Many of us have heard the benefits of eating well since elementary school. In adulthood, these ideas tend to stick with us, in healthy and unhealthy ways. For some people, these lessons became useful guidelines that shaped a positive, balanced approach to food, one that prioritizes both pleasure and healthy self-discipline. But for others, the lessons laid the foundation for a rigid, inflexible posture toward eating. This mindset can unfortunately lead to a condition called orthorexia nervosa, a clinical concept that’s only just beginning to be researched and understood. In this article, we’ll explore what orthorexia is, how you can recognize it, and how you can recover.
What Is Orthorexia?
In a few words, orthorexia nervosa is an unhealthy obsession or focus on healthy eating. People with orthorexia tend to cut out entire food groups and categories, consuming only certain “clean” or “safe” foods. They believe that these behaviors are healthy, but in reality, their bodies are being deprived of essential nutrients. And, the increasing fixation on food often cuts off their social lives and damages their intimate relationships as well.
An important note: Harvard Health Blog’s article on orthorexia notes that it’s important to distinguish people with orthorexia from people who follow a specific diet for religious or environmental reasons.
What is the Meaning of Orthorexia?
Steven Bratman, MD, coined the term orthorexia to describe his own experience with food and eating. The word has Greek roots: ortho means correct, and orexi means appetite. (Anorexia, lack of appetite, finds its source here, too).
What is the Difference Between Orthorexia and Anorexia?
Anorexia nervosa is another type of eating disorder. “The main criteria that distinguishes anorexia from other eating disorders is that they have a low body weight, usually a BMI below 18 and an intense fear of gaining weight,” says Christy Barongan, a licensed clinical psychologist with Grow Therapy.
Behaviorally, anorexia and orthorexia can overlap. For instance, both involve food restriction, according to the Academy of Nutrition and Dietetics’ orthorexia information. “Unlike anorexia, for people with orthorexia, the focus is generally on the quality instead of the quantity of food being restricted,” writes registered dietitian Sarah Klemm, RDN, CD, LDN.
Another differentiating characteristic is body image concerns. A key component of anorexia’s diagnostic criteria is distorted body image. The individual can’t perceive their body shape, size, and/or weight accurately, and this distortion is part of what drives their disordered eating behaviors. With orthorexia, distorted body image may or may not be present — and even when present, it’s likely not what drives the unhealthy eating patterns.
A Frontiers in Psychiatry journal article summarizes the difference between anorexia and orthorexia this way: “[Orthorexia] is marked by open, rationalized rules related to eating and a focus on the quality of foods instead of fears of gaining weight and body image disturbances.”
What is Orthorexic Behavior?
Orthorexic behaviors are characterized by rigidity. These actions revolve around specific notions about what foods are supposedly healthy and which aren’t. These “food rules” start dictating an individual’s daily life. Their desire to cut out foods and ingredients eventually cuts out the things that bring meaning to life: intimate partnerships, healthy friendships, fulfilling social opportunities, and engrossing work.
Examples of Orthorexia
The peer-reviewed journal Federal Practitioner created a hypothetical clinical profile that can illuminate how orthorexia looks different from garden-variety healthy eating.
The patient, Mr. P, says he’s wanted to “be healthy” since childhood. He has always focused on exercise and a healthy diet, but lately he’s feeling more and more anxious about his eating patterns. Mr. P has a relatively unalarming physical exam, and his weight is in the expected range for his height and stature. However, his clinical interview reveals concerning behaviors, which the mental health provider uses to form an orthorexia diagnosis.
Here’s what the hypothetical Mr. P presents:
- He started eating vegetarian a couple of years ago by gradually cutting out entire food groups or ingredients (e.g., gluten) from his diet
- He takes pride in eating organically grown produce, nuts, and beans
- He feels guilt and shame when he “slips up” on his diet
- He feels annoyed when others eat meat or fast food
Here’s what his spouse says about Mr. P:
- He spends 3 to 5 hours a day preparing food or talking with friends and family about the “correct” foods to eat
- He inaccurately believes that “errors” in his diet can cause physical and mental illnesses
- He compensates for “slipping up” in his diet by fasting for a day
- He refuses to go to restaurants and insists on bringing his own food when friends invite them over for dinner
This hypothetical picture helps answer the question of “What is orthorexia?” In particular, the symptoms described show how the condition can isolate someone from healthy intimate relationships, damage their overall well-being, and prevent a fulfilling social life.
What Are the Signs of Orthorexia?
The National Eating Disorder Association (NEDA)’s orthorexia resource lists the following warning signs and symptoms of orthorexia:
- Compulsively checking ingredient lists and nutrition labels
- Growing more concerned about the healthfulness of certain ingredients
- Cutting out entire food groups or categories (e.g., all sugar, all meat, all dairy, all animal products)
- Allowing themselves to consume only foods considered “healthy,” “pure,” “clean,” or “safe”
- Demonstrating unusual interest in others’ food choices
- Spending hours each day thinking about what food will be served at future events
- Feeling highly distressed when “safe” foods aren’t available
- Obsessively following “healthy lifestyle” blogs, channels, and/or social media accounts
Eating Disorder Hope adds several possible behavioral and emotional signs to this list:
- Rigid food rules — and self-esteem linked to keeping them
- Obsession with where foods come from
- Increased supplement use
- Unusual concern with how foods are prepared
- Planning life around food prep and/or food rules
However, remember that a person doesn’t have to display all of these indicators to have a serious concern.
