Author: Jeanne Sager

There was no name for orthorexia when Lisa Fogarty started showing the signs of the eating disorder as a young tween. “I gave up eating foods with sugar when I was 12,” Fogarty recalls. “I lost a little weight and got positive attention for it, so I kept going. I remember loving how it felt to not feel full, so I gradually restricted more and more until I was skipping meals and labeling a lot of foods, including carbs and veggies like sweet potatoes, as bad.”
Most of us associate some foods with being inherently “bad” for our bodies—after all, no one is eating a platter of brownies expecting it to make us healthier. But people with orthorexia don’t just categorize some food as “bad” and some as “good”: They’re preoccupied with the differentiation, and they eschew the “bad” and only eat the “good.” Put more simply, people with orthorexia are obsessed with healthy eating—to the point of what doctors call disordered eating (which commonly includes having an eating disorder).
After dire warnings about the childhood obesity crisis in the aughts, Americans have slowly but surely come around to the idea that a nutritious diet is crucial to our overall health. Spend more than a few minutes on any social media site, and you’re bound to run into a slew of posts about eating healthy: Raw food. Clean eating. Farm-to-table. Whole30. Non-GMO.
Surely those people are just trying to make good choices for their bodies, right? Well, most of them are!
But what happens when you go from eating healthy so you can sustain your body and mind to allowing healthy eating to become an obsession? How do you go from a diet that’s designed to keep your heart muscles happy and your mind sharp to a therapist’s office and a diagnosis of orthorexia?

What is orthorexia?

In 1997, a name appeared for the restricted diet that’s followed Fogarty and thousands like her into adulthood. That’s when Steven Bratman, MD, a physician from Fort Collins, Colorado, wrote an article in Yoga Journal that changed the face of the eating disorder discussion in America and around the world. It’s believed to be the very first time the term “orthorexia” was written down.  
Titled “Health Food Junkie,” the article centered around Bratman’s premise that healthy eating can be good for you, but it can also become an unhealthy obsession.
“Many of the most unbalanced people I have ever met are those who have devoted themselves to healthy eating,” Bratman wrote at the time. “In fact, I believe some of them have actually contracted a novel eating disorder for which I have coined the name ‘orthorexia nervosa.’ The term uses ‘ortho,’ meaning straight, correct, and true, to modify ‘anorexia nervosa.’ Orthorexia nervosa refers to a pathological fixation on eating proper food.”
How does someone end up, as Bratman described in 1997, “dominated by efforts to resist temptation, self-condemnation for lapses, self-praise for success at complying with the chosen regime, and feelings of superiority over others less pure in their dietary habits”?
The experts say orthorexia has direct ties to other eating disorders (such as anorexia, bulimia, or binge eating disorder) and the risk factors inherent in them all.

Signs of Orthorexia

Of course, just because you love kale smoothies and could live the rest of your life without ever eating an Oreo doesn’t mean you’re orthorexic. Some people have better dietary habits than others, and just about every medical practitioner out there will tell you to eat a nutritious diet as often as possible.
“Orthorexia is defined as an ‘unhealthy obsession’ with healthy eating, a term which literally means ‘fixation on righteous eating,’” says licensed marriage and family therapist Ashley Moser, site director at the Renfrew Center, an eating disorder treatment facility in Charlotte, North Carolina.  
Here’s how Moser says you can tell if you (or a loved one) might be crossing the line into an obsession with healthy eating:

• Compulsively checking of ingredient lists and nutrition labels
• Refusal to eat foods labeled as “unhealthy” or processed
• Showing high levels of distress when “healthy” foods are unavailable
• Variety of foods eaten becomes fewer and fewer
• Increased social isolation and eating alone

