Orthorexia and autism

What is orthorexia?
IN BRIEF

Orthorexia is when a person wants to eat so well, and puts so much energy and time into it, that it becomes a problem. Sometimes, a person wants so badly to eat to perfection, they may even refuse to eat if the meal isn't perfect in their opinion.

How to define orthorexia?

Orthorexia affects eating behavior. It’s when a person wants to eat well to the point of being afraid of eating the wrong foods. It takes up so much space in their lives that it interferes with other important aspects of their lives.

Strict separation between “good foods” and “bad foods”

The person will spend a great deal of time researching food, choosing and planning meals to avoid “bad foods”. Food research will lead the person to refuse to eat more and more kinds of food. Foods will be classified into two categories: “good foods” and “bad foods”. The person will only eat the good foods.

Strict dietary rules

A person going through a period of orthorexia will set several rules that correspond to their beliefs about food. They will follow these rules even when they contradict each other. In some cases, due to their avoidance of “bad foods”, an orthorexic person may not be able to get all the nutrients they need.

Since when is eating well a negative thing?

Eating well is always positive. However, people going through a period of orthorexia will experience more negative consequences related to their eating behaviors than benefits related to eating “perfect” foods.

Lack of nuance between “good foods” and “bad foods”

First of all, there are no good or bad foods. There are only foods that are good for you in some circumstances and not so good in others. For example, instant noodles are not “good for you” in most circumstances. But when you’re in a financial bind or short of time, they’re a good way to tide you over. Sometimes it’s better to accept an affordable but imperfect meal than no meal at all.

A person going through a period of orthorexia might prefer not to eat rather than eat an accessible but imperfect meal. However, skipping a meal can also have adverse health consequences.

Social impacts of orthorexia

In addition, people experiencing orthorexia will avoid social events with people they want to see in order to avoid the temptation of breaking their rules. This can lead to isolation. Some people may become so rigid in their rules that they can no longer even look at people who are eating “bad foods”. This can lead a person going through a period of orthorexia to stop eating with others.

Caution

A person who describes their food preferences, choices and needs in order to ensure that there are safe foods that can be eaten with pleasure at a social event is not making a moral judgment. Reprimanding them for doing so could lead them to isolate themselves.

Food-related complaints

People with orthorexia may make nasty comments to other people, and publicly express judgment when they see someone eating a “bad food”. People living with orthorexia may therefore behave unkindly towards those around them, even though they sincerely believe they are “encouraging them to eat better”. If someone close to you behaves in this way towards you, you can mention that respecting eating habits is a two-way street. You respect the person’s particular choices, but they must respect you in return. However, in some cases, the person may not be able to restrain themselves, so you should remember that it’s not personal, and that the desire to eat healthily is taking up too much space in that person’s mind.

Autism and social interaction

Autistic people already face challenges in their social interactions, so if being orthorexic further complicates their access to others, it can have an even greater negative impact than for a non-autistic person.

Please note

Everyone has the right to live according to their values. Having a diet that allows you to choose foods that are consistent with your values and beliefs is perfectly legitimate. Not choosing to have a particular diet is perfectly legitimate. It's important to respect other people's choices. If someone close to you has orthorexia or is approaching it, you can't force them to change their habits. On the other hand, if their health is in danger, you must act to bring them back to a diet that allows them to respect themselves while also taking care of themselves.

The energy spent managing healthy eating

A person experiencing orthorexia will spend a great deal of time planning and preparing meals. The person will think about meal planning even when it’s not the task at hand. The person will have intrusive thoughts related to food that will distract them from their daily activities. In addition, the person may feel nervous when thinking about food.

Risk of anorexia

Finally, a person who is going through a period of orthorexia and who sets themselves a lot of rules around choosing “healthy” foods is at risk of becoming anorexic. In today’s culture, people often think that very thin people are always healthier than others. This confusion can lead to a person who is experiencing a period of orthorexia to end up fearing weight gain to the point of experiencing a period of anorexia as well.

The difference between dieting and orthorexia?

A diet is a set of rules and tricks to help you decide what to eat. These rules must suggest foods to eat. A diet shouldn’t forbid you to eat dessert and enjoy yourself. It should tell you how to do it in a way that’s good enough for your body.

Choosing to follow a diet is not a bad thing; it’s a lifestyle choice. However, when a person puts more emphasis on what they can’t eat than on what they can, they are sliding towards orthorexia. If the person is inflexible about these rules to the point of not eating enough or imposing these rules on others, this becomes orthorexia.

