Orthorexia Explained: Meaning, Symptoms & How to Find Recovery
Orthorexia occurs when a person’s obsession with eating only “clean” or “healthy” foods negatively affects their physical health, mental health or personal relationships. People with orthorexia seek dietary perfection or purity. This quest includes consuming only the “right” or “pure” foods, vitamins and supplements.
Orthorexia definition
Currently, there is no official definition of orthorexia nervosa, and it is not listed as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Studies are ongoing to develop a clear definition. [Donini, 2022]
Orthorexia origins
A doctor coined the term orthorexia nervosa, referencing a pathological fixation on eating proper food. He mentioned the pseudo-spiritual nature of eating pure food that could lead one to perform numerous acts of penitence and ever-stricter diets and fasts. [Bratman, 1997]
The impact of orthorexia
Eating disorder experts agree that orthorexia includes:
An obsessive focus on achieving optimal health by eating the “right” foods
Preoccupation with food, inflexible food rules and compulsive behaviors related to food
Clinically significant medical, mental or physical health consequences [Cena, 2019]
When a quest for “clean” eating causes distress or impacts work, school, or relationships, eating disorder treatment can help.
Causes
What causes orthorexia?
Dieting is one of the main gateways that leads to disordered eating. A person with a history of dieting may develop orthorexia if their “clean” eating habits are taken to an extreme.
Factors increasing the risk of orthorexia
Having a personal or family history of eating disorder thoughts and behaviors (e.g., dieting, purging or excessive exercise)
Perfectionism and neuroticism personality traits
Obsessive and compulsive tendencies
A desire for control and order
Poor body image or body dysmorphia
Rigid thinking and inflexibility
Being an athlete or fitness practitioner [Novara, 2021; Messer, 2022; López-Gil, 2023; Horovitz, 2023]
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Orthorexia SYMPTOMS
Key Signs & Symptoms
Dieting is one of the main gateways that leads to disordered eating. A person with a history of dieting may develop orthorexia if their “clean” eating habits are taken to an extreme.
Rigid and distorted beliefs about foods and food groups
Extreme food restrictions (cutting out entire food groups)
Extreme concern about possible chemicals or toxins in food, whether they have been proven to be harmful or not
Taking an excessive amount of time to buy and prepare foods
Being preoccupied with food, including persistent, uneasy or disturbing thoughts about food
These symptoms can cause stress and anxiety, especially at social gatherings when preferred foods are not available. Orthorexia can greatly impact one’s social life and could lead to isolation.
Clean eating and orthorexia
Many people cite “clean” eating as helping them overcome mental and physical health challenges. “Clean” eating typically includes:
A desire to make healthy lifestyle changes
Avoiding processed foods, artificial colors and artificial flavors
Consuming organic or whole foods in their natural state as much as possible
“Clean” eating itself is not a problem. But an extreme focus on “clean” eating and rigid food choices can potentially cause nutritional deficiencies or malnutrition.
Health Risks
Physical complications of orthorexia
Nutritional deficiencies (protein, fat, vitamins, minerals) or malnutrition
Osteoporosis
Gastrointestinal issues
Impact on organ function
Hormone changes
Mental health consequences of orthorexia
Anxiety and depression
Social isolation and withdrawalFeelings of shame and guilt
Feeling like a failure
Relationship challenges and struggles
Orthorexia treatment
Eating disorder treatment can help individuals recover from orthorexia by providing:
Psychoeducation and social support
Treatment for medical issues and co-occurring mental health conditions
Therapy for orthorexia
Therapy for orthorexia may look similar to therapy for obsessive-compulsive disorder (OCD). Therapists work individually and within a group setting to help patients identify coping skills to manage their fixations, obsessions and compulsions. Values work is often incorporated as well.
Cognitive behavioral therapy challenges orthorexia beliefs and rigid eating patterns.
Exposure therapy can help people with orthorexia become more comfortable eating a wider variety of foods.
Nutritional counseling for orthorexia
Registered dietitians provide counseling, education, meal planning and meal support to help people with orthorexia:
Develop more normalized eating patterns
Eat more challenging foods (“fear” foods) as part of their meal plan
Release some of the rigidity and control over what they eat.