Typically folks who battle orthorexia have similar risk factors to those who battle other eating disorders, says Lauren Smolar, director of programs at the National Eating Disorders Association (NEDA). She divides those risk factors into three categories: Social pressures, psychological risk factors, and/or biological predispositions.
For example, someone with a family member who has (or had) an eating disorder might have a biological predisposition to disordered eating, whereas someone who struggles with weight stigma or teasing and bullying might have social pressures that increase their risk of an eating disorder, including orthorexia.
From a psychological standpoint, issues such as body image dissatisfaction and a personal history of an anxiety disorder can up one’s risk for an eating disorder such as orthorexia.
What’s more, there are typically what doctors call comorbidities that come along with orthorexia. That means that you can have two (or more) conditions at the same time. With orthorexia, that typically involves other eating disorders as well as an anxiety disorder and/or obsessive–compulsive disorder (OCD), Smolar says. OCD in particular is often found in folks with orthorexia, but because orthorexia isn’t an “official” diagnosis, there is little research on why the two crop up together so frequently.

Diagnosing Orthorexia: How does it work?

If you look at the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (more commonly known as the DSM-5), you won’t find orthorexia nervosa listed.
The DSM-5 is the diagnosing manual used by the American Psychiatric Association, which declined to add orthorexia as its own diagnosis in its most recent edition.
So does that mean orthorexia doesn’t exist as anything more than a word thrown out by Bratman once upon a time?
Not at all, says Thom Dunn, PhD, a professor of psychological sciences at the University of Northern Colorado who has committed much of his time to researching orthorexia.
Although orthorexia isn’t in the DSM, neither was binge-eating disorder before 2013, “although it was widely acknowledged that it existed before then,” Dunn tells HealthyWay.
Researchers like Dunn have found conclusive evidence that orthorexia is real, and professionals in the eating disorder field—such as the folks at NEDA—do recognize orthorexia as something that can not only occur with other disordered eating conditions but is a separate condition in and of itself.
[pullquote align=”center”]“The irony is that people are being unhealthy in their pursuit of being strictly healthy.”
—Thom Dunn, PhD[/pullquote]
What sets orthorexia apart from other eating disorders is an obsession with being “healthy” that takes someone to the point of actually being the exact opposite.
“For some people, their desire to be healthy becomes all consuming and it starts to affect their ability to live their lives,” Dunn explains. “For some, they get malnourished. The irony is that people are being unhealthy in their pursuit of being strictly healthy.”
So, if orthorexia isn’t an “official” diagnosis, how can someone be diagnosed with it?
Often, patients aren’t—at least not where health insurance companies are concerned.
“Most often these people get an anorexia diagnosis since they are underweight,” Dunn says. That can be enough to trigger a health insurance company to start paying for treatment. If not, practitioners like Dunn may diagnose someone with “other specified feeding or eating disorder” (OSFED), which is in the DSM.
For Fogarty, that’s exactly what had to happen. Now 40, she spent her twenties and thirties drifting in and out of therapy for anorexia; it was at age 34 that a therapist and nutritionist both told her that she had “orthorexic tendencies” and began treating her for her food-related obsessions in addition to her tendency to starve herself.
She works with a nutritionist now to help develop the skills she needs to vary her diet. “The biggest obstacle I have is overcoming the fear of new foods or foods that I still associate as bad,” Fogarty says, “like taco shells or white pasta. The recent campaign against carbs really screwed with my head a bit, I admit.”

Orthorexia Treatment and Recovery

For those who have extreme orthorexia that has caused them to become malnourished, hospitalization may be required. After all, Moser says, while it’s sometimes referred to online as the “good eating disorder,” there’s nothing positive about restricting your food intake to the point of getting sick.
And someone with orthorexia can get very sick. “Some of the risks include medical complications from malnutrition, which affects every organ system in the body,” Moser points out.
It’s a fact Fogarty knows all too well. When she was 21, she was slated to enter a hospital and be force-fed food, which is what first prompted her to seek treatment.
Fogarty has been trying to make treatment work for nearly 20 years. That’s because there is no quick cure for an eating disorder. Often recovery begins with treatment—be it hospitalization or intensive, outpatient therapy—and turns into living in recovery.

