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8 orthorexia symptoms: physical and behavioral concerns

A balanced diet can improve your physical, mental, and emotional health. But when healthy eating turns into an obsession that causes distress and impairment in a person’s life, there could be a pattern of disordered eating known as orthorexia nervosa.

There are a variety of risk factors, both genetic and environmental, that influence the development of orthorexia. Orthorexia isn’t as commonly known as other eating disorders, such as officially recognized conditions including anorexia nervosa or bulimia nervosa. So you may not realize you have it. And you may mistake this eating disorder for healthy or “clean” eating. Only a doctor or mental health provider can identify the signs and symptoms of orthorexia. But knowing the symptoms can help you take the steps you need in order to get help.

Last updated on 
December 6, 2023
December 6, 2023
8 orthorexia symptoms: physical and behavioral concerns
In this article

What is orthorexia nervosa?

Orthorexia nervosa is a term coined by Steven Bratman in 1997 for an obsession with healthy or “clean” eating. This obsession leads to restrictive behaviors. But, unlike other eating disorders, the person is focused on food quality as opposed to quantity.1

Although it’s not currently classified as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), many mental health providers acknowledge the negative consequences of obsessive “pure” eating.1

Without formal diagnostic criteria and recognition by the American Psychological Association, it’s difficult to approximate how many people struggle with orthorexia nervosa. But various studies have estimated prevalence to be between 1% and 6.9%, with a higher rate in health care professionals and performance artists.1

Regardless of its status, professionals can agree that orthorexia is a serious concern that often requires treatment and medical care.

What are the symptoms of orthorexia nervosa?

If you are concerned that you or someone you love may have orthorexia nervosa, you’ll want to familiarize yourself with some of the most common symptoms of this eating disorder. Remember, prioritizing nutritious eating doesn’t necessarily mean you have an orthorexia. Rather, orthorexia nervosa is present when you are extremely obsessed with healthy eating, despite your academic, occupational, or social functioning may be impaired due to your fixations.

1. Cutting out entire food groups
2. Experiencing emotional distress when healthy foods aren’t accessible
3. Compulsively checking nutritional labels and ingredient lists
4. Obsessing over “clean” food planning, preparation, and consumption
5. Experiencing extreme guilt or anxiety when eating forbidden foods
6. Viewing food as a source of health as opposed to pleasure
7. Caring a great deal about what others are eating
8. Obsessing over healthy lifestyle influencers on social media

Possible physical symptoms of orthorexia

Similar to anorexia, people with orthorexia severely restrict the amount and variety of foods they consume, which can cause malnutrition and nutritional deficiencies.4 Although more long-term research is needed, anecdotal evidence indicates that orthorexia nervosa affects the body similarly to anorexia nervosa and may result in the following physical symptoms:1,4,5

  • Severe weight loss
  • Weak bones and loss of bone mass
  • Fatigue, weakness, lethargy
  • Fainting or dizziness
  • Vomiting and rapid breathing (due to metabolic acidosis)
  • Stomach bloating
  • Constipation
  • Stomach pain, nausea, and vomiting (due to pancreatitis)
  • Abnormally slow heart rate
  • Difficulties falling or staying asleep
  • Numbness or tingling in extremities
  • Muscle cramps
  • Feeling cold due to a drop in body temperature
  • Brittle hair and dry skin
  • Fine hair growth all over the body (lanugo)

Isn’t healthy eating a good thing?

Eating nutritious and balanced meals has countless benefits on your life. But when your pattern of eating becomes pathological and obsessive to the point of restricting food, engaging in ritualized eating, and avoiding various food types deemed “unhealthy,” the consequences can be significant. Over time, these restricting behaviors due to a fixation on healthy food can lead to imbalance, malnutrition, medical complications, and nutritional deficiencies, as well as a poor sense of well-being.3

One study called orthorexia nervosa “a disease disguised as a virtue.”10 Indeed, this eating disorder may go under-diagnosed because it presents differently than other eating disorders, and some of the behaviors are glorified, especially on social media.

Orthorexia nervosa may go under-diagnosed because it presents differently than other eating disorders.

