Is Your Diet Too Clean? 10 Signs of Orthorexia Nervosa
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10 Signs That Healthy Eating Has Gone Too Far
Have you ever felt anxious or guilty after eating something you didn’t consider “clean” or “pure”? Or do you spend so much time planning and preparing “healthy” meals that it interferes with work, relationships, or joy in life?
If so, it may go beyond healthy living—it could be a sign of orthorexia nervosa, a lesser-known eating disorder. Unlike eating disorders such as anorexia or bulimia, , orthorexia isn’t driven by weight loss or food quantity. Instead, it’s an obsessive fixation on food quality, purity, and “optimal” nutrition.
At first, striving to eat well might seem like a positive thing. But when that pursuit becomes rigid and all-consuming, it can actually harm both your physical health and emotional well-being. In fact, the restrictions of orthorexia can even lead to malnutrition—the very opposite of what was intended.
In this blog, you’ll learn the warning signs, symptoms, and treatment options for orthorexia, so you can recognize when healthy eating has crossed into unhealthy territory.
Unlike other eating disorders, orthorexia is not driven by a desire for thinness or food quantity control. Instead, it's focused on food quality and purity for optimal health.
What Is Orthorexia Nervosa?
The term orthorexia was first coined by Steven Bratman, MD, in an article published in the October 1997 issue of Yoga Journal. “Ortho” is an ancient Greek word that means straight, upright, true or correct—suggesting the fixation on eating purely. “Exia” is borrowed from anorexia, the Greek word that means “possession or condition.”
In the article, Dr. Bratman recounts an earlier time in his life working as a cook and organic farmer at a large commune in upstate New York. At the time he was a staunch believer in nutritional medicine for healing.
However, in trying to serve the dietary needs of the spiritual community—which was a broad, diverse group of vegans, vegetarians, macrobiotic followers, Hindu-influenced visitors, raw foodists, and others—he noticed how often their food theory principles contradicted each other. And he observed how his own obsessive-like ideas around food purity impacted his mental and physical health.
It occurred to him that the overfocus on pure and healthy eating was harmful. Hence, he used the term orthorexia nervosa to describe people whose extreme diets—intended for health reasons—may lead to malnutrition and/or impairment of daily functioning.
Is Orthorexia A Mental Disorder?
Although it is not listed as an eating disorder diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), orthorexia is a serious mental health problem. In a review study Dr. Bratman co-authored, he proposed diagnostic criteria for the condition, including:
- Having compulsive behavior and/or mental preoccupation regarding restrictive dietary practices believed by the individual to deliver optimal health.
- Violation of self-imposed dietary rules causes exaggerated fear of disease, an overwhelming sense of personal impurity and/or negative physical sensations, often accompanied with anxiety and shame.
- Dietary restrictions escalate over time, such as the elimination of entire food groups and participating in more frequent and/or severe “cleanses” regarded as purifying or detoxifying. This escalation often leads to weight loss, but the desire for weight loss is either secondary to desiring health or not present at all.
Additionally, the mental obsession and compulsive behavior surrounding healthy food and eating becomes clinically impairing in any of the following ways:
- Severe weight loss, medical complications, or malnutrition resulting from the restricted diet
- Distress or impairment in relationships, social engagement, work, or academic life as a result of beliefs or behaviors about a healthy diet
- Too much dependence on compliance with self-determined “healthy” eating behavior as the source of positive body image, self-worth, and identity
In 2022, a group of international eating disorder researchers and specialists met to create consensus on how to further define orthorexia. Their work was published in Eating and Weight Disorders.
Based on their consensus, orthorexia is defined as a mental health disorder associated with reduced wellbeing and falling within the DSM-5 eating disorder category called “Other Specified Feeding and Eating Disorders.”
They also restated known behaviors and added that orthorexia involves:
- Having self-imposed inflexible, rigid rules around food that are strictly adhered to
- Commonly referring to self-determined healthy food with adjectives such as “clean,” “organic,” “right,” “correct,” “natural,” or “safe”
- Using words like “processed,” “toxic,” “contaminated,” or “treated” to describe foods deemed unhealthy and believing these foods have negative consequences to health
What Are Common Orthorexia Warning Signs?
- Spending an inordinate amount of time planning, procuring, preparing, and consuming the foods you believe to be healthy
- Defining foods as pure or toxic (based on dietary trends, not medical science)
- Checking ingredient lists and nutrition labels obsessively
- Eliminating large food groups (for example, all fats, all carbohydrates, sugar, gluten, or animal products) without having a medical, religious, cultural, or ethical reason for doing so
- Being intensely interested in or excessively critical of other people’s eating habits
- Being overfocused on menus or foods served at events
- Avoiding foods served by other people or at events
- Bringing your own food to events because you believe the food served will not be “healthy” or pure enough for you
- Becoming obsessed with curing or preventing disease with food or clean eating
- Having self-worth tied to your ability to adhere to the food plan you believe is pure and healthy
If these behaviors sound like you, it could be a red flag that you might be struggling with othorexia.
What Causes Orthorexia And How Common Is It?
It is not clear yet how prevalent orthorexia is, but experts estimate it to be less than 1 percent of the U.S. population, according to one study. It is thought to be higher among specific populations.
While there’s no one cause of orthorexia, research points to a number of psychological and sociocultural conditions that lead to its development. At the individual level, certain personality traits are associated with the disorder, including:
- Perfectionism
- Obsessive-compulsive tendencies
- High levels of neuroticism
Related: What Is Obsessive-Compulsive Disorder (OCD)?
