Orthorexia Nervosa: Signs, Symptoms, and Treatment

What is orthorexia nervosa?

Orthorexia, or orthorexia nervosa, is a damaging obsession with healthy eating and the quality and purity of food in your diet. The term, coined by American physician Steven Bratman, literally means “fixation on righteous eating.” Although orthorexia is not officially recognized as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), obsessing over every ingredient in your diet, severely restricting the types of food you eat, and trying to eat the “perfect” diet can take a serious toll on your physical and mental health.

Orthorexia has become more widespread with the advancement of “clean eating.” This is a form of diet that aims to limit consumption of processed foods and those that are high in sugar, unhealthy fats, and preservatives. It also involves choosing whole foods in their most natural state. For example, sticking to a vegan, gluten-free, dairy-free, raw food, or all-organic diet could all fall under attempts to “eat clean.” However, orthorexia can develop out of any rigid way of eating, including the paleo and keto diets.

While many of these diets can be healthy, orthorexia takes things to extremes, becoming overly restrictive, often leading to excessive weight loss and even malnutrition and other health issues. And the impact goes far beyond the physical. Orthorexia can disrupt your day-to-day functioning, negatively affect your social activities, interfere with your relationships, and cause extreme emotional distress.

But your life and well-being doesn’t have to revolve around what you eat. With treatment, self-help, and support, you can get back to a balanced and truly healthy way of eating and enjoying life.

The difference between healthy eating and orthorexia

Healthy Eating	Orthorexia
You do your best to make nutritious food choices most of the time, but you’re flexible when you need to be.	You stick rigidly to your diet and may refuse to eat or become anxious if you don’t have access to food that meets your specifications.
You cut out certain foods for general health reasons, or because you physically feel better when you avoid them.	You cut out certain foods or even entire food groups because you view them as “bad” or “impure.”
Your identity is based on various interests, friends, work, and hobbies.	Your identity is based largely on the purity and perfection of your diet.

Signs and symptoms of orthorexia

Since eating healthfully is normally an admirable goal, orthorexia is easy to overlook. But if you’re worried that your diet is taking over your life, or worried about a love one’s eating habits, asking the following questions can help.

Actions

Orthorexia is marked by certain patterns and behaviors. Do you (or your loved one):

Refuse to eat from entire food groups? You may be depriving yourself of key nutrients.

Go out less with friends and family so that you’ll able to stick to your diet? If your desire to eat healthfully is limiting your social life, it may have gone too far.

Spend a lot of time planning your meals in advance? If you’ve eliminated many ingredients from your diet, you’ll find there’s a lot you can’t eat. You might also derive a sense of accomplishment from mapping out your meals and contemplating how to best achieve your health goals.

Devote a lot of time to researching nutritional components of food? Has this replaced other activities you used to enjoy? Do you feel like you’re always finding ways that food could be unhealthy? This could include an obsession with ‘healthy lifestyle’ blogs or joining multiple Internet chat rooms on the subject.

Spend over your budget on food? The more complicated your diet, the more expensive it can become.

Judge other people’s eating habits or encourage them to also limit certain foods? There’s an aspect of morality attached to orthorexia. You may find yourself categorizing food as “good” and “bad.” You might also assign negative character traits to people who eat too much of a certain food.

Feelings

If you have orthorexia, you’ll experience many “highs” and “lows” related to your diet. At first, you may experience a rush of achievement and superiority. Often, though, orthorexia is a coping mechanism for hidden pain and other uncomfortable feelings. Do you:

Feel guilty after eating “bad” foods? Even if eating healthfully is your overall goal, you should be able to enjoy a restaurant meal or a dessert out with friends from time to time.

Feel a heightened sense of accomplishment after eating “good” foods? Orthorexia differs slightly from other eating disorders in that the focus, at least on the surface, is on health rather than losing weight. Therefore, there’s an aspect of purity involved, and the goal of ridding your body of “toxins.”

Find it difficult to eat a meal prepared by someone else? You may feel out of control unless you know the specific ingredients of your meal.

Feel self-loathing when you stray from your diet? Even when your eating regimen becomes increasingly harder to maintain, you base your self-esteem on how well you can follow it.

Find it difficult to concentrate on work or school because you’re thinking about food? How does your body feel? You may feel tired or unfocused because you’re undernourished.

Follow a strict diet to feel more in control? Reflect on what else is going on in your life. Are there other issues you feel you can’t control?

Care more about the idea of your food than the taste of it? Are you very concerned with the source, and how your food is processed or packaged? For example, you may worry if vegetables were exposed to pesticides, or whether nutrients were lost during cooking.

