Most psychologists and psychiatrists consider orthorexia a real condition, but it is not in the current Diagnostic and Statistical Manual of Mental Disorders (DSM), used by mental health professionals to diagnose and research disorders, nor is it in the first draft of the 2013 version. Without explicit diagnostic criteria, determining whether someone has orthorexia is subjective."There's no official line. The time to get concerned is when the behavior and preoccupation or obsessions start to interfere with life or create difficulties and distress," Bulik says.
As with obsessions and addictive behaviors in general, the first step in conquering the condition is to admit to the problem—which is especially hard with orthorexia because of the pride in adhering to stringent, positive limits. Treatment options mimic those of other eating disorders. Cognitive behavioral therapy teaches how to replace obsessive thoughts with healthier alternatives. Instead of fearing that going out to eat with friends will destroy his health, for example, an orthorexic learns to think, "I can eat at a restaurant and remain healthy." A gradual-exposure strategy, reintroducing a bit of chocolate and other forbidden foods one by one, is another common approach. Experts suggest working with an array of professionals, including a therapist and nutritionist, to begin to see food more realistically and rebuild a healthier, more balanced diet.
"We all want to live longer, and we all want to be healthier," Kronberg says. "What you put into your system does make a difference in how you function, behave, and think. But when you take that to an extreme, when you lose your flexibility, you're stressing the system—not supporting it. The most important factor is balance."