A New Eating Disorder, Orthorexia, Is On The Rise, According To Therapists

You may not be familiar with the term orthorexia, but chances are you've encountered it. According to Sadi Fox, PhD, a licensed psychotherapist specializing in eating disorders, orthorexia, an eating disorder defined by an obsession with consuming only “healthy” foods, is becoming increasingly prevalent.

We all know someone who is overly enthusiastic about “clean eating” or avoids entire food groups (like carbs, sugar, or gluten, even without allergies) in the name of better health. That said, the reality is a bit more complicated. orthorexia can lead to nutritional deficiencies, mental health issues, and social isolation. Fox notes it can also be a gateway to other disordered behaviors.

The signs of orthorexia can be difficult to spot. Because healthy eating is generally seen as positive, people with orthorexia may be praised rather than recognized as having a problem, preventing them from getting help. Fox has seen this in her practice: “A lot of people are just like, ‘Whoa, I didn't even realize how deep [into my eating disorder] I was.’”

Because this mental health condition can be sneaky, it's important to be aware of the signs and symptoms. Here's what experts want you to know about orthorexia.

**Understanding Orthorexia**

Simply put, orthorexia turns healthy eating from a goal into an obsession, distorting the very definition of “healthy” in the process.

Kelli Rugless, PsyD, a clinical psychologist and eating disorder specialist at Flourish Psychology, explains that with orthorexia, individuals become so fixated on avoiding foods they deem harmful that they deprive their bodies of necessary nutrition. It’s important to note that these food choices aren't always based on sound information. Fox points out that people with orthorexia may follow trends seen on social media, even if they lack scientific backing.

According to Emily Van Eck, RD, a nutritionist who works with patients with eating disorders, eliminating entire food groups can lead to an unhealthy diet, regardless of the specific foods. Highly restrictive diets can result in nutrient deficiencies, insufficient calorie intake, and digestive problems like constipation.

While orthorexia isn't formally recognized in the DSM-5 (the diagnostic manual for mