When healthy habits become rigid: understanding disordered eating and orthorexia
Meal planning, consistent training, checking nutrition labels, eating at certain times, or paying attention to what we put into our bodies – in isolation, none of these behaviours are necessarily a cause for concern.
Many can be positive parts of how we look after ourselves. Clinically, what interests me is what happens when the sense of choice starts to disappear and rigidity appears.
Can plans change without disproportionate distress? Can a meal be spontaneous? Can exercise be missed without anxiety or a need to compensate?
Questions like these can tell us more than the seemingly “healthy” lifestyle somebody presents to themselves and the outside world.
However, this does not mean that healthy habits, disordered eating, and eating disorders exist on a simple continuum. What look like similar behaviours can have very different psychological functions and clinical implications. The behaviour itself is only part of what we need to understand.
“Healthy routines help organise a person’s life. Rigid routines begin to organise the person.”
Why control can feel useful
Food, exercise, and ideas of health operate on psychological functions for different people.
For some, restriction creates predictability when other parts of life feel uncertain. Exercise may provide reassurance or help regulate difficult emotions. Ritualised eating can reduce the number of decisions somebody has to make. When life feels unpredictable, rules can make one part of it feel knowable, consistent, and reliable.
That sense of safety is important to understand. A routine may appear unnecessarily strict to somebody looking from the outside while serving a very real psychological purpose for the person relying on it.
“Control may feel protective before it starts feeling restrictive.”
Clinically, we’re interested in more than whether somebody has rules around food or exercise, with a strong focus on what is underlying the rules. What role do these rules do? What happens when a rule is broken? How tightly do these rules have to be followed? Those questions take us from control to rigidity.
Structure helps life. Rigidity asks life to accommodate it.
For me, this is one of the most useful distinctions. Healthy structures provide support while remaining responsive to circumstance; rigidity becomes something difficult to negotiate with.
This might look like:
- A workout that cannot be missed
- Meals that must happen at particular times
- Foods divided into inflexible categories
- An unexpected dinner creating significant anxiety
- Eating something outside the plan prompting restriction or additional exercise later
- Social occasions causing stress because the food cannot be predicted
- A life of evaluation, assessment of ‘goodness’ and guilt
Notably, behaviours like these are often socially rewarded and admired.
Discipline with food and exercise attracts praise. Restrictive food choices may be interpreted as commitment to health. Exercising regardless of tiredness or competing demands can look like dedication. In some social and professional environments, behaviours that feel restrictive to the individual can be positively reinforced by the people around them.
Additionally these rules often merge with a sense of identity and how we come to see ourselves. If somebody sees unwavering discipline around food, fitness, or their body as evidence that they are competent, healthy, or in control, relaxing those rules can feel like giving up part of who they are.
“A rule becomes hard to question when it represents evidence of who we believe ourselves to be.”
When “healthy eating” becomes the source of rigidity
Orthorexia is one area in which these questions become particularly interesting.
The term orthorexia nervosa is commonly used to describe an excessive preoccupation with eating foods perceived as healthy, clean, or “pure.” It is not currently recognised as a standalone diagnosis in major diagnostic classification systems, but the behaviours associated with it are widely discussed and seen in clinical settings.
“The important thing is not that somebody cares deeply about nutrition.”
Concern may arise when the pursuit of “healthy eating” becomes increasingly restrictive; when more foods are excluded; when breaking dietary rules causes significant anxiety, guilt, or distress; or when those rules begin affecting nutrition, relationships, social life, or everyday functioning.
The language of health can make this difficult to recognise. From the outside, somebody may appear extraordinarily committed to their wellbeing. Internally, their world may be becoming progressively smaller.
What do clinicians look at?
No single food choice, exercise routine, or eating habit tells us everything we need to know. We need context.
- How flexible is the behaviour?
- How much distress occurs when plans change?
- Is the person adequately nourished?
- How much time and mental space does food occupy?
- Are relationships or social occasions being affected?
- Are there compensatory behaviours?
- Does the routine continue despite physical consequences?
- Does somebody still experience meaningful choice?
- How long is the restricted (bad food) list?
“These distinctions matter, because similar-looking behaviours can arise from very different clinical factors.”
Disordered eating and diagnosable eating disorders are not interchangeable, and appropriate assessment is important in understanding what somebody is experiencing and what kind of support they may need.
At Harbor, this is why our approach is individually formulated. We are interested in the whole person and the function a behaviour serves within their particular life, rather than interpreting a behaviour in isolation.
Restoring choice
Support does not mean simply taking somebody’s rules away: if a routine provides safety, abruptly removing it can create more distress. Instead, clinical work involves understanding why that structure feels necessary and, where appropriate, gradually creating enough safety for greater flexibility to become possible, while also maintaining the structure that offers safety and security.
That might involve nutritional and medical support alongside psychological work around anxiety, emotional regulation, identity, perfectionism, body image or compensatory behaviours. It depends entirely on the individual.
A healthy relationship with food of course includes routine. It includes an interest in nutrition, exercise, planning and taking care of the body. The difference is that life still has room to happen.
“Recovery is not the absence of structure. It is the return of choice.”
A person’s routine can look incredibly impressive but feel imprisoning from within. As clinicians, perhaps one of the most useful questions we can ask is how much choice and flexibility a person retains within habits that appear perfectly healthy from the outside.
