New Insights Into the Link Between Perfectionism and Orthorexia

Clean eating influencer Alice Liveing (‘Clean Eating Alice’ ) recently opened up about how becoming a “fitfluencer” on Instagram lead to serious ill-health. Alice spoke about how her struggles with clean eating, accompanied by extreme workouts, took a toll on her physical health. This included a loss of her menstrual cycle, poor sleep, low mood and energy levels, and poor cognitive functioning.

Alice’s battle with extreme healthy eating in exchange for Instagram followers highlights how the promotion of a healthy lifestyle can quickly become problematic if these goals are accompanied by unrealistic health ideals. When the desire for health is replaced by the desire for perfect health, perfect bodies, and perfectly healthy eating behaviours, they run the risk of becoming all-consuming and “addictive”.

Orthorexia

As a dieting trend, clean eating includes popular dieting behaviours such as the paleo diet, Atkins diet, and raw food diet. Taken to the extreme, clean eating and other similar dieting practices may result in orthorexia — an obsessional fixation with healthy eating. Characterised by some as the pursuit of the “perfect diet”, orthorexia is gaining interest among researchers and practitioners.

Orthorexia is not officially recognised as an eating disorder. However, a recent consensus statement by experts in this field suggests that it is distinct from well-known eating disorders such as anorexia. Proposed diagnostic criteria for orthorexia include compulsive dietary practices that are believed to promote optimum health, an exaggerated fear of disease from breaking dietary behaviours that is accompanied by emotional reactions such as fear and shame, and escalating dietary restrictions from disordered eating behaviours to eating pathology.

Potential diagnosis of orthorexia depends on how long an individual experiences symptoms, but this is typically more than six months. Orthorexia can impair functioning in social, academic, and work domains. Physical effects of orthorexia, for example, include metabolic acidosis, severe weight loss, and malnutrition. Emotional effects include basing self-worth and body image on adhering to healthy eating. Because of somewhat flawed measuring instruments of orthorexia, prevalence data is speculative and can vary widely — one recent estimate was as high as 55% in exercising populations.

Many factors are thought to be linked to the onset of orthorexia. Some examples include a history of eating or mental disorders; lifestyle factors such as high levels of exercise frequency; and social factors including excessive influence of social media. Orthorexia also shares many risk factors that are associated with other eating disorders, like perfectionism.

Who is at risk?

Perfectionism is a personality trait that is characterised by irrational standards and harsh self-criticism. These aspects can be considered as two overarching dimensions — perfectionistic strivings and concerns. Perfectionistic strivings include a personal commitment to being perfect and perfectionistic concerns include concerns and fears about being imperfect.

There is research that links perfectionism to orthorexia. We recently sought to systematically gather and review this research to better understand what research has taken place and what was found. We were able to estimate the relationship across studies and also explore factors that might affect this relationship.

We found 13 studies, with nearly 5,000 participants from education, sport, exercise, and general domains. Both perfectionistic strivings and perfectionistic concerns were positively associated with orthorexia. It was, perfectionistic strivings, rather than perfectionistic concerns, though, that emerged as the most important of the two aspects of perfectionism.

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Interestingly, this latter finding differs from previous meta-analytical work on eating disorders that suggest perfectionistic concerns are more important to wider eating pathology. As a result, our finding suggests that the underlying motives for orthorexia may differ with its development being more about idealisation, rather than hiding flaws.

With so many Gen-Z and Millennials relying on social media for lifestyle and nutritional advice, and the ceaseless fixation with fad diets, we can expect orthorexia to increase. As a result, researchers and practitioners face a substantial challenge to keep pace, to better understand it, prevent it, and help those for whom healthy eating has really become extremely unhealthy.