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Orthorexia

What Is It, Signs and Symptoms, Treatment, and More

Author:Anna Hernández, MD

Editors:Alyssa Haag,Stefan Stoisavljevic, MD,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy Johnson, LMSW


What is orthorexia?

An eating disorder is a mental disorder characterized by abnormal eating habits that negatively affect an individual’s physical or mental health. Orthorexia is an eating disorder characterized by an obsessive focus on eating “clean” and “healthy” foods. Although orthorexia often starts as an attempt to achieve a healthy lifestyle through a seemingly healthy diet, an individual with orthorexia may become obsessed with eating clean. Altogether, strict dietary restrictions and inflexible eating patterns can have adverse effects, such as nutritional deficiencies,  malnourishment, or decreased quality of life, among other mental and physical health consequences. 

Patient refusing to eat "unhealthy" food.

What causes orthorexia?

The exact cause of orthorexia is not entirely understood; however, like other eating disorders, orthorexia tends to affect young people who struggle with the social pressure to look a certain way and appear healthy. Risk factors for developing an eating disorder include biological factors, like genetics and hormones, as well as environmental factors, such as the psychosocial pressure to have the socially-defined “ideal body” perpetuated by social media; or having careers that promote weight loss, like modeling and sports. Other factors related to one’s past experiences, including a history of bullying, loneliness, low self-esteem, and childhood trauma, are all linked to the development of eating disorders.

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What are the signs and symptoms of orthorexia?

The hallmark of orthorexia is an excessive concern about the quality and purity of the individual’s diet. Individuals with orthorexia may find themselves compulsively checking ingredient lists or nutritional labels and may avoid eating anything but a narrow group of foods that are deemed “healthy” or “pure.” Therefore, although weight loss may occur because of the individual’s food choices, it is not usually the primary goal.  Individuals with orthorexia may have ritualized patterns of preparing and eating food. They can become obsessed with researching food, measuring food, or planning their meals. When it comes to eating food, individuals with orthorexia might develop complex patterns and rules, such as processing food in a certain way (e.g., not cooking the food because they believe it decreases nutritional value). 

The individual’s beliefs about what is healthy may lead to cutting essential nutrients or whole food groups (e.g., sugar, carbohydrates, dairy products, meat, or all animal products) from one’s diet, which can lead to severe nutritional deficiencies or malnutrition. Individuals with this condition often limit their intake to foods that are organic, farm fresh, whole, raw, or vegan. After time, the individual’s self-esteem may become tied to the purity of their diet and they may feel superior to others in regards to their food intake. 

Some people with orthorexia may experience anxiety simply by being around “unhealthy” foods and may feel an intense need to separate themselves from their forbidden foods. In certain cases, individuals may believe that breaking their dietary rules may decrease their overall health or lead to physical or mental illnesses When individuals break their dietary rules and stray from their usual eating habits, they typically experience severe anxiety, distress, shame, or guilt.

Because individuals with orthorexia tend to regard food as a source of health rather than pleasure, they often avoid social events where food is involved and may experience high levels of distress when “safe” or “healthy” foods are not readily available. Avoiding social events and self-isolation may eventually lead to depression, intensified thought disturbances, and adverse eating behaviors. 

How is orthorexia diagnosed?

Diagnosis of orthorexia is typically carried out by eating disorder specialists when someone presents with an obsessive focus on eating clean. Orthorexia Nervosa is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5); however, it is just as clinically significant as any other eating disorder and can have severe physical and mental health consequences if not treated. Eating disorders that do not fit the criteria for anorexia, bulimia, or binge eating disorder might be diagnosed as “Other specified feeding or eating disorder,” according to the DSM-5.  Because orthorexia still does not have any formal diagnostic criteria, there is still considerable debate about whether it is a stand-alone eating disorder, obsessive-compulsive disorder (OCD), or an extreme form of culturally influenced behavior. 

How is orthorexia treated?

Treatment of orthorexia involves a combination of nutritional rehabilitation and psychotherapy, such as cognitive behavior therapy, which is aimed at restoring and stabilizing eating patterns and changing the individual’s thoughts and beliefs about food and how it impacts their health.  Individuals with severe depression or anxiety can be treated with antidepressants, such as a selective serotonin reuptake inhibitor (e.g., fluoxetine, paroxetine, sertraline), in combination with psychotherapy. 

What are the most important facts about orthorexia?

Orthorexia is an eating disorder characterized by an obsessive focus on clean eating and restrictive dietary practices. Like other eating disorders, orthorexia is not a choice but an unconscious behavior that develops due to an unhealthy relationship with food. Signs and symptoms of orthorexia include a fixation on food quality and avoidance of certain foods or entire food groups deemed as “bad” or “unhealthy.” The rigidity of the individual’s eating habits can lead to avoidance of social events that revolve around food and feelings of depression and self-isolation. Although orthorexia is not an official diagnosis by the DSM-5, it can have severe physical and mental health consequences and can be treated with therapy by eating disorder specialists. 

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Related links

Eating disorders: Clinical practice
Eating disorders: Nursing Process (ADPIE)
Obsessive-compulsive disorder

Resources for research and reference

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing.

Avşar O (2017) Orthorexia Nervosa- As an Eating Disorder. EPOA 1: 11-13

Cena, H., Barthels, F., Cuzzolaro, M. (2018). Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. DOI:10.1007/s40519-018-0606-y 

Donini, L. M., Marsili, D., Graziani, M. P., Imbriale, M., & Cannella, C. (2005). Orthorexia nervosa: Validation of a diagnosis questionnaire. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 10(2), e28–e32. DOI:10.1007/bf03327537 

Koven, N., & Abry, A. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric Disease and Treatment, 385. DOI:10.2147/ndt.s61665