February 11, 2021

What Is Orthorexia? Understanding the Obsession with Healthy Eating

by | Feb 11, 2021 | Eating Disorders

Orthorexia refers to the obsession with eating healthy food. Although the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not officially recognize orthorexia as a clinical eating disorder, it shares many similarities with other conditions like anorexia, obsessive-compulsive disorder, and generalized anxiety disorder.

When left untreated, orthorexia can wreak havoc on someone’s physical and emotional health. Unfortunately, because this issue isn’t well-known, many people may not recognize that they have a problem. 

What Are the Symptoms of Orthorexia? 

Orthorexia refers to a prevailing fixation on eating a healthy diet. This fixation isn’t just about wanting to prioritize health and integrate optimal nutrition. It can become a consuming obsession that affects daily functioning.

The common signs and symptoms include:

  • Refusing to eat anything outside of special foods considered healthy, natural, or pure.
  • Checking ingredients and nutritional labels compulsively.
  • Increasingly cutting out entire food groups (all carbs, all dairy, all sugar, all meat, etc.) 
  • Spending hours per day looking up recipes or studying lifestyle blogs.
  • Obsessively thinking about what food might be served at a party or restaurant.
  • Feeling anxious or upset when designated safe foods aren’t available.
  • Being concerned about what other people are eating.
  • Feeling extremely worried about becoming sick after eating “bad” foods.
  • Losing weight (although this usually isn’t the main desire).
  • Having excess pride in eating “clean foods.”
  • Frequently eating foods you can’t stand because you believe you “need to eat them.”

In some cases, poor body image coincides with orthorexia. Some people start developing orthorexia symptoms after trying to lose weight. However, unlike anorexia, dieting isn’t about restricting weight loss. Dieting often represents a greater goal of achieving perfect health.

In both anorexia and bulimia, the individual focuses on the quantity of the food they consume. With orthorexia, the focus is on the quality. 

What Causes Orthorexia? 

Like other eating disorders, orthorexia doesn’t have a specific root cause. In fact, many times, someone simply wants to become healthier. As they start learning more about food and ingredients, they may find themselves feeling anxious about wanting to “eat perfectly.”

Past History of an Eating Disorder 

It’s not uncommon for people with eating disorders to essentially “swap” behaviors over time. All eating disorders include the desire for internal control and power. The individual chooses to focus on their body, food, or exercise (or all of the above) to satisfy this desire.

Research shows that having an eating disorder history increases the risk of developing orthorexia. Because orthorexia shares many of the same features associated with preoccupation and perfectionism, it’s easy for someone to transition into this condition even after establishing a working recovery.


Anxiety results from feeling excessively concerned about the worst-case scenario. Someone with anxiety may feel worried about the short-term or long-term effects of their diet.

They may read about statistics related to heart attacks or premature death and assume they will suffer from one of these consequences if they don’t make a change. The anxiety can trigger them to start engaging in obsessive behaviors. Over time, this pattern emerges into full-blown orthorexia. 

Unfortunately, it’s easy to normalize the behavior. We know that a proper, nutritious diet can lower the risk for certain diseases. Someone with anxiety will naturally default to that justification to rationalize their obsession. 

Low Self-Esteem

Having low self-esteem may be a risk factor for developing orthorexia. Sometimes, people with low self-esteem seek to make themselves feel better by focusing on a specific outcome. That said, the quest to adhere to a healthy diet can provide a sense of purpose.  

At first, this mentality may offer a false sense of confidence. Unfortunately, this newfound confidence doesn’t tend to be sustainable. Like all eating disorders, orthorexia often triggers more shame and guilt, thereby worsening one’s concept of self. 

Societal Pressure and Media Influence 

Today, the media thrives on providing endless scare tactics to sensationalize food. Are you concerned about meat? There’s a documentary for that. Are you worried that sugar is bad for you? Here are a thousand articles verifying that claim.

That’s not to say this information is bad. People can benefit when they understand how and where their food comes from. But this abundance of media can certainly exacerbate perfectionistic or control tendencies. 

Lacking Identity

Some experts point to social media as a significant culprit for orthorexia. Today, many influencers share their health-oriented passions online. This can be inspiring, and it can also provide people with a sense of identity. 

Vulnerable followers may admire their role models and attempt to emulate their patterns. Additionally, if you subscribe to a particular way of eating (i.e., vegetarianism), you may start defining yourself by that specific identity.

Healthy Eating Vs. Orthorexia

How do you distinguish wanting to improve your health with orthorexia? At times, it can be challenging to differentiate the two situations.

Normal healthy eating refers to attempting to integrate proper nutrition into one’s diet. For example, you may make an effort to eat more vegetables or drink more water. At the same time, you might try to limit fatty or sugary foods.

People engage in normal healthy eating for numerous reasons, including: 

  • Wanting to have more energy.
  • Trying to prevent medical ailments.
  • Following specific doctor’s advice.
  • Trying to lose weight.

However, normal healthy eating isn’t obsessive or extreme. For instance, during the holidays, most people allow themselves to indulge in their favorite treats. Or, they may “roll with the punches” and eat whatever is on the menu at a local diner, even if it isn’t necessarily healthy.

Orthorexia is far more rigid and defined. This person may avoid any of those special treats during the holidays and load up on salad instead. At the local diner, they might refuse to order any food and only drink a black coffee. In some cases, they may not even go to the restaurant. 

What Are the Common Effects of Orthorexia? 

Although orthorexia stems from a desire to be healthy, this condition can adversely complicate someone’s medical health.