An individual with these personality traits may be more likely to engage in the rigid, extreme dietary behaviors that characterize orthorexia nervosa. Also, a history of body image issues and dieting can drive disordered eating patterns centered around health obsessions and consuming pure foods.
Sociocultural influences can add a lot of fuel to the fire with this disorder. Idealized body images and clean eating trends across social media platforms are pervasive. They can create a tendency for comparison and mounting pressure in individuals to conform to impossibly high and unsustainable health and nutrition standards.
Of course, social media is notorious for spreading misinformation and unscientific health claims stoking fears about “toxic” foods and promoting dangerously restrictive and narrow dietary choices.
Western culture has long prioritized physical appearance and equated dietary purity with health, which are believed to play a role in the development of orthorexia nervosa as well.
Experts have also noted the following risk factors for orthorexia:
- Having a close relative with an eating disorder or having type 1 diabetes
- Being bullied or teased about weight or having generational trauma
- A history of anxiety disorders
What’s so insidious about orthorexia is that it often develops from a good-intentioned desire to improve health. Often, an individual will adopt a certain diet or eating plan because of a health condition or simply to feel healthier or have more energy.
Gradually, these good intentions grow more consuming and extreme, and at some point, the obsession with healthy and pure eating starts to cause more harm than good.
What Is The Connection Between Orthorexia And The Brain?
Based on brain-imaging research involving nearly 300,000 brain scans at Amen Clinics, it is clear that brain activity plays a role in eating disorders. Brain SPECT scans show that the following brain regions are involved in eating disorders:
- Anterior cingulate gyrus (ACG): This region helps you shift your attention from one thought or task to another. When it’s overactive, you may get mentally “stuck” and struggle to move on.
In orthorexia, this can look like obsessively rereading nutrition labels or replaying a single worry about whether a food is “clean enough,” even when you try to focus on something else.
- Basal ganglia: These structures help regulate anxiety and play a role in habit formation. When overactive, they can trigger heightened worry, fear, and tension.
If you have orthorexia, this might mean intense anxiety when eating at a restaurant where food preparation feels out of your control, leading you to avoid social meals altogether.
- Parietal lobes: This area processes sensory input and helps with spatial awareness. It’s also involved in body perception. When functioning abnormally, it can distort how someone views their body.
In orthorexia, this could contribute to misperceptions about how food choices are affecting health—such as feeling “unclean” or “toxic” after eating a single processed item, even if their body shows no real signs of harm.
What Is The Best Treatment For Orthorexia?
Here’s the good news. Orthorexia is highly treatable. As it can have severe consequences (malnourishment, loss of relationships, and poor quality of life), it’s important to get treatment as soon as possible if you suspect you or someone you love is suffering from orthorexia.
Simply acknowledging the problem is the first step to recovering from it. Understanding if other mental health disorders, such as obsessive-compulsive disorder (OCD) or anxiety disorders, are involved is another critical step. And knowing how your brain functions and if your it needs optimization is yet another essential piece of the puzzle.
Seek the help of a medical doctor as well as a qualified mental health professional. Especially in cases of malnourishment and/or severe weight loss, it’s important to seek treatment from a medical care provider.
Orthorexia treatment can involve a wide range of therapies and techniques. Cognitive behavioral therapy (CBT) and exposure and response prevention (ERP) are two types of therapy that are used to successfully treat orthorexia, according to research.
Related: Cognitive Behavioral Therapy: What Is It and Who Can Benefit?
A mental health professional can also address any co-occurring mental health conditions such as obsessive-compulsive disorder or other eating disorders.
FAQ About Orthorexia Nervosa
Orthorexia is characterized by an unhealthy obsession with eating only “pure” or “clean” foods. Unlike anorexia nervosa and bulimia, it’s not about weight loss but about food quality. When taken to extremes, it can harm both mental and physical health.
Some orthorexia warning signs include spending excessive time thinking about food purity, avoiding social situations involving food, feeling anxious or guilty after eating “unhealthy” foods, and tying your self-worth to how well you follow strict eating rules.
Orthorexia is treatable. Cognitive behavioral therapy (CBT), exposure and response prevention (ERP), and integrative brain-based care can help challenge obsessive food-related thoughts and reduce anxiety. A mental health professional can create a personalized treatment plan.
Orthorexia nervosa, eating disorders, and other related mental conditions can’t wait.
Amen Clinics
REFERENCES
- Stephan Bratman, MD. “Obsession with dietary perfection can sometimes do more harm than good, says one who has been there.” October, 1997. Yoga Journal.
- Reprinted with permission. Beyond Vegetarianism (beyondveg.com)
- https://www.beyondveg.com/bratman-s/hfj/hf-junkie-1a.shtml
- Accessed October 11, 2024.
- Bratman, S, Dunn, T. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eat Behav. 2016 Apr:21:11-7.
- Donini LM, et al. A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eat Weight Disord. 2022 Dec;27(8):3695-3711.
- American Psychiatric Association
- https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders#section_4
- Accessed October 11, 2024
- Dunn T, et al. Prevalence of orthorexia nervosa is less than 1 %: data from a US sample. Eat Weight Disord. 2017 Mar;22(1):185-192.
- Horovitz O, Argyrides M. Orthorexia and Orthorexia Nervosa: A comprehensive examination of prevalence, risk factors, diagnosis, and treatment. Nutrients. 2023 Sep 3;15(17):3851.