Another study on the link between Instagram use and orthorexia nervosa symptoms found that frequent Instagram use was associated with higher rates of orthorexia nervosa. The authors found a high prevalence of orthorexia nervosa symptoms among healthy eating influencers, which in turn affect the mental health of users consuming their content.6

What causes orthorexia nervosa?

Like other eating disorders and mental health conditions, there is not one isolated cause of orthorexia nervosa. Rather, several factors, known as risk factors, influence the development of orthorexia. Risk factors that increase the likelihood of developing orthorexia nervosa may include:1,4,6,7

  • Perfectionism
  • Anxiety
  • A need for control
  • Achievement-oriented attitude
  • Fearful and dismissing attachment styles
  • Past trauma
  • A belief in food as medicine
  • Exposure to extreme views as a child
  • Preoccupation with being weight, health, and fitness
  • History of an eating disorder
  • Parent with a history of an eating disorder
  • Preoccupation with appearance
  • Impaired flexible problem solving
  • Excessive Instagram use
  • Obsessive-compulsive disorder

Additionally, some demographics may have a higher prevalence of orthorexia than the general population.

These may include:1,8
  • Athletes
  • People who work in healthcare
  • Performance artists

Lastly, research has shown that following a restrictive diet, such as paleo, ketogenic, or raw food diets, may increase your risk of developing orthorexia. People who believe in the health benefits of these diets and engage in this type of rigid eating tend to engage in compensatory behaviors, such as increased restriction or fasting, if they violate their diet.9

How is orthorexia treated?

There is 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
  • Multidisciplinary team comprised of dieticians, 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 a viable option if you lack treatment access due to geography, transportation, or scheduling.

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.

Call for remote treatment

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.


  1. Scarff, J. R. (2017). Orthorexia Nervosa: An Obsession With Healthy Eating. Federal practitioner: for the health care professionals of the VA, DoD, and PHS, 34(6), 36–39.
  2. Rogoza, R., Donini, L.M. (2021). Introducing ORTO-R: A Revision of ORTO-15. Eating and Weight Disorders 26, 887–895.
  3. National Eating Disorders Association. (n.d.). Orthorexia.
  4. Koven, N. S., & Abry, A. W. (2015). The Clinical Basis of Orthorexia Nervosa: Emerging Perspectives. Neuropsychiatric disease and treatment, 11, 385–394.
  5. National Eating Disorders Association. (n.d.). Health Consequences.
  6. Turner, P. G., & Lefevre, C. E. (2017). Instagram Use is Linked to Increased Symptoms of Orthorexia Nervosa. Eating and Weight Disorders: EWD, 22(2), 277–284.
  7. Cheshire, A., Berry, M., Fixsen, A. (2020). What Are the Key Features of Orthorexia Nervosa and Influences on its Development? A Qualitative Investigation. Appetite 155: 104798.
  8. Bert, F., Gualano, M. R., Voglino, G., Rossello, P., Perret, J. P., & Siliquini, R. (2019). Orthorexia Nervosa: A Cross-sectional Study Among Athletes Competing in Endurance Sports in Northern Italy. PloS one, 14(8), e0221399.
  9. King, E. (2021). When Healthy Turns Harmful: Increasing Understanding of Potential Risk Factors and Approaches to Decreasing Orthorexic Behaviors. All Graduate Theses and Dissertations.
  10. Bratman, S., Knight, D. (2000). Health food junkies: overcoming the obsession with healthful eating. New York: Broadway Books.


Further reading

The similarities between anorexia nervosa and orthorexia

Anorexia nervosa (AN) and orthorexia nervosa (ON) can often be confused with each other due to the similar...

The relationship between orthorexia and bulimia

Orthorexia nervosa (ON) is a more recently acknowledged disorder. While yet to be recognized by the DSM...

What causes orthorexia nervosa?

Orthorexia nervosa (ON) is an eating disorder that is characterized by an obsession...

Orthorexia treatment plan

Orthorexia nervosa (ON) is a serious eating disorder that can be very tricky to detect, as...

What are the warning signs of orthorexia nervosa?

Striving to follow healthy eating habits is a good thing. But being obsessed with the nutritional quality...

What is orthorexia nervosa?

Orthorexia nervosa is an eating disorder that manifests itself as an unhealthy...

8 orthorexia symptoms: physical and behavioral concerns

A balanced diet can improve your physical, mental, and emotional health. But...