What You Probably Don’t Know About Orthorexia

We have become obsessed with our food choices. As obesity reaches an all-time high in the United States, increasing awareness around healthy eating and healthy lifestyles have consumed many people. In a desperate attempt to find a solution to lose weight and eat clean, many people began trying new diets, cutting out certain foods, and focusing on where foods come from.

Although there is nothing wrong with focusing on healthy eating and a healthy lifestyle, an unhealthy obsession is different… Obsessions lead to eating disorders.

<H2>What is Orthorexia Nervosa? </H2>

The definition of Orthorexia means “proper” or “correct appetite”. Orthorexia nervosa is an eating disorder that causes people to fixate on healthy eating to the detriment of their mental and physical health. In other words, they go too far in trying to eat “clean foods,” which broadly refers to fruits, vegetables, dairy products, legumes, and minimally processed foods, such as meats without added hormones or antibiotics. 

For example, an individual with Orthorexia Nervosa who started the Paleo diet became obsessed with it and took dieting to an extreme. 

Orthorexia nervosa was first conceived in 1996 by Dr. Steven Bratman, M.D. who, over time, began to see recurring patterns of the eating disorder in his practice. He actually coined the term after witnessing his parents’ obsessive healthy eating habits. 

Although orthorexia is not an officially recognized psychiatric disorder or eating disorder by the American Psychiatric Association, it has been gaining more attention in recent years in the media and by the mental health community. 

People who exhibit signs of orthorexia are not simply concerned with healthy eating; rather, they are obsessed with being “pure,” meaning that they want to free of anything (in foods) they believe will “pollute” their bodies. 

In this sense, their primary motivation is to feel as “clean” as possible. Regardless of their efforts, individuals with this particular disorder never seem to be satisfied. In fact, Orthorexia nervosa can be aspirational or even spiritual. For some, it is a way to fill an empty void where they may lack love or spiritual experiences.

These features distinguishes orthorexia from other eating disorders, such as anorexia nervosa, which is simply referred to as anorexia or bulimia, which is a binge-eating disorder. In contrast, a person who suffers from anorexia is obsessed with losing weight rather than being “pure.” 

However, according to the Diagnostic and Statistical Manual (DSM-5), a cross-sectional study has also shown that anorexia or bulimia and orthorexia nervosa are often diagnosed separately, but can be co-curring disorders.

Orthorexia also differs from slightly from obsessive-compulsive disorder (OCD). The obsessions are considered beneficial to a person whereas OCD obsessions are perceived as harmful.  

<H3>Obsession Definition</H3>

According to the Merriam-Webster Dictionary, an obsession is “a persistent disturbing preoccupation with an often unreasonable idea or feeling.” It only allows you to focus on one thing, which could be a person, goal, or place. Over time, the obsession gains full control over thought and action. 

Some effective ways to overcome an obsession include distractions, achieving a goal, physical activity, and focusing on helping others. For patients who suffer with disorders such as orthorexia or anorexia, these solutions may help. However, depending on the severity of the case, treatment from a mental health professional may be required.

<H3>What is Clean Food?</H3>

As stated above, clean foods or healthy foods include the following:

  • Fruits
  • Vegetables
  • Dairy products
  • Minimally processed foods (foods that may not have added ingredients)
  • Foods that are low in salt and sugar

In addition to the Paleo diet, other forms of clean eating include dairy-free, grain- or gluten-free, and veganism. 

For those who adhere to eating clean food, it is more than simply eating better; it is a way of life. An individual’s aim is to improve his or her life from a holistic standpoint. An individual will engage in disordered eating. He or she will make it a point to stay away from foods that contain added ingredients, such as artificial sweeteners, refined flours or sugars, preservatives and chemicals. Clean eating also emphasizes getting plenty of sleep and exercise.

On the other hand, Orthorexia causes people to lose sight of these positive goals. Rather than focusing on eating for nourishment, eating becomes an effort to be as “pure” as possible. Individuals with Orthorexia who consume even a small amount of a “pollutant” will cause them a great deal of stress and anxiety.

<H2>Orthorexia Symptoms</H2>

The symptoms for orthorexia are apparent to anyone who interacts with a person with this type of eating disorder. The most noticeable symptom is the excessive concern for food quality. Specifically, a person with orthorexia will investigate where foods come from, how they were processed, and the packaging. 