Living With Orthorexia

It’s partly because of the near constant and often contradictory headlines about what different foods will do to our bodies (butter’s healthy—no, it’s not—wait, yes, it is!) that orthorexia recovery can be so difficult.
While an alcoholic may be able to steer clear of bars and ask their friends to throw booze-free bashes, we can’t ignore all the news or stay away from the grocery store and its human-sized displays touting the purported benefits of the latest health craze.
[pullquote align=”center”]“It is important to provide education on balanced eating and approach food with a more neutral stance of ‘all foods fit.’”
—Ashley Moser, LMFT[/pullquote]
That’s why orthorexia treatment focuses not just on therapy but on forming a healthier relationship with food.
“It is important to provide education on balanced eating and approach food with a more neutral stance of ‘all foods fit,’” says Moser. “It’s helpful to remember these messages when faced with societal pressure to eat healthy.”
If you’re struggling to develop a food plan without falling back on old habits, set up an appointment with a nutritionist. They can help you map out meals that are healthy—both in the sense of giving your body the nutrition it needs and in the sense of stretching beyond orthorexic tendencies. You may also want to start a food journal, which you can review and/or share with your nutritionist on a regular basis to ensure you’re actually meeting your nutrition goals rather than denying yourself.
You can also work with a nutritionist to set goals that test the bounds of what you’ve come to consider as “safe” and “okay” foods. For example, Fogarty has been challenged by her nutritionist to eat dessert at least once or twice a week with her family.
“That’s hard,” she admits. “But my nutritionist is trying to make me understand that the things I think will happen, like losing control or gaining 10 pounds overnight, won’t happen when you just let go of some of these fears. It’s an ongoing process and it takes therapy and nutritional counseling.”
Not sure where to begin? That’s okay. Call the NEDA support line at 800-931-2237 or look into their online chat options to talk to someone on their team.

Tick bite symptoms are about as maddening as it can get. Sometimes they show up. Sometimes they decide to hide like an ostrich with its head in the sand.
And yet, everywhere you turn, there are warnings that getting bitten by a pesky tick can put you at risk for some serious diseases, including Lyme, the most rampant tick-borne disease of them all.
If you’ve been bitten by a tick or you’re wondering if one of those wily arachnids snacked on your skin, you’re probably searching for a rash that looks like a bullseye somewhere on your body. So what happens if you find one? And, for that matter, what happens if you don’t?

Tick Bite Symptoms: The Bullseye

The bullseye rash has become synonymous with tick bite symptoms ever since Yale University researchers first discovered Lyme disease and deer ticks—the critters spreading the infection—way back in the 1970s. The first cases of Lyme disease cropped up in and around Lyme, Connecticut (hence the name), where 51 residents were diagnosed with juvenile arthritis or arthritis of unknown cause. The more research scientists did, the more sure they were that the problem was the bite of the deer tick, or Ixodes scapularis.
Fast forward some 40 years, and the Centers for Disease Control (CDC) estimates 329,000 cases of Lyme disease now occur annually in the United States. The species of tick that makes people sick has spread from Connecticut to 14 states in the Northeast and upper Midwest, and they typically come out to bite people during the late spring, summer, and early fall (from about April to October).
As the tiny disease-carrying creatures have spread, the tick bite symptoms that doctors tell patients to look for have changed rather drastically too.  
The bullseye that was once known as a classic sign that someone has been bitten by a tick and was at high risk of contracting Lyme is no longer a given, says Bruce Robinson, MD, a clinical professor of dermatology at Lenox Hill Hospital in New York City and the creator of JAS, Just Amazing Skincare, a plant-based skincare collection.
“It can look like an ordinary mosquito bite,” Robinson says of a tick bite. “It can look like any version of a bite from a filled-in circle of red to a bullseye.”
In fact, Robinson finds that many patients show up thinking they have a “new mole,” only to find out that the new spot on the body is actually a tick bite.
Even more confounding? Different bodies react differently to tick bites, says David Claborn, doctor of public health and director of the master of public health program at Missouri State University. Your tick bite symptoms might include itching. Your friend’s tick bite symptoms might involve pain. But each of you could have been bitten by the same little critter!
“Much depends on the body’s reaction to the bite,” Claborn explains. “Allergic reactions can cause a great deal of discomfort—or worse. If the person has pulled the tick off, the tick’s mouthparts may have been left in the bite site and these can fester up.”

