What is orthorexia nervosa?
Orthorexia nervosa is a term coined by Steven Bratman in 1997 to describe an obsession with healthy or “clean” eating. This fixation can eventually lead to a number of disordered behaviors, including severely restricted food intake.1
In many cases, ON can resemble other eating disorders, but what makes orthorexia nervosa unique is a focus on food quality rather than quantity. Similarly, the fixation with ON isn't necessarily on body weight, shape, or size (though it can be) but is often tied to establishing a "clean" or "pure" diet or lifestyle.1
To be sure, eating whole, "clean" foods can be part of a healthy routine. It's not necessarily the way someone with ON eats that's problematic, but the fixation that drives it. When a focus on healthy eating habits starts taking priority over other considerations and responsibilities in someone's life, it can lead to increasingly disordered and potentially dangerous thoughts and behaviors.
What generally separates ON from a genuinely healthy relationship with food and eating is when a person experiences actual distress from being unable to eat "clean," prepare their own food, or follow their own rules. This distress can become disruptive and lead to other mental and physical health concerns. It is generally agreed that orthorexia should be treated as a serious condition that requires specialized treatment and medical care.1
What are the symptoms of orthorexia nervosa?
It can be hard to recognize when a focus on nutrition starts to develop into an eating disorder, but there are some common orthorexia symptoms that may help distinguish the condition from regular healthy eating.
1. Cutting out entire food groups
Cutting out entire food groups, such as all dairy, carbohydrates, or sugar, is a common sign of orthorexia. Here, avoiding food has little to do with allergies or apparent health issues. Instead, it involves believing that all foods in that particular food group are "unhealthy" or "unclean."
Another sign of orthorexia nervosa is when this type of behavior escalates over time, with more food groups eventually being eliminated. Although these food choices can lead to weight loss, that isn’t the ultimate goal. Instead, eliminating these foods is done to "achieve optimum health."1,2
2. Experiencing emotional distress when healthy foods aren’t accessible
One of the biggest things that differentiates a focus on healthy eating from orthorexia nervosa is how people react when they can't eat the types of foods they deem "acceptable."
There are no "good" or "bad" foods except those that cause allergies or legitimate medical concerns. All foods are fine in moderation. Someone with a healthy relationship with food and eating acknowledges this and may enjoy all types of foods, even while maintaining a nutritious diet.
Someone who struggles with orthorexia nervosa has rigid, self-imposed rules around food, including foods that are "good" and "bad" to eat. When they're unable to follow these rules, it can lead to real distress and anxiety or feelings of guilt and shame.3 These feelings can be so intense they can lead to social isolation, as someone with ON may feel safer at home, where they have control over food, rather than going out, with the risk of encountering unacceptable foods.
Exposure to extreme views growing upRigid thinkingPreoccupation with details or rulesHypermoralityPsychologically, the condition has been strongly linked to obsessive-compulsive disorder (OCD), with some experts arguing that ON should actually be classified as a subset of OCD.4 Orthorexia is marked by intrusive thoughts (obsessions) around food purity and health and attempts to quiet these thoughts through compulsive behaviors involving diet and food preparation.4
The condition also shares a number of traits with anorexia nervosa (AN), including:4
- Perfectionism
- Anxiety
- A need for control
- Achievement-oriented mindset
Still, AN is widely frowned upon in society, so orthorexia nervosa may develop as a more "socially acceptable" way to restrict food.1 This feeling may be bolstered by excessive use of Instagram and other social media, where "clean eating" is largely celebrated, normalized, or held up as the "morally superior" way to live.6
Other orthorexia nervosa risk factors
Eating disorders can impact anyone at any point in their life, but research suggests some people may be especially at risk for developing orthorexia nervosa, including:1,8
- Athletes
- Healthcare workers
- Performance artists
Those who follow restrictive diets, such as the paleo, ketogenic, or raw food diet, may also have an increased risk of developing orthorexia. This can be due to the relationship between rigid thinking, a preoccupation with rules, and prevailing beliefs around "clean eating" and morality. People who engage in this type of rigid eating also tend to engage in compensatory behaviors, such as increased restriction or fasting, if they violate their diet.9
Isn’t healthy eating a good thing?
Eating nutritious and balanced meals has countless benefits. But when a person's eating pattern becomes pathological and obsessive, restricting entire food groups, engaging in ritualized eating, or deeming certain foods "good," "bad," "pure," or "impure," the consequences can be significant.
Over time, this fixation on healthy eating rules can lead to:
3 - Food restrictions
- Mental and physical imbalance
- Malnutrition
- Medical complications
- Nutritional deficiencies
- A poor sense of well-being
One study called orthorexia nervosa “a disease disguised as a virtue.”10 Indeed, this eating disorder may go underdiagnosed because it presents differently than other eating disorders and some of the behaviors are glorified, especially on social media.
How to treat orthorexia symptoms
As ON is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), there is no way to officially clinically diagnose the condition and no established treatment protocol for orthorexia nervosa. However, professionals have suggested best practices, such as:1,4
- Individualized treatment based on one’s unique needs
- A multidisciplinary team comprised of dietitians, doctors, and therapists
- Cognitive behavioral therapy
- Psychoeducation
- Selective serotonin reuptake inhibitors (SSRIs)
- Antipsychotics, such as olanzapine
- Exposure and response prevention
- Habit reversal training
- Cognitive restructuring
- Relaxation methods
- Psychoeducation related to dietetic science
- Physical exam and lab studies
Individuals with orthorexia may reject medications since they are not natural or pure, so pharmaceutical intervention may not be possible, at least not until they are committed to recovery.
Treatment for orthorexia may occur on an inpatient or outpatient basis. Inpatient programs involve living at the facility for the duration of the eating disorder treatment program. Outpatient care is more flexible and involves living at home and attending scheduled treatment sessions. Still, many treatment barriers exist. Virtual care may be viable if you lack treatment access due to geography, transportation, or scheduling.
If you think you or a loved one have experienced any symptoms of orthorexia nervosa, it’s important to seek eating disorder treatment right away.
Help is available
If you think you or a loved one have experienced any symptoms of orthorexia nervosa, it’s important to seek eating disorder treatment right away.
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