Residential and Virtual Outpatient options for treating orthorexia
Learn more about our program from our Director of Eating Disorder Programming, Dr. Anita Johnston, PhD, CEDS.
Residential treatment for orthorexia may be recommended if a patient has become restrictive to the point that their orthorexia may have evolved into anorexia or another diagnosable eating disorder and if their physical and psychological symptoms have led to malnutrition, marked distress, or are preventing them from engaging in school, work, or activities of daily life.
In your search for an orthorexia treatment center, one should consider the treatment center's experience in treating orthorexia, understanding of the cultural components of orthorexia, and various treatment approaches used to treat orthorexia.
Individuals who struggle with orthorexia can find themselves consumed with the quality of their food, rather than the quantity. They might cut out entire food groups to the point of malnutrition, decline social gatherings where food is involved, or feel extreme emotional distress and a need to purge after eating “bad” or “impure” foods. In short, their lives become so consumed by “pure” and “healthy” eating that their physical and mental health begins to deteriorate. There are various warning signs that might surface to indicate that you are struggling with orthorexia including:
This manifests as compulsive checking of nutrition facts and ingredient lists and labeling certain foods as “clean” and “pure” (usually those that are organic, vegan, raw, or farm-fresh) while other foods are labeled “bad” and “off-limits” (often foods that are processed or contain dairy, meat, or sugar).
The orthorexic creates strict and rigid rules about the foods they are allowed to eat (and not eat).
People with orthorexia are so consumed with keeping their rigid eating rules that they are willing to do anything–even disrupt their lives–to stick to these rules. For example, they might shut out family and friends for fear that social gatherings will involve “off-limit” foods.
People with orthorexia may cut out entire food groups like all sugar, all dairy, all carbs and grains, and all meat products, leading to serious malnourishment problems.
Even though they might not allow themselves to eat “off-limits” foods, people with orthorexia will often have so much anxiety around foods they deem “bad,” that they will avoid situations where these foods are present.
With so many different rules to rigidly follow, it’s no surprise that the orthorexic has little time to think of anything else but their next meal. They are often advocates for weekly meal plans and will sacrifice time with friends or family to meal prep or grocery shop, ensuring they have their “good” foods ready and available at all times.
Spending excessive time finding “clean eating” role models to emulate and follow is a hallmark sign of orthorexia. Hours are often spent scrolling through social media to see what these role models are (and aren’t) eating for breakfast, lunch, and dinner.
Maybe they were out of town and nothing else was available or maybe they broke down and ate “forbidden food” at a party or during a binge. Whatever the reason, whenever an orthorexic breaks one of their food rules, they will experience mind-crippling shame and distress. They believe they have consumed “bad food,” and will beat themselves up as if they violated a high moral code.
Treatment in an orthorexia residential treatment center is an effective way of treating orthorexia because in the residential setting, a patient is able to be supported by a multidisciplinary team of professionals who are equipped to work with the patient on the primary symptoms of the eating disorder, alongside co-occurring issues which continue to drive the disordered behaviors.
At our Maui location, individuals in our program stay with us for anywhere from 45-60 days on average to fully immerse themselves in a treatment and recovery process. We provide 24/7 nursing support, consultations with physicians and psychiatrists, group and individual therapy, meal support, recreation, and more.
Orthorexia itself can also cause pronounced physical and psychological effects on the body and mind.
First and foremost, eliminating entire food groups and subsisting on foods that fail to meet the body’s physical needs can cause nutritional imbalances and other serious medical issues. There is evidence to support that people suffering from orthorexia may experience malnutrition, anemia, impaired bone health, hormonal imbalances, and abnormally slow heart rate.
Individuals battling orthorexia often become so consumed with their pursuit of a “pure” and “healthy” eating lifestyle that they have little time or interest in doing anything that does not pertain to that one goal. This puts them at risk of becoming socially isolated. They may also battle all-consuming thoughts about food or struggle with feelings of shame and anxiety when they feel they haven’t eaten perfectly. Further, orthorexics miss out on the important social components of eating and food (sharing a meal with friends or family, cooking together, going out), that are universal and essential parts of any healthy, happy society.
As mentioned above, orthorexia is also often a precursor to the development of other eating disorders such as anorexia nervosa, bulimia nervosa, or even binge eating disorder - all of which could require intensive therapy and medical support to heal from.
Seeking support in an orthorexia residential treatment center is key if the patient has begun to develop medical issues relating to orthorexia such as: significant weight loss resulting in malnutrition, anemia, impaired bone health, hormonal imbalances, or abnormally slow heart rate. Within an orthorexia residential treatment center, these symptoms can be monitored by 24/7 nursing staff, doctors, and psychiatrists.