Why Tick Bites Are So Dangerous

Being bitten by a tick is unpleasant. It can itch. It can cause pain, and for some people, diseases and other conditions can set in.
For example, Claborn says, if the tick is feeding near the spinal cord or base of the brain, a type of paralysis called tick paralysis can occur. This usually resolves quickly after the tick is removed or drops off. Another condition linked to tick bites causes an allergy to red meat, Claborn says, although the full explanation for how this allergy develops is not yet known.
There’s also ehrlichiosis (a bacterial disease fairly common in parts of the U.S.), Rocky Mountain spotted fever, tularemia (a bacterial disease often associated with hunting rabbits that is actually transmitted by ticks) and diseases common to the Midwest caused by the Bourbon virus and the Heartland virus.
[pullquote align=”center”]“For some people, Lyme disease can go away on its own within several weeks, but for others, if not treated, Lyme disease can spread to the central nervous system, muscle and joints, eyes and heart.”
—Jack Cornwell, MD[/pullquote]
Finally, there’s  Lyme disease, the most common tick-borne illness in the U.S. Every year, approximately 30,000 cases of Lyme disease are reported to the CDC by state health departments and the District of Columbia, but the CDC estimates there are substantially more cases that go undiagnosed and thus unreported.
It’s Lyme disease that gets the most attention in part because it’s most prevalent but also because it has devastating effects for some people who don’t get treatment or aren’t treated in a timely manner.
“For some people, Lyme disease can go away on its own within several weeks,” explains Jack Cornwell, MD, medical director at CareWell Urgent Care, “but for others, if not treated, Lyme disease can spread to the central nervous system, muscle and joints, eyes and heart.”
“Everyone’s body reacts differently, and symptoms may vary in severity,” Cornwell continues, “but since Lyme disease can affect multiple systems, it’s important to see a doctor right away if you suspect it.”

When will tick bite symptoms show up?

What tick bite symptoms should you be looking for, and when should you be looking?
Unlike a bee that stings and flies off quickly or even a mosquito that lands, snacks, and flies away within seconds, ticks stick around on your body. An adult female tick can actually stay for as long as 7 to 10 days without being noticed, although nymphs (young ticks) or larvae (very young ticks) tend to feed off a subject for less than four days according to Robinson.
[related article_ids=1001374]
Some more good news here: In most cases, to transmit Lyme disease, a deer tick has to be attached to its host for 36 to 48 hours, Robinson says. Grabbing a tweezer and pulling that sucker off before it hits that point means you can usually stop potential infection before it sets in, although it’s still good to check in with your doctor as your estimate of how long the tick was attached may be off.
Gross? Yes.
But if you don’t notice a tick using you as a snack, don’t beat yourself up too hard. It happens, and it’s extremely common—hence the CDC’s warning that estimates of Lyme disease are on the low side. Ticks are tiny, even smaller than your pencil eraser, so you may or may not notice one on your body. And they like to move into warm, moist spots on the body, such as the crack of your butt or the fold between your leg and labia (or penis).
And even when they drop off, the signs that a tick has bitten you may not be immediate. Rashes may appear anywhere from 3 to 40 days after a bite, Robinson warns.
Even then, the rash only occurs in about 70 to 80 percent of the population. When it does, it will typically (but not always!) look like a bullseye or target that expands gradually over a period of days, spanning a diameter of 12 inches (30 cm) or more across.
You may also experience fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes. Any or all of these symptoms of a tick bite are reason to head to your doctor ASAP.
If Lyme isn’t caught early, it can progress to additional symptoms, including:

• Severe headaches and neck stiffness
• Additional rashes on other areas of the body
• Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
• Facial palsy (loss of muscle tone or droop on one or both sides of the face)
• Intermittent pain in tendons, muscles, joints, and bones
• Heart palpitations or an irregular heartbeat (known as Lyme carditis)
• Episodes of dizziness or shortness of breath
• Inflammation of the brain and spinal cord
• Nerve pain
• Shooting pains, numbness, or tingling in the hands or feet
• Problems with short-term memory