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Orthorexia FAQs
Have a question we didn't answer? Contact us
Diet culture messages can inspire eating disorder thoughts and behaviors because the underlying message is always “you’re not good enough as you are.” The consequences of diet culture include feelings of guilt, shame, regret, low self-esteem and body image issues. This can lead to eating disorder behaviors: a cycle of restricting, binge eating or purging.
People with orthorexia are primarily focused on whether a food is “clean,” “pure” or “healthy” whereas those with anorexia are primarily focused on their body size, weight and shape. When it comes to eating disorder diagnosis, anorexia is a well-researched eating disorder that is included in the DSM-5. Orthorexia is not a distinct diagnosis in the DSM-5, although people with anorexia and other eating disorders may have symptoms related to orthorexia.
Avoidant/restrictive food intake disorder (ARFID) symptoms include restricting food due to sensory features, worrying about choking or vomiting, or having no interest in food. As with orthorexia, people with ARFID may experience specific food-related beliefs or have a tendency toward obsessive-compulsive disorder (OCD). With ARFID, the obsession with eating “clean” or “pure” foods is not commonly seen or observed.
People with obsessive-compulsive disorder (OCD) may face higher risks of orthorexia than others. Some people with OCD may hyperfocus on food rituals. Shopping, preparing and cooking food is seen as part of the ritual to help the person feel “safe,” “clean” or “holy.” As orthorexia obsessions and compulsions become more frequent, and as foods are more restricted, the individual can become malnourished. In malnourished individuals, mental health begins to deteriorate. The brain of someone who is malnourished often focuses even more on their obsessions and compulsions.
Cutting out any food or group of foods can increase the risk for developing an eating disorder like orthorexia. When people stop consuming dairy products due to a milk allergy or cut out gluten-containing products for celiac disease, they may develop more generalized fears and anxieties around food. This can lead to extreme or obsessive thoughts and behaviors related to eating. However, many people with food allergies and intolerance do not develop eating disorders.
Since people eating a vegan or vegetarian diet are choosing to eliminate specific foods or entire food groups, they face an increased risk of developing eating disorders like orthorexia. Some people choose to go vegan or vegetarian because they believe it is a socially acceptable way to restrict the foods they eat. However, many people who eat vegan or vegetarian diets do not develop eating disorder thoughts and behaviors.
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References
1. Cena, H., Barthels, F., Cuzzolaro, M., et al. (2019). Definition and diagnostic criteria for orthorexia nervosa: A narrative review of the literature. Eating and Weight Disorders, 24, 209-246. https://doi.org/10.1007/s40519-018-0606-y.
2. Mehler, P.S., & Andersen, A.E. (2022). Eating disorders: A comprehensive guide to medical care and complications (4th ed). Johns Hopkins University Press.
3. Donini, L,M., Barrada, J.R., Barthels F., et al. (2022). A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eating and Weight Disorders, 27(8), 3695-3711. doi: 10.1007/s40519-022-01512-5.
4. Novara, C., Pardini, S., Maggio, E., et al. (2021). Orthorexia nervosa: Over concern or obsession about healthy food? Eating and Weight Disorders, 26, 2577-2588. https://link.springer.com/article/10.1007/s40519-021-01110-x#citeas.
5. Messer, M., Liu, C., McClure, Z., Mond, J., Tiffin, C., & Linardon, J. (2022). Negative body image components as risk factors for orthorexia nervosa: Prospective findings, Appetite, 178. https://doi.org/10.1016/j.appet.2022.106280.
6. López-Gil, J.F., Tárraga-López, P.J., Soledad Hershey, M., López-Bueno, R., Gutiérrez-Espinoza, H., Soler-Marín, A., Fernández-Montero, A., & Victoria-Montesinos, D. (2023). Overall proportion of orthorexia nervosa symptoms: A systematic review and meta-analysis including 30 476 individuals from 18 countries. Journal of Global Health, 13. https://doi: 10.7189/jogh.13.04087.
7. Horovitz, O., & Argyrides, M. (2023). Orthorexia and orthorexia nervosa: A comprehensive examination of prevalence, risk factors, diagnosis, and treatment. Nutrients, 15(17), 3851. doi: 10.3390/nu15173851.
8. Bratman, S. (1997). The health food eating disorder. Yoga Journal