All patients entering our orthorexia residential treatment center are required to complete a comprehensive medical and psychological assessment prior to admission. These assessments provide us with a detailed account of past and current issues and allow us to build an appropriate and responsive treatment plan that is individualized to the patient’s needs and personal goals. The medical clearance provides our medical team with a baseline for comparison and ensures that any medical symptoms of orthorexia such as malnutrition, abnormal labs, GI upset, insomnia, and others can be addressed in the residential treating setting.
Throughout the course of one’s stay at our orthorexia residential treatment center, the medical symptoms of orthorexia are able to be monitored by our medical staff. Within a safe and controlled setting, patients are able to re-engage in consistent eating patterns that allow for nutritional stabilization and improved physical and mental health. Because orthorexia can lead to nutritional deficiencies, our staff are qualified to assess and provide appropriate prescriptions and recommendations regarding medications, supplements, and vitamins to restore the patient's mind and body to optimal functioning.
Orthorexia, like all eating disorders, is considered biopsychosocial in nature. This means that there are biological, psychological, and social origins and impacts of orthorexia.
With orthorexia in particular, there are also strong cultural aspects that must be considered during the course of treatment. In our current western culture, labeling foods as “good” or “bad,” cutting out entire food groups like sugars and carbs, and saying “no” to certain foods is often not only recommended but also praised and applauded.
Because of this, those who are trapped in the emotional and physical distress of orthorexia are often simply praised as “healthy eaters” and “health-conscious.” Tragically, instead of recognizing they have a serious problem, many people with orthorexia believe their lifestyle is “normal” and admirable.
At ‘Ai Pono, we utilize an ‘all foods fit’ approach to eating. Since one of the root symptoms and causes of orthorexia is labeling or categorizing foods as “good or bad” or “healthy or unhealthy,” we move towards acceptance of a greater variety of foods and away from moralization of foods. We also work towards an intuitive eating approach, where patients gently and closely explore their true hunger and fullness cues and reexamine food beliefs and preferences within a safe and structured setting.
We consider all meals and snacks to be therapeutic groups and provide support before, during, and after meals. We also integrate food “exposures” on a daily basis at meals, but also through weekly food outings, trips to the grocery store, and in supporting patients in eventually plating and preparing their own meals.
Often, those who struggle with orthorexia (and eating disorders in general), also struggle with poor body image or even body dysmorphia. These negative thoughts about body and appearance may continue to drive maladaptive eating patterns and continue to feed the eating disorder. In order to “put the eating disorder out of a job,” we need to explore and reframe our relationships with our bodies in order to arrive at a place of body positivity or neutrality.
Patients at ‘Ai Pono’s Maui location engage in various groups and activities designed to enhance body awareness, proprioception, and grounding. Groups such as Body Awareness, Ecstatic Dance, and Mindfulness help patients to explore their bodies as they relate to others and the space around them. We also facilitate gentle yoga twice weekly and mindful walks in order to re-explore and reimagine how we can move our bodies in supportive and nurturing ways.
Patient’s may also find that EMDR can be utilized to explore the origin of food beliefs or food-related trauma in order to desensitize their experience with those foods.
The Residential Program at ‘Ai Pono provides 24/7 nursing support within a homelike setting on the beautiful island of Maui, Hawaii. Many women travel to us from all over the United States to get away from the stressors of their everyday life and focus solely and completely on their recovery. In this serene setting, the hard work of recovery is able to take place without immediate feelings of overwhelm or overstimulation.
At our orthorexia residential treatment center, we have all the benefits of a residential setting including 24/7 medical support, safety and containment, a multidisciplinary team, 4x individual sessions per week, intensive group therapy, and meal support, but we also maintain a connection with the outdoor environment. During the course of their stay with us, patients are able to immerse themselves in nature on a routine basis. We utilize our outdoor spaces for individual and group sessions whenever possible and find that this exposure to the natural environment of Hawaii allows our residents to feel safe, grounded, and ready to do the deeper work of recovery.
Dialectical Behavioral Therapy Skills Groups focusing on assertive communication and emotional literacy
Narrative Therapy/Storytelling
Mindfulness
Beach and other Outdoor Excursions
Visits to Local Cultural Sites
Horticultural Therapy
Hawaiian Cultural Groups
Full Moon Letting Go/Intention Setting Gatherings
These unique offerings provide patients with a truly holistic experience and ample creative outlets through which to examine and process the deeper meaning behind their eating disorder.
Some individuals struggling with orthorexia may not necessarily require an orthorexia residential treatment center. For those patients requiring a lower level of care and residing within the State of Hawaii, ‘Ai Pono offers a Virtual Intensive Outpatient Program. Our Virtual Intensive Outpatient Program is a group-based model that includes up to 4x three-hour sessions per week with therapy groups, nutrition groups, and meal support.
Patients enrolled in our Online IOP receive the same evidence-based treatment that we deliver at our orthorexia residential treatment center and all facilitators have extensive experience not only in the eating disorder treatment field in general, but also with Dr. Anita Johnston’s unique approach.
Click here for more information on our Virtual Intensive Outpatient Program for residents of Hawaii.
