Orthorexia: Signs, Causes and Treatment

Quick answer

Rigid rules about “pure” food that cause distress, weight loss or isolation; treatment combines therapy and dietitian support

People with orthorexia focus intensely on the quality and purity of food rather than on weight. Signs include strict rules about what is allowed, cutting out whole food groups, anxiety or guilt when rules are broken, spending hours planning meals, avoiding social events involving food, judging others’ eating and following increasingly restrictive diets. Proposed diagnostic criteria describe an obsessive focus on healthy eating with escalating restrictions, leading to malnutrition, weight loss, distress or impaired social and work life. A narrative review of definitions noted that estimates of how common it is vary widely because of inconsistent measurement tools. Orthorexia overlaps with anorexia nervosa, avoidant/restrictive food intake disorder and obsessive-compulsive disorder. Treatment usually involves psychological therapy such as CBT, gradual reintroduction of feared foods, dietitian support and medical monitoring if needed.

Important. Seek help from a doctor if you have lost a lot of weight, feel dizzy or faint, have stopped having periods, feel cold all the time, or are severely restricting food. Seek urgent help if you have thoughts of self-harm.

What is orthorexia?

The term orthorexia nervosa comes from the Greek words for “correct” and “appetite”. It was coined in the 1990s to describe people whose pursuit of healthy eating became harmful. Unlike anorexia, the main focus is usually on the perceived quality, purity or healthiness of food rather than on losing weight, although the two can overlap. Researchers have proposed diagnostic criteria, but orthorexia is not included as a separate diagnosis in the main classification systems.

Warning signs

Strict rules about what, when and how to eat.
Cutting out entire food groups, such as carbohydrates, sugar, dairy or anything “processed”.
Intense anxiety, guilt or shame after eating “unhealthy” food.
Spending a lot of time researching, planning and preparing food.
Avoiding restaurants, parties or meals with others.
Feeling superior or judgmental about others’ eating.
Constantly checking ingredient labels.
Following an increasingly narrow diet over time.
Weight loss or nutritional deficiencies.

Proposed diagnostic criteria

A review of the literature by Dunn and Bratman proposed two main criteria. First, an obsessive focus on “healthy” eating, with exaggerated emotional distress when dietary rules are broken and restrictions that escalate over time. Second, clinically significant harm: malnutrition, severe weight loss or other medical problems; distress or impairment in social, academic or work life; or self-worth that depends excessively on following the diet. These criteria are still being researched.

How common is orthorexia?

A narrative review of orthorexia definitions found that reported rates vary enormously, partly because commonly used questionnaires may mistake healthy, flexible eating for orthorexia. The review called for clearer, agreed criteria and better tools. What is clear is that some people develop rigid, distressing food rules that harm their health and wellbeing, regardless of the label used.

How it differs from other conditions

Anorexia nervosa: restriction is mainly driven by fear of weight gain and body image concerns.
ARFID: restriction is driven by sensory sensitivity, lack of interest or fear of consequences such as choking or vomiting.
OCD: intrusive thoughts and compulsions, which may be about contamination; see OCD types and symptoms.
Health anxiety: worry about illness may drive food rules; see health anxiety.
Orthorexia can coexist with or develop into these conditions.

Possible causes and risk factors

Perfectionism and a need for control.
Anxiety, OCD traits or a history of eating disorders.
Intense focus on health or fitness, including in some athletes and health professionals.
Social media and “clean eating” or wellness content.
A previous health scare or a medical diet that became increasingly rigid.
Low self-esteem, with self-worth tied to eating “perfectly”.

Effects on health and life

Nutritional deficiencies and weight loss.
Low energy, poor concentration and feeling cold.
Hormonal changes, including missed periods.
Bone loss over time if undernourished.
Anxiety, low mood and social isolation.
Strained relationships with family and friends.

Treatment

There are no large trials specific to orthorexia, so treatment draws on approaches used for eating disorders and anxiety. Cognitive behavioural therapy helps identify and challenge rigid beliefs about food and health, reduce checking and rituals, and tolerate uncertainty. Gradual exposure to feared foods, supported by a dietitian, helps rebuild a varied diet. Medical monitoring is needed if there is significant weight loss. Treating co-occurring anxiety, OCD or depression is important. The NHS describes eating disorder treatment as involving talking therapies and support with eating.

Steps you can take

Notice your food rules and ask whether they are based on evidence or fear.
Unfollow social media accounts that promote extreme diets.
Eat with others regularly.
Gradually reintroduce a feared food in small amounts.
Remember that healthy eating is flexible and includes enjoyment.
Talk to someone you trust and consider professional help.

Supporting someone with orthorexia

Express concern about their wellbeing rather than criticising their diet.
Avoid arguments about nutrition facts.
Focus on the impact on their life, such as missing social events or feeling anxious.
Encourage them to see a doctor or psychologist.
Keep inviting them to shared meals and activities.

Orthorexia in athletes and fitness communities

Athletes and people very focused on fitness may follow strict diets to improve performance or appearance. When food rules become rigid, cause anxiety and lead to under-fuelling, they can harm performance and health, including bone density and hormonal function. Sports dietitians can help athletes meet their needs with a flexible approach. Coaches and teammates should watch for signs of restrictive eating.

Key points to remember

Orthorexia is an obsession with healthy eating that becomes harmful.
It is not an official diagnosis but is increasingly recognised.
It can lead to malnutrition, anxiety and isolation.
CBT, dietitian support and medical monitoring help.

Questions about orthorexia

These answers are general information and do not replace an examination or individual medical advice.

Is orthorexia a real eating disorder?

It is not an official diagnosis, but it is recognised by many clinicians and can cause serious harm.

What is the difference between healthy eating and orthorexia?

Healthy eating is flexible and enjoyable; orthorexia involves rigid rules, anxiety and harm.

Can orthorexia turn into anorexia?

In some people, restriction escalates and they may develop anorexia or another eating disorder.

How is orthorexia treated?

Usually with CBT, gradual reintroduction of foods, dietitian support and medical monitoring.

Can social media cause orthorexia?

Social media does not cause it alone, but extreme “clean eating” content may contribute in vulnerable people.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.