Tick Bite Testing

Once you show up in the doctor’s office, they’ll examine your rash or bite mark—if you have one—and run some blood tests.
Unfortunately, even if you are tested for Lyme, as many as 60 percent of cases are missed by diagnostic testing, says Jo Ellis, director of education with Bay Area Lyme Foundation. And that’s even when doctors use the blood tests that are what Ellis calls the “gold standard” for diagnosing Lyme.
“As a result of the difficulty in diagnosing and treating Lyme disease, at least 500,000 Americans, and possibly up to one million, suffer from its debilitating later-stage symptoms,” Ellis says.
So what does that mean for you if you’ve been bitten by a tick? If you continue to experience any of the symptoms mentioned above, follow up with your doctor immediately. Sometimes performing the test at a later date may result in a positive.
Some doctors have now taken to treating patients prophylactically—aka without a confirmed diagnosis—if it can be confirmed that they were bitten by a tick (an attached tick or a bullseye rash are major indicators). But that means calling your doctor very quickly after a suspected tick bite, Cornwell notes.
[pullquote align=”center”]Many doctors’ offices and urgent care centers have the ability to send ticks out for testing for Lyme, which can help a doctor make the diagnosis even if a blood test is negative.[/pullquote]
“The window for taking prophylactic doxycycline, the medicine that decreases the likelihood that you develop Lyme disease, closes between 48 and 72 hours after infection,” he warns.
If you found the tick attached to your body and you were able to remove it with a pair of tweezers, you can stick it in a Ziploc baggie and bring it along to your doctor’s office for testing, although it’s not required.
“There is no way to know for sure if a tick is carrying Lyme disease or not unless the tick is tested,” Cornwell explains. Many doctors’ offices and urgent care centers have the ability to send ticks out for testing for Lyme, which can help a doctor make the diagnosis even if a blood test is negative.
This only works if the entire tick is intact, however, so Cornwell is quick to warn patients to pull gently with their tweezers so they can ensure they get the entire tick off the skin.
If the tick comes out in pieces, however, don’t stress yourself, especially if you’re not showing any symptoms!
“Plenty of laboratories offer to test ticks to determine whether they’re carrying any diseases. But that’s generally not worth your money,” Robinson notes, explaining that the tests can be $50 or more at some labs. “Even if the tick is infected with something, it doesn’t mean that it was able to transmit that infection, and if your tick comes back positive for Lyme disease or another infection, you probably won’t be treated unless you yourself start having symptoms.”

Don’t anger the tick!

Notice that the experts suggest grabbing a set of tweezers to remove a tick? No matter what you’ve seen on Pinterest or what your best friend swears her grandpa used to do to remove a tick, tweezers are the only doctor-recommended removal method for ticks.
“Common folk wisdom strategies for getting that tick to detach include holding a lit match toward it, smothering it with petroleum jelly or nail polish, and dabbing the spot with acetone or bleach,” Robinson says, but he’s quick to note that “all are questionable ideas!”
“With the lit-match strategy, you may just end up burning yourself, and while you might kill the tick, that won’t necessarily cause the tick to detach,” he warns. “ A dead tick is not going to come off any more easily than a live tick. As for the other methods above, even if they do work—and it’s not clear that they will—they may take long enough to allow a tick to pass on an infection.”
So grab the tweezers and grasp the tick as close to the surface of your skin as possible (this way you get the head as well as the body). Then firmly but steadily pull the tick directly backward from the bite site without twisting or jerking, Robinson suggests.
If there are still bits of the tick in the bite, use the tweezers to remove them as well. After everything’s gone, grab the rubbing alcohol and a cotton swab or a washcloth with soap and water, and clean the area to prevent additional infection of the wound.  

Don’t panic.

Although the number of Lyme cases in the U.S. has been trending upward and tick bites are not to be ignored, simply being bitten by a tick does not mean you will get sick.
“Only 2 percent of tick bites result in Lyme disease,” Cornwell says, “So while it’s important to be proactive, not every bite will result in an infection.”