What is Orthorexia? Definition, Signs, Symptoms & Treatment

Orthorexia Overview

Orthorexia nervosa is an eating disorder in which there is an obsession with eating healthy food. There is currently no official way to diagnose this eating disorder, but this condition can have severe consequences on both physical and mental health. 

Despite a focus on clean eating, people with symptoms of orthorexia can develop health problems. The rigid eating patterns and self-imposed dietary rules can lead to widespread problems in a person’s life, including severe weight loss, malnourishment, relationship difficulties, and an overall poor quality of life.

The History and Origin of the Term

The term orthorexia was coined by Steven Bratman in 1997. It is a combination of the Greek word “ortho” which means correct and “orexis” which means appetite. 

How is Orthorexia Different from Healthy Eating? 

Healthy eating is a balanced interest in one’s dietary regimen and nutrition. In contrast, orthorexia nervosa is characterized by compulsive behaviors and a rigid preoccupation with a perceived healthy lifestyle. This compulsive behavior and obsession with clean eating can lead to anxiety and other medical complications. 

For example, a person suffering from orthorexia might spend an excessive amount of time prepping food or over-educating their friends/family on more nutritional foods to eat, which can lead to self-isolating behaviors and poor relationships. Healthy eating, however, is being conscious of the foods you eat and making nutritionally guided choices. In contrast with orthorexia, healthy eating does not interfere with every aspect of your life.

How is Orthorexia Different from Other Eating Disorders?

Orthorexia is less well understood than other disordered eating patterns such as anorexia nervosa, bulimia nervosa, and binge eating disorder. We do know, however, that while people with other eating disorders are obsessed with the “quantity” of food consumed, people with orthorexia are focused on the “quality” of food consumed.

Orthorexia is an underdiagnosed condition, and people can slip into this eating disorder unknowingly. In fact, given social media and modern society’s diet culture, a person with orthorexia may even be applauded as a “health food junkie.”

In many cases, people with orthorexia nervosa also have other mental illnesses like obsessive-compulsive disorder (OCD), while others with orthorexia develop other mental health conditions over time. Even though these mental health conditions may have overlapping symptoms, there are differences between these conditions.

Signs and Symptoms of Orthorexia Eating Disorder

People with orthorexia excessively fixate on the quality (rather than the quantity) of food. Orthorexia often starts with healthy or clean eating and progresses to avoiding certain foods or ingredients (for example, salt, sugar, fat), entire food groups, such as dairy or grains, and foods with preservatives, additives, etc.  

Psychological Orthorexia Symptoms

• An obsessive focus on healthy eating with fixed nutritional beliefs

• Compulsive behavior or mental preoccupation with eating healthy foods and other dietary practices that are perceived as healthy

• No specific desire to lose weight, with the fixation being on healthy eating

• As dietary restrictions escalate over time, the elimination of entire food groups

• Frequent and/or severe cleanses (fasts) to purify or detoxify the body 

• Thinking of food as a source of health instead of a source of pleasure

• Exaggerated beliefs that including or eliminating specific types of foods can affect well-being or prevent or cure health conditions

• A sense of impurity or feelings of shame related to unhealthy food choices 

• Exaggerated emotional distress when making food choices perceived as unhealthy, unclean, or impure

• An intense fear of disease when self-imposed dietary rules are violated

• Negative physical sensations such as disgust when in proximity to unhealthy foods

• Strong feelings of guilt after slipping up

• Exaggerated positive body image, self-worth, self-image, and pride related to compliance with healthy eating behavior

• The moral judgment of others based on their dietary choices

Physical Signs and Symptoms

• Malnutrition or severe weight loss as a result of dietary choices

• Excessive meal planning and preoccupation with diet (spending hours preparing upcoming meals)

• Obsessive focus on food choices and food purchase, preparation, and consumption

• Fixation on food quality and purity

• Inflexible eating patterns (avoiding unhealthy foods at all times)

• Obsessively checking nutrition labels

• Telling others the correct foods to eat

• Social isolation and withdrawal from people and activities that do not align with a healthy lifestyle

• Problems in interpersonal relationships and social, academic, or vocational functioning in daily life are secondary to strict beliefs and behaviors about healthy eating

Causes and Risk Factors of Orthorexia

The exact cause of orthorexia nervosa is unknown. However, scientists believe it occurs due to certain changes in the brain, similar to people with anorexia nervosa or obsessive-compulsive disorder.

Psychological Factors

Surveys have found that orthorexic tendencies are linked to traits such as perfectionism, preoccupation with body weight and body image, and fearful or dismissive attachment styles.

Environmental Influences 

Environmental influences that may contribute to the development of orthorexia include feeding practices during childhood, food preferences and pickiness, changes in taste perception, being overweight or obese, and a history of eating disorders in close family members. 

Risk Factors

Significant risk factors for orthorexia include preoccupation with body weight and appearance and a history of an eating disorder. 