Is it orthorexia or anorexia?

While the outward motivation of orthorexia is different from anorexia, both eating disorders share the same desire to control life and uncomfortable emotions using food. Further, many people try to lose weight under the guise of bettering their health. Someone with orthorexia might opt for wild salmon over a low-calorie shake, or nutritional supplements over diet pills, but the goal is still the same. So, while aiming to eat healthfully is more socially acceptable than purging or drastically restricting calories, it’s important to consider your true intentions for how you manage your diet.

• If you have anorexia, you might feel ashamed and try to hide any changes in your eating habits. People with orthorexia usually wear their diet as a badge of honor. If you have orthorexia, you may feel more inclined to encourage your friends to follow a similar path.
• Those with anorexia tend to focus on avoiding all food, while sufferers of orthorexia embrace meals they think are healthy.
• Do you pay particular attention to ingredients or the way food is prepared? If you have anorexia, you will likely be more concerned with caloric intake than specific nutritional value.

Orthorexia and obsessive-compulsive disorder

Along with anorexia, orthorexia also shares symptoms with obsessive-compulsive disorder (OCD). Some similar tendencies include recurring thoughts about food and health that interfere with daily life, excessive stress over food contamination, and a compulsion to prepare meals in a specific manner. If you have orthorexia, your ritualized eating style also leaves little time for other activities.

Underlying causes of orthorexia

As with other eating disorders, the root causes of orthorexia are complicated and wide-reaching. Although on the surface, your goal is to gain better health, often food becomes a means to work out other issues. Some underlying causes can include:

Fear of illness or health complications. Perhaps you’ve had a health scare. Maybe you have a recurring ailment, such as headaches, and you’ve seen an improvement when you cut out certain foods. While a healthy diet can certainly help extend your life, the truth is, none of us will live forever—and it’s important not to lose sight of the reasons you’d like to live a long, healthy life.

Desire for control. If you feel the need for stringent control over your diet, consider whether you’re trying to compensate for other areas in your life. This could include both health-related issues and other anxieties. In life, there’s always an element of unpredictability. Getting to the root of your fears can go a long way toward regaining a healthy perspective.

Creating an identity. Nowadays, it’s easy to find passionate communities around certain food movements. For example, many people are adopting vegetarian and vegan diets in an effort to help the environment. Also, the more specific your diet, the more necessary it becomes to stick with people with similar habits. While having a support group to encourage healthy habits is a positive thing, consider how much your eating habits isolate you from other friends and family members or how much your identity is dependent on food. You always want to nurture the other aspects of your identity that make you an interesting, well-rounded person.

Orthorexia treatment and recovery

First of all, recognizing that you may have taken your diet too far is no small feat. You’re in the right place to start recovery. Keep in mind that healing is a journey. It will most likely feel strange at first to eat foods you haven’t allowed yourself. You may at times question your decision to abandon your former strict diet, and even try to return to it from time to time. While it’s natural to relapse occasionally, don’t lose sight of the reasons why you decided a limited diet was no longer good for you.

First steps toward recovery

• Make a list of the ways your obsession with food has harmed others. Have you lost friends because you’ve shamed them for the way they eat? Similarly, have you cut off any of your loved ones because they didn’t follow a diet like yours? As painful as it may be, recalling incidents where you may have hurt someone’s feelings over food is instrumental to the healing process. Reflect on times you ate at someone’s house. Did you refuse to eat the meal they prepared? If you have children, consider how your lifestyle choices may have restricted them too.
• Make a list of the ways your obsession with food has harmed yourself. Be honest with yourself. How much time have you spent thinking about food and planning meals? Has it affected your performance at work or school? Have your thoughts about food prevented you from pursuing other goals and hobbies? Consider any relationships you’ve severed or neglected to obsess over food. Was maintaining your diet worth the isolation?
• Find a mantra. Find something positive that you can repeat to yourself when you get the urge to slip back into old habits. Something with the general message of “food doesn’t define me,” or “I’m more than my diet.” Get creative or funny!

Exploring what’s fueling your orthorexia

While it may have started as an attempt to eat healthier, often diets that turn into obsessions are coping mechanisms to avoid facing other issues. Trying to break away from your orthorexia may unearth some uncomfortable feelings. Do you find it difficult to introduce more foods into your diet? Why do you think this is the case? It may help to journal your thoughts to uncover your true motivations. If you know your eating pattern is unhealthy, but you can’t seem to break away from it, it may help to talk to a therapist.