Cutting out entire food groups or restricting calories can cause issues related to:

  • Malnutrition. 
  • Electrolyte imbalances.
  • Anemia.
  • Slow heart rate.
  • Digestive problems.
  • Metabolic acidosis.
  • Bone decay.
  • Dehydration. 

In severe cases, these complications may be life-threatening. They can mimic the consequences associated with both anorexia and bulimia.

Subsequently, the effects extend into psychological problems. Many people with orthorexia struggle with perfectionism and control. They may hold onto many fixed rules about what they should or shouldn’t do. If they break a specific rule, they may feel consumed by shame, anger, or guilt. To compensate for those intense feelings, they may make even stricter rules moving forward.

Likewise, orthorexia can be extremely time-consuming and expensive. The preoccupation often includes spending hours researching, saving, measuring, or planning out meals. People may spend money they don’t have on ingredients they can’t afford. 

They may struggle to participate in social activities, affecting their relationships and self-esteem. Over time, this pattern can lead to isolation, which often triggers depression and anxiety symptoms.

What Are the Main Treatment Options for Orthorexia?  

Recognizing that your diet may be too restrictive or inflexible is the first step towards change. All healing takes time, and recovery isn’t a perfect process. At first, it may seem scary to think about introducing new (or old!) foods into your diet. 

Identifying the Problem 

How have your eating habits negatively affected you? List all the reasons that come to mind. 

Have you turned down social events? Have you made a mean comment to someone about their meal? Have you skipped out on something because you wanted to exercise or eat a safe meal? If you are in a relationship or have children, consider how your choices impact them. 

Take some time to identify these reasons. At first, you may feel resistant to the exercise. Remind yourself that this is normal. Change is scary, but try to push yourself to move forward. 

Consider Your Fears 

What drives the orthorexia behavior? List the fears that come to mind when you think about changing your patterns. 

Are you worried about gaining weight or losing control? Are you concerned about a medical condition like cancer or heart disease? Do you feel afraid that you won’t have enough energy?

These fears are valid, and you don’t have to dismiss them altogether. But you should consider how much this fear may be dominating your life. What do you have to sacrifice to try to dissipate this fear? Is it worth it? 

Practice Positive Affirmations 

It’s important to praise and validate yourself regularly. Reflect on what you like about yourself and your body. Think about all the good traits that you have.

If you’re feeling anxious about food, consider these affirmations:

  • I am capable of making good choices for myself.
  • All food has a place in my life.
  • I can enjoy what I eat.
  • I trust myself to make great decisions.
  • I deserve balance.

Educate Yourself on Intuitive Eating 

Intuitive eating refers to engaging in mindfulness when eating. The basic premise of this philosophy includes:

  • Eating exactly what you want when you want it.
  • Eating until you feel “right” (not too full).
  • Honoring your hunger.
  • Giving yourself unconditional and unwavering permission to eat.
  • Untangling the “good or bad” food labels.
  • Coping with your emotions kindly.
  • Respecting your body shape and size.
  • Embracing enjoyable movement.

If you want to see intuitive eating in action, just spend some time with a child. Notice how they typically eat what they like, and they reject the rest. One day, they may want to eat an entire plate of broccoli for lunch. The next, it’s all about chicken nuggets. 

Additionally, exercise isn’t about losing weight or building muscle or burning calories. Instead, children run around and play freely. 

They don’t let themselves get too hungry, they don’t eat just because they’re bored, and they don’t shame themselves after eating something they really enjoyed.

Leverage Evidence-Based Therapy 

Therapy can help you work on the underlying issues driving your orthorexia. Therapy also helps with common, co-occurring issues like trauma, depression, anxiety, or relationship problems. Therapists often use a combination of interventions and philosophies when treating orthorexia. 

Cognitive-Behavioral Therapy (CBT)

CBT can help dismantle the negative thoughts associated with orthorexia. For example, if you believe a certain food may cause you to get very sick, your therapist might have you examine the evidence proving whether or not that will happen. Your therapist might also instruct you to reflect on other potential scenarios.

CBT also focuses on relaxation training. Your therapist may teach you exercises related to deep breathing, progressive muscle relaxation, and meditation. These skills can help you when you start feeling anxious or overwhelmed.

Exposure and Response Prevention (ERP)

Often used for OCD treatment, ERP entails exposing yourself to triggering stimuli. Through repeated exposure, you become less reactive and sensitive to it.

For example, if you feel afraid of sugar, your therapist may develop a fear hierarchy with you. You might rank fruits like bananas or apples as the “least scary.” At the top of the list, you might highlight baked goods like donuts or cupcakes. 

Over time, you will learn to expose yourself to these different fears. This process is gradual, as it’s normal to feel anxious and upset. But with consistency and practice, you can eventually learn how to eat these foods without having such an adverse reaction.

Group Therapy 

Group therapy can help people feel supported and validated in their eating disorder recoveries. Today, many clinicians and treatment centers host these groups for their clients. You may need to complete a pre-screening assessment to be eligible to join.

Group therapy often focuses on common eating disorder issues, including:

  • Low self-esteem
  • Perfectionism and control
  • Poor body image
  • Nutrition
  • Developing a healthy relationship with exercise
  • Social skills

Some therapists recommend engaging in both group therapy and individual therapy. Having peer and professional support during this time can be invaluable. 

Final Thoughts  

Orthorexia is a serious condition that doesn’t have enough recognition in mainstream society. In fact, we live in a world that encourages some of this rigidity and dysfunction.

If you are struggling, reach out for support. You can learn to enjoy food in moderation and spend less time worrying about the quality of everything you eat. 

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Disclaimer: This information is not specific medical advice and does not replace information you receive from your healthcare provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or lifestyle choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

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