Diagnosing Orthorexia

Diagnostic Criteria

Unlike eating disorders such as anorexia and bulimia, which are classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are currently no formal diagnostic criteria for orthorexia. The American Psychiatric Association does not list it as a specific condition. The proposed diagnostic criteria for orthorexia nervosa include a mental preoccupation with healthy eating and many of the psychological and physical signs of orthorexia listed above. 

Assessments and Tests

A diagnosis of orthorexia nervosa is made mainly on a clinical basis following interviews with a mental health professional. While there aren’t formal diagnostic criteria, below are a few proposed diagnostic tools that healthcare professionals can utilize in addition to clinical judgment to diagnose orthorexia. 

• ORTO-15: a screening tool with 15 questions helps to identify signs and symptoms of orthorexia

• ORTO-R: the updated version of ORTO-15 with six questions about symptoms and behaviors of orthorexia

• Bratman Orthorexia Test (BOT): BOT is not commonly used; this is a 10-question screening tool based on the obsessive thinking about food quality and health beliefs. This screening tool consists of “Yes/No” responses. 

• Eating Habits Questionnaire (EHQ): this tool consists of 21-questions regarding a person’s feeling and problematic behaviors with healthy eating. 

Family members and friends who are familiar with the person can also provide collateral information to aid in diagnosis.

Professionals Involved in Orthorexia Management

A multidisciplinary team approach, including physicians, psychotherapists, and dieticians, is necessary for the diagnosis and management of orthorexia. 

Health Consequences of Orthorexia

Physical Problems and Health Risks

• Weight loss 

• Malnutrition (nutritional deficiencies from a lack of essential nutrients in a restricted diet)

• Constipation

Mental Health Implications

• Mood swings

• Anxiety

• Depression

Long-Term Side Effects

If left untreated, orthorexia can have wide-ranging long-term effects on a person’s health. Potential health problems related to disordered eating patterns include:

• Chronic fatigue syndrome

• Anemia

• Electrolyte disturbances

• Osteoporosis

• Heart and lung problems

• Kidney failure

• Memory problems

Treatment Options: How is Orthorexia Treated?

Psychological Therapies

Cognitive behavioral therapy (CBT) can help people with orthorexia understand how their thoughts and emotions (perfectionism, distorted body image) affect their dietary choices and health. CBT can also help to reduce obsessive-compulsive behaviors. 

Emerging perspectives in orthorexia treatment include relaxation therapy to manage anxiety related to eating unhealthy foods. 

Other aspects of treating orthorexia include education and nutrition counseling to correct inaccurate beliefs about food groups. A registered dietitian can help to plan meals that include healthy food without being restrictive.

Medical Interventions

Most people with orthorexia can be treated on an outpatient basis. However, in severe cases with significant weight loss or malnutrition, hospitalization may be necessary for supervised feeding and weight restoration. 

There are no studies on the efficacy of medications in people with orthorexia. However, given that the symptoms of orthorexia are similar to anorexia, doctors may prescribe antidepressants (selective serotonin reuptake inhibitors or SSRIs) to address anxiety and obsessive-compulsive traits. However, treatment with medications can be challenging in people with orthorexia as they perceive medications to be unnatural substances.

Support Groups and Resources

Support groups, such as the National Association of Anorexia Nervosa and Associated Disorders (ANAD), help to fill the gaps in care for people with eating disorders. Peer support groups are usually led by people who have lived experience of recovery from eating disorders. They provide a space for people to find support and access additional resources.

How to Help Someone with Orthorexia

Warning Signs Someone Might Need Help

You should consider consulting a mental health professional if a loved one shows the following signs and symptoms of orthorexia or disordered eating patterns:

• A fixation on the quality of food and an obsession with eating a healthy diet

• Inflexible eating patterns affecting daily life and social events

• Cutting out entire food groups

• Severe distress upon breaking self-imposed dietary restrictions

• Constant worry about sickness or disease related to unhealthy food choices

• Obsession with wellness and being healthy (rather than wanting to lose weight)

• Losing weight due to a restricted diet

Communicating Concerns Effectively

If you think a loved one may have orthorexia, here are some tips to effectively communicate your concerns:

• Before you approach the person, educate yourself about orthorexia from reliable sources, such as a healthcare professional who treats eating disorders.

• Initiate a discussion in a safe, quiet, and comfortable place that is free of distractions.

• Avoid approaching the person when they are angry, frustrated, tired, eating a meal, or in a restaurant. 

• Discuss your concerns in an open, non-judgmental, respectful, and kind way. Explain that you think their eating behaviors might indicate the need for professional help.

• Use “I” statements to express your concerns, such as “I am concerned about you,” rather than “you” statements, such as “You have got me worried.”

• Avoid blaming the person or speculating on the cause of the eating disorder.

• Ask how you can support the person rather than telling them what to do or offering solutions. 

• Avoid showing frustration or getting angry even if the person dismisses your concerns.

Further Reading and Resources

• Understanding eating disorders

• What to say if you suspect a loved one has an eating disorder

• What not to say to someone with an eating disorder