Accepting and managing uncomfortable feelings

After you’ve identified some of the feelings fueling your orthorexia, it’s important to find a healthier response. This may make you feel worse at the beginning of your recovery. For example, if you’ve discovered that your orthorexia gives you an illusion of control, changing your eating pattern may cause your anxiety to come flooding back. But don’t feel tempted to go back to your destructive diet; the key is to work toward accepting yourself and all of your emotions.

Figure out what you’re feeling. When you try to open up your diet, what emotions does this trigger? Is it anxiety? Helplessness? Loneliness?

Accept your emotions. Denying unpleasant feelings doesn’t make them go away. Instead, allow yourself to experience them without judgement.

Tune in to your experience. Where do you feel the emotion in your body? What thoughts does it trigger?

Be objective. Realize that these negative feelings don’t define you. Think of them as passing storm clouds; they aren’t permanent. Practicing mindfulness and activating your body’s relaxation response can help.

Finding better coping mechanisms

Once you understand the underlying causes of your disordered eating, you need to find healthier coping mechanisms that fulfill you. Here are some ideas:

If you’re anxious, go for a walk; turn on some music and dance; or hold a cherished object. If you’re using your food rituals as a way to block people out, recognizing this is the first step to removing your barriers. Getting a pet or interacting with animals is another way to get out of your head.

If you’re depressed or lonely, acknowledge that some of the root causes of orthorexia involve feeling part of a community or carving out an identity. Consider your other hobbies and passions that don’t involve food. Maybe you could join a group that focuses on one of them. Also, volunteering can help open your eyes to the world beyond your diet.

If you’re unfulfilled, try to seek meaning in another way outside of food. For example, try meditation, find a spiritual community, or connect more with nature.

Developing a healthier relationship with food

As you’re working through the underlying causes of your disordered eating, you may be wondering how to replace it. With so much advice on diet and nutrition out there, it can be hard to tell the good from the bad. Generally, we all need a balance of protein, fat, carbohydrates, fiber, vitamins and minerals to give us optimal energy and health. The key is, instead of aiming for perfection, look to include some of each food group in every meal. Replacing processed foods with fresh ingredients whenever possible is a good place to start. Similarly, cooking at home rather than relying on take-out is also helpful in maintaining a healthy diet. However, it’s important not to think of certain foods as “off-limits.” Instead, focus on moderation and be kind to yourself.

Replacing the restriction mentality

While it can feel scary at first to eat without a blueprint, after some time, you’ll become more attuned to your body and better able to respond to what it needs.

Pay attention to your body’s rhythms. Don’t eat unless you are hungry. Eat slowly and stop when you are full.

Eat mindfully—fully experience your food. Mindful eating will help you gauge when you’ve had enough. Take note of your food’s textures and tastes. Try to avoid eating while watching TV, working on the computer, or when otherwise distracted.

Be careful with food and fitness tracking technology. Since they are so specific, regular use of them can intensify anxiety and obsessive behaviors. If you’re struggling with orthorexia, you’re probably already prone to perfectionism. It’s good to measure your portions, but at the same time, don’t deny yourself if you still feel hungry.

Don’t ignore cravings (within reason!) If you’ve had a healthy dinner, for example, you can allow yourself a scoop of ice cream as a treat.

How to help someone with orthorexia

Orthorexia, like any other eating disorder, distorts the way your loved one thinks. Attacking them or undermining their beliefs will only make them shut you out. They will dismiss you as someone who doesn’t take their health seriously; in fact, your efforts may backfire and lead them to try to convince you that your lifestyle is the one that needs to change! Instead, try slowly establishing trust. If the person with orthorexia views you as an ally, you have a better chance at gaining ground with them.

Agree with their stated motivations. Acknowledge that diet is indeed a powerful tool for solving health problems, and that many advertised products have too many additives. If they can see that you value the importance of a healthy diet, they’ll be more likely to listen to you.

Share your own experiences. If you’ve also struggled with the line between a healthy diet and extremism, you might want to share that with your loved one. 

Seek advice from a health professional. You can also enlist other friends and loved ones for support.

Avoid threats, emotional outbursts, and scare tactics. Since orthorexia is often rooted in anxiety and self-doubt, you’ll only make your loved one feel worse and break down the lines of communication.

Take the pressure off yourself. You can’t solve someone’s eating disorder for them. Don’t forget to take care of yourself and seek counseling to help manage your own feelings if necessary.

Last updated or reviewed on November 17, 2023