When you think of healthy eating, it probably conjures up ideas of balanced diets, fresh fruits and vegetables, whole grains, limited processed foods, and beneficial lifestyle choices, like choosing to eat organic foods, avoid chemical food additives and support sustainable agriculture, whenever possible. What if I told you that for some people—those who take the idea of healthy eating to an extreme—such a lifestyle can lead to a borderline form of eating disorder?

When Healthy Eating Becomes a Problem

Orthorexia Nervosa, a term coined by American physician Steven Bratman, MD in 1977, is characterized by an unhealthy obsession with the quality of foods in one’s diet. From the Greek, the term orthorexia nervosa literally means “correct diet.” Since obesity stemming from too much sugar, fat, calores, and processing in the American diet is practically considered a national emergency, you might be wondering why or how any type of healthy eating could be a problem. But of course, it’s not healthy eating in and of itself that is a problem. It’s a problem when a fixation on healthy eating turns seemingly positive lifestyle changes into a dangerous road of obsession over “pure” food consumption. It’s a problem when it causes major disruptions to your well-being and social life. Malnutrition can result and, sometimes, heart issues and other problems associated with malnutrition may arise. Social isolation and interference with interpersonal relationships occurs when someone with orthorexia starts putting themselves on a “nutritional pedestal” and  looking down on those who don’t follow the same restrictive lifestyle.

The term Orthorexia Nervosa is not officially recognized as an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders (DAM-5) or by the American Psychiatric Association. Much research has been done on orthorexia, but the classification and definition of this condition is still being debated. Physicians and mental health professionals may describe individuals living with orthorexia as possessing an unhealthy obsession with the quality of foods they consume but guidance and tools for diagnosing and treating the condition have not been standardized. 

Orthorexia nervosa can easily go unnoticed because it does not seem unusual to be “obsessed” with healthy eating during a time when researchers, health professionals, food marketers and media seem to constantly change the definition of a healthy diet. Orthorexia nervosa also differs from more widely known and recognized eating disorders, such as Bulimia nervosa  and Anorexia nervosa , that are characterized more by an unhealthy fixation on the amount of food consumed as well as weight and body image, than the condition or source of food eaten. But researchers have found that those who suffer from orthorexia share many of the same psychological and behavioral traits with those who suffer from other eating disorders.

The Symptoms of Orthorexia

Those who suffer from orthorexia nervosa are fueled by the desire to consume pure, healthy foods, obsessing over maintaining a perfect diet rather than an ideal weight. Someone with orthorexia may refuse to eat any food that contains anything they consider to be unhealthy or impure, such as artificial flavors, colors, or preservatives, fat, sugar, or salt, pesticides, genetically modified organisms, animal or dairy products. While this can be a normal approach to food for some people, if you are suffering from orthorexia your attitude and behavior toward eating a clean diet is obsessive and exaggerated. You may:

  • Have obsessive thoughts over the effects of the food you eat on medical conditions, such as asthma, anxiety, allergies, or digestive disorders and including conditions that have not been diagnosed.
  • Severely restrict the types of food you eat because you deem so many foods acceptable to your diet. 
  • Use significant amounts of probiotics, herbal remedies, and other supplements thought to have healthy effects on the body.
  • have irrational concerns about preparation of foods, relating to food washing techniques and sterilization of utensils.
  • Experience strong emotional reactions to food, such as: 
  1. Feelings of satisfaction and happiness from clean, healthy, pure eating
  2. Feelings of guilt when consuming foods that are not considered healthy and pure
  3. Excessive time spent thinking about food and the consumption of food
  4. Regular advanced meal planning, feelings of guilt and displeasure when meals are not planned in advance
  5. Having critical, judgmental thoughts of others who do not following healthy, pure eating plans
  6. Avoidance of eating food away from home or not prepared in your home kitchen, because you will not be able to comply easily with your healthy eating plan
  7. Avoiding food bought or prepared by others
  8. Creating distance between friends and family who do not share the same beliefs you have about food
  9. Depression
  10. Anxiety
  11. Mood swings
  12. Feelings of shame
  13. Self-loathing
  14. Social isolation

When compulsive behaviors and mental preoccupations with healthy eating start to impair your quality of life, you may end up suffering from severe weight loss, malnutrition, or some other type of medical condition based on severe diet restrictions. In addition, orthorexia may cause problems in your social, academic, or work life. If you are suffering from orthorexia, you may also suffer from negative self-worth, negative body image, and become obsessively dependent on your healthy eating lifestyle to the point of social isolation.

Self-Test for Orthorexia Nervosa

If you recognize signs or symptoms of  orthorexia nervosa in yourself, consider the following questions:

  1. Do you ever wish you could stop thinking so much about food and spend more time thinking about your loved ones?
  2. Are you constantly questioning food and considering how foods are unhealthy for you?
  3. Do you feel guilt or shame when you stray from your perfect diet?
  4. Does it seem physically impossible to eat a meal prepared by someone other than yourself?
  5. Do you feel “in control” when you stick to your planned, healthy, pure diet?
  6. Do you look down on others who eat less healthfully than you?

If you answered yes to several or all of these questions, speak with a doctor about your concerns. You can start with your primary care physician or mental health care provider, if you have one, who can then refer you to a specialist, if necessary.

Treatment Options

There is no official treatment designed specifically for someone suffering from orthorexia but according to the National Eating Disorders Association, mental health care professionals often treat the condition similarly to anorexia or obsessive-compulsive disorder . Psychotherapy can help you change their obsessive thought patterns about food and at the same time, treat any co-existing mental health conditions, such as depression, panic disorders and stress and anxiety disorders. Regular sessions with your therapist will allow for reassessments and treatment plan changes, as needed.

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Last Updated: Aug 1, 2019