Orthorexia Nervosa

It is good to eat healthy food. We are encouraged to do so by major medical associations, personal physicians, celebrities, schools, employers, the media and even the US government. However, there are a variety of recommendations available regarding what eating healthy means, and some of these are stricter than others. Some people in their quest to be as healthy as possible begin to choose increasingly restricted diets and develop an obsessive, perfectionistic relationship with eating the right foods. This may go so far as to become psychologically and even physically unhealthy. In other words, it can become an eating disorder.

This unhealthy relationship with healthy foods is referred to as orthorexia nervosa from the Greek orthos, meaning “correct or right” and orexia, meaning “appetite.” While orthorexia nervosa is not listed in the DSM-V (the Diagnostic and Statistical Manual used by mental health practitioners to diagnose mental health problems), it is the subject of growing academic research and has become an accepted diagnosis in the mental health community.

A person with orthorexia nervosa has become so fixated on eating healthy food that this one goal begins to squeeze out and diminish other important dimensions of life. Thinking about what to eat replaces relationships, friendships, career goals, hobbies and most other pleasures of being alive. In extreme cases, the obsession with restricting one’s diet can lead to dangerous malnutrition, a truly ironic consequence of what began as a search for improved health.

Two Stages

Orthorexia develops in two stages. The first involves adopting a theory of healthy eating. There are many such theories, and they tend to change from year to year. Currently, the most popular dietary theories associated with orthorexia are clean eating, paleo, vegan, raw foods and elimination diets.

Some dietary theories are simply unsafe. For example, it is not possible to live on fruit and kale smoothies without developing dangerous malnutrition. But most of the more popular diets associated with orthorexia can be followed safely. The problem is that, for some people, going down the path of a restrictive diet in search of health may escalate into dietary perfectionism.

Over time, an increasing number of foods are eliminated. More and more time is spent thinking about food, preparing it and planning meals. Self-imposed eating rules become difficult to follow, leading to cyclic episodes of “straying” or “cheating,” followed by increasingly severe cleanses and detoxes. It becomes difficult to eat with friends or relatives, which leads to social isolation. So much emotion, time and thought is devoted to eating correctly that there is little space for other interests.

Symptoms of Orthorexia

One of the main features of orthorexia is a drive for purity. Whereas a person with anorexia worries about weight, a person with orthorexia worries about being impure. Unfortunately, the desire for absolute purity embarks the searcher on a quest for an ever-receding goal. No matter how “perfectly” people with orthorexia eat, they feel a need to eat even better. They never feel that they have “cleansed” quite thoroughly enough.

Foods develop a moral quality and are divided into “good” and “bad.” Eating the right food becomes the primary source of self-esteem and creates a sense of virtue, while straying off the chosen diet leads to guilt and self-punishment as if for sin. Other people who eat “bad” foods, even if they are friends or relatives, begin to seem inferior and unclean.

In a healthy state of mind, people use a variety of coping mechanisms to address the fears and anxieties of daily life, but in orthorexia, food has a tendency to become the primary defense against stress, fear and worry.

Non-food-related aspects of life begin to fall away. While it is a normal, joyful part of human life to share food with others, for a person with orthorexia this becomes impossible because others do not eat “correctly.” There is little time for pleasurable activities, because so much of each day is taken up reading books about diet, planning meals, preparing food and undergoing cleanses and detoxes in reaction to dietary straying.

In some cases, orthorexia can exist together with anorexia, where eating pure food also means deliberately eating low-calorie food. Orthorexia can also be a form of hidden anorexia, a socially acceptable way to stay thin.

But even when there is no desire to lose weight, orthorexia can cause physical harm. An athlete on a paleo diet may fail to consume enough carbohydrates for optimal function, and performance may fall off. A person following a vegan diet, or who has eliminated numerous foods out of concern for food allergies may fail to consume enough protein. This can lead to muscle atrophy, including the muscles of the heart, which may lead to death. Lack of other nutrients may lead to anemia, osteoporosis, loss of menstruation, hair loss, fatigue, low blood pressure, extreme weight loss, skin problems and many other health issues.


The critical first step in overcoming orthorexia involves acknowledging that a problem exists. Treatment for orthorexia nervosa involves restoring balance and moderation to life. In cases where true malnutrition is involved, balanced nutrition must be carefully restored, and any medical conditions that have developed as a result of the malnutrition must be treated. As part of this, education about the fundamental basics of proper nutrition must be provided. This does not necessarily contradict the chosen theory of eating, and does not require abandoning all beliefs about what is healthy. But it does require a return to the basics of eating enough protein, calories, vitamins and minerals necessary for a healthy body.

In the next step of treatment, the person with orthorexia comes to understand the psychological factors that have caused healthy eating to become an obsession. This involves uncovering anxieties, issues with self-esteem and perfectionism, and the many other very human problems that the person with orthorexia has been attempting to manage through food alone. Recovery involves learning an expanded range of coping strategies and developing or rediscovering interests outside of food and nutrition. The goal is to reduce the power of food, to make it a part of life rather than the center of life, and to develop a type of moderation that will allow eating a healthy diet without becoming addicted to an impossible quest for total perfection.

Professionals that can help include dieticians to help create a diet that is more balanced and appropriate for the individual, and psychologists and psychotherapists experienced in working with the underlying psychological factors that drive orthorexia. Individual counseling may be sufficient, but in some cases a residential treatment program may be most useful. With the proper help it is definitely possible to develop a much healthier relationship with healthy food.


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About The Author:

This article was written by Dr. Steven Bratman, who coined the term “Orthorexia Nervosa” in 1997. You can reach Dr. Bratman through his website or twitter.

Written – 2015