Find out more
GUIDES

Several countries offer their populations official dietary advice. Canada's "Canada's Food Guide" helps people choose healthy, diversified foods classified into three food groups. Brazil offers a guide with 10 questions to ask yourself to find the best meals available in your community. A good diet helps you know what to eat. It doesn't tell you what not to eat! See : Food guides around the world.

Link to autism

Special interests and orthorexia

Many autistic people have specific interests and are very curious to learn more about these subjects. Autistic people can spend hours researching, taking notes and classifying information to learn all about their favorite subjects. Food is a common specific interest. It’s only natural! Eating is essential to life. There’s so much to learn about food and cooking. A specific interest in food can be very useful to an autistic person. Some will make a career out of it, becoming cooks, waiters, nutritionists or bakers.

However, autistic people have many traits that make them vulnerable to developing eating disorders. Unfortunately, when an autistic person is vulnerable to eating disorders, the specific focus on food can also bring negative consequences and push the person towards orthorexia.

Autistic traits that can make you vulnerable to orthorexia

Specific interests: the environment and food

In addition to healthy eating, some people also want to eat food that has the least possible negative impact on the environment. A specific interest in the climate crisis, or the decline in biodiversity, leads us to question many human behaviors. As important as it is to do one’s part for the environment, it’s often difficult to find food options that tick all the environmental protection boxes: zero waste, vegan, local, GMO-free, organic, and so on.

What’s more, packaged, pre-cut or ready-to-eat foods are a great help to some autistic people with sensory difficulties. These products are also practical for people with motor difficulties.

If it’s not always possible to eat only foods that are “perfect” for the health of the body, it’s also not possible to eat foods that are perfect for the health of the climate and ecosystems, especially when you’re atypical. This is not related to one’s values.

Choosing a diet and being autistic

Tastes and textures

Many autistic people have sensory particularities that can add constraints to diet choices. For example, some autistic people may have sensory sensitivities to food textures and taste. Processed foods can be of great help to these people, as the texture is predictable. Unfortunately, it’s difficult to find processed foods in bulk, since packaging plays a role in maintaining texture. So it’s not always possible for a hypersensitive autistic person to take part in a zero-waste challenge.

Coordination and feeding

What’s more, an autistic person with coordination difficulties may find it hard to cook everything themselves. This can make it more difficult to follow certain diets that are healthy for the body, but require self-preparation of meals.

Choosing a balanced diet that takes into account needs, values and abilities

It’s important to make compromises between the rules our bodies set and the rules we’d like to set for ourselves. It’s not helpful to feel guilty about not being able to take part in every ecological or health challenge.

The first rule of good health is to be alive. Eating enough is essential. It’s also essential for having the energy to get through our days. For people with autism, who often can have difficulty eating enough because of their sensory peculiarities, eating is a healthy act, whatever the food.

Not being able to take part in all the green diet challenges because of constraints due to autism or a disability shows that these challenges were designed for neurotypical people without disabilities. Nothing prevents an autistic person from adapting these challenges to their reality and constraints. In fact, it’s an excellent idea, since the aim of these challenges is to create a sustainable world for everyone, including autistic people.

References

Dell’Osso, Liliana, Benedetta Nardi, Francesca Benedetti, Ivan Mirko Cremone, Danila Casagrande, Gabriele Massimetti, Claudia Carmassi, and Barbara Carpita. “Orthorexia and Autism Spectrum in University Workers: Relationship with Gender, Body Mass Index and Dietary Habits.” Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity 27, nᵒ 8 (November 24, 2022): 3713-23. https://doi.org/10.1007/s40519-022-01514-3.

Demartini, Benedetta, Veronica Nisticò, Vincenzo Bertino, Roberta Tedesco, Raffaella Faggioli, Alberto Priori, and Orsola Gambini. “Eating Disturbances in Adults with Autism Spectrum Disorder without Intellectual Disabilities”. Autism Research 14, no. 7 (July 2021):

1434 43. https://doi.org/10.1002/aur.2500.

 

Pini, Stefano, Marianna Abelli, Barbara Carpita, Liliana Dell’Osso, Giovanni Castellini, Claudia Carmassi, and Valdo Ricca. “Historical Evolution of the Concept of Anorexia Nervosa and Relationships with Orthorexia Nervosa, Autism, and Obsessive-Compulsive Spectrum.” Neuropsychiatric Disease and Treatment Volume 12 (July 2016): 165160‑. https://doi.org/10.2147/NDT.S108912.

 

Tchanturia, Kate. “What We Can Do about Autism and Eating Disorder Comorbidity”. European Eating Disorders Review 30, nᵒ 5 (September 2022): 437-41. https://doi.org/10.1002/erv.2942.

Catherine Bouchard-Tremblay

Science popularizer