials and/or asking for references from the facility. It is also a good idea to ask about the program’s success rates so you have an idea of how effective the program’s treatments have been in the past. 

4. Take the patient’s wishes into consideration. 

Different patients may respond better to specific approaches to treatment, program structures or even the environment within the facility. Before choosing a treatment program, consider how the patient feels about the different options available and take the client’s preferences into account. When they’re happy with the program choice, compliance and recovery are more likely to occur. 

5. Consider your budget. 

Although your budget should not be your primary concern when selecting a treatment program, you must still consider whether or not the program is affordable. Be sure to ask about payment plans and insurance coverage as you compare your options. 

Seeking Eating Disorder Treatment at Oliver-Pyatt Centers

Oliver-Pyatt Centers offers comprehensive care for patients recovering from eating disorders. We understand the nuances of less common eating disorders like orthorexia nervosa and ARFID, as well as the differences between them. We also understand that these disorders require a different approach to treatment than anorexia nervosa, bulimia nervosa, and other common eating disorder diagnoses. 

Oliver-Pyatt Centers offers all levels of care for patients with eating disorders, including both residential and outpatient programs. We recognize that every patient is unique, so we offer customized programming to each individual who enrolls at our facility. We also offer support for family members of patients who are in treatment for eating disorders. 

If you or someone you love is experiencing the symptoms of an eating disorder, effective treatment is available. Getting treatment as soon as possible is the best way to reduce the risk of complications. Please contact Oliver-Pyatt Centers today to learn more about enrolling in one of our programs.