How Is Orthorexia Diagnosed?
Clinicians don’t yet have a standardized answer to the question of what is orthorexia. A 2019 literature review of orthorexia nervosa studies found that there’s no shared definition or standard diagnostic criteria for the condition.
That same year, a psychiatrist and nutrition scientist told NPR, “I just think orthorexia is maybe a little bit too hard to pin down, or it’s looked at as a piece of other related disorders — the eating disorders, obsessive-compulsive disorder, and general anxiety disorder as well.”
Still, orthorexia matters and can significantly worsen an individual’s physical, psychological, and social life. A group of clinicians including Bratman, the person who originally coined “orthorexia,” proposed a set of diagnostic criteria including:
- Obsession with healthy nutrition
- Emotional consequences (e.g., distress, anxiety) when self-imposed food rules aren’t followed
- Psychosocial impairments (e.g., social isolation)
- Possible malnutrition and weight loss
Struggling with food?
What Are the Consequences of Orthorexia?
Many people struggle with the reality that healthy eating can become a bad, damaging thing. That’s why orthorexia can go unnoticed and untreated; health care professionals may overlook or even praise orthorexic behaviors, mistaking them for positive food choices.
But wanting to eat healthfully becomes dangerous “when it crowds out other areas of life or masks worries that can’t be solved by food.” Eating Disorder Hope’s Understanding Orthorexia handout differentiates between positive nutrition and pathological nutrition:
| Positive nutrition… | Pathological nutrition… |
| Promotes health and physical functioning | Pursues health but, in reality, deteriorates the body |
| Promotes social interaction and relationships | Causes isolation and interferes with relationships |
| Allows you to enjoy food as part of a balanced life | Sees food as something to be controlled |
| Promotes a feeling of accomplishment, while allowing for flexibility | Doesn’t allow for mistakes or flexibility; success depends on keeping rigid food rules |
| Is motivated by the desire for a healthy life | Is motivated by the need to manage anxiety |
Without intervention, people living with orthorexia can become malnourished and have serious medical complications, according to Eating Disorder Hope. This includes:
- Malnourishment
- Reduce cognitive functioning
- Impaired immune functioning
- Emotional dysregulation (e.g., depression)
- Suicidal ideation and self-harming behavior
- Organ failure
- Kidney problems
- Fertility issues
- Altered menstrual cycles
- Social isolation
- Cardiovascular and heart issues
- Worsened job performance
- Lowered bone density
How to Get Help For Orthorexia
Building your support team is critical for recovering from orthorexia. These are the people who will help you reevaluate your food rules and break them when you’re ready. These professionals and loved ones can help you tackle any underlying fears, anxieties, perfectionism, or low self-esteem. And they’ll help you find freedom to live fully again and even find pleasure in food. Below, find four steps toward building your support team.
1. Know the Clinical Background
NEDA notes that there are no clinical treatments specifically designed for orthorexia recovery. However, many mental health professionals treat this condition as a variation of anorexia or obsessive-compulsive disorder. This means treatment could involve psychotherapy to face “fear foods” and restore body weight as needed.
However, providers may differ in approach given the lack of relevant studies; as the Federal Practitioner journal notes, more research is needed to understand if orthorexia is best treated as an eating disorder, an anxiety disorder, or as a symptom of another condition.
If you’re struggling, know that orthorexia is both serious and treatable — and don’t let clinicians’ confusion stop you from pursuing recovery and appropriate care.
2. Learn About the Approaches
Several therapeutic approaches could help people with orthorexia. Eating Disorder Hope shares that the evidence-based treatments recommended for most eating disorders are cognitive behavioral therapy (CBT), family-based treatment, and dialectical behavior therapy (DBT). These methods are showing promise in treating orthorexia nervosa. Also, the Cleveland Clinic suggests exposure and relapse prevention, which is a specific type of psychotherapy, as likely a good option.
3. Connect With a Registered Dietitian Nutritionist
People living with orthorexia often have misunderstandings about food and nutrition. Learning to undo these inaccurate beliefs is essential for moving from pathological to positive nutrition — and a registered dietitian nutritionist (RDN) can provide this education. This provider will partner with you in understanding your body and its needs, as well as how your current eating patterns are affecting your health and well-being. Over time, this type of care can free you to build a truly healthy relationship with food, one that’s based on science and compassion.
4. Identify and Empower Your Support Network
Not all of your friends and family will understand your struggles; some may feel frustrated, confused, or scared. But you may have one or two loved ones who have given you compassion and support in the past. Find an open time and a safe space to share your concerns with these people, and empower them to help you grow. These people can give you encouragement when you’re struggling to cope, and they can provide accountability when they notice you getting stuck in your rules.
Recovering From Orthorexia Is Possible
Healing from orthorexia is absolutely possible. Hundreds if not thousands of people have been able to find freedom and flexibility after living in orthorexia’s chess game. If you’re struggling, know that you can recover, and a mental health therapist can help you get there.