Some other symptoms of orthorexia can include the following:

  • Anxiety about how foods will affect other health issues, such as allergies, digestive issues, and asthma
  • The avoidance of certain foods and even food groups
  • A significant decrease in the number of foods one considers acceptable to eat
  • Excessive worry about how foods are prepared
  • Obsessively checks food labels and ingredient lists

Similar to other mental disorders, it is very difficult to control or stop these behaviors. As a result, sufferers may feel ashamed and embarrassed. 

<H2>High Risk Behavior</H2>

In severe cases of orthorexia, the symptoms listed above as well as other behaviors and symptoms are amplified. Here are some other symptoms of orthorexia: 

  • Experience extreme emotional turmoil if they don’t follow their diets
  • Create detailed meal plans for the next day
  • Criticize others who don’t share their concerns for healthy eating
  • Isolation from friends and family
  • Experience intense anxiety simply being near certain foods
  • Avoid going out to eat due to fear of not being able to follow their diet
  • Unintentional weight loss
  • Fear of illness due to eating unhealthy foods
  • Malnourishment
  • Depression
  • Shame and embarrassment  

Severe cases of orthorexia may result in death due to extreme weight loss and malnourishment. 


Fruitarianism is another type of clean dieting. As the term implies, a fruitarian is a person who primarily eats fruits (75 percent or more) as well as nuts and seeds (the remaining 25 percent). Fruitarianism is a subset of veganism, which is a diet that focuses on eating only plant-based foods. 

Fruitarians choose to eat fruits for various reasons, namely that they contain vitamins and antioxidants. Furthermore, research also suggests that fruits can help reduce the risk of cancer and other diseases. Other reasons are based on cultural, economic, ethical, religious, and environmental grounds. 

Some fruitarians also simply want to reduce their caloric intake, detox, become more environmentally friendly, or even to feel morally superior. 

However, those who consider adopting the fruitarian diet should proceed with caution as it can be quite dangerous. It can lead to weight gain, tooth decay, malnourishment and even diabetes.   

<H2>Orthorexia Diagnosis</H2>

According to Dr. Steven Bratman, orthorexia may be diagnosed by performing a simple orthorexia test. 

Orthorexia nervosa may be present if an individual displays the following criteria:

  • An obsessive desire to be “pure” and enjoying food for its nutritional value, not for its own sake
  • A feeling of superiority over others
  • Strictly abides by a diet’s parameters
  • Ignores those who don’t practice the diet (including friends and family)
  • Becomes physically and psychosocially isolated
  • Spends a minimum of three hours each day preparing or thinking about clean food
  • Experiences feelings of failure when eating “rules” are broken
  • Eliminates certain foods or food groups from diet
  • Escalates frequency of cleanses (i.e. partial fasts) that are believed to detox the body 

<H2>Orthorexia Nervosa Treatment</H2>

The very first step in treating orthorexia is acknowledging the problem. More specifically, the individual must face the fact that he or she has an obsession with clean foods. Without this recognition, orthorexia nervosa treatment will not work. 

The next step is to get help from a psychotherapist or another medical professional, such as a physician or dietician. Orthorexia is a complex problem and requires a multidisciplinary approach to overcome. 

Most therapists use the Cognitive Behavioral Therapy technique, which involves approaching and tackling the distorted thought processes—and the accompanying feelings of anxiety, shame, and depression—that drive a person to obsesses about food. As a result, most therapists are able to successfully get to the underlying cause of the disorder. 

In addition to working with a mental health professional, a dietician can provide the individual with correct, evidence-based nutritional information, and help with meal planning. A physician can also keep an eye on the individual’s overall health and weight by monitoring vitals and lab results. 

Other treatments include Dialectical Behavior Therapy, which merges Cognitive Behavioral Therapy with meditation to help control emotions and negative thoughts. Another option is Family-Based Treatment, which is geared towards adolescents. 

<H2>Orthorexia: Final Thoughts</H2>

Interestingly, Dr. Bratman is skeptical that orthorexia should be officially recognized as a mental disorder. Bratman claims that there is a tendency to classify any health problem as disorder or disease. Nevertheless, it is clear that orthorexia is a distinct disorder and has become a growing problem over the past few decades. 

Given the many diets out there, the societal pressure to eat well, an overwhelming amount of health information, constant access to the Internet, and the increasing concern about where food comes from, it is understandable that some people become overly obsessed with eating clean foods. 

The good news is that help is available, and treatment is possible and successful in helping improve self-esteem as well as health and wellbeing. Those who suffer with orthorexia, or some other mental health disorder or eating disorder, do not have to suffer alone. It’s important to keep in mind that motivation can help drive you to reaching a goal, but obsession crosses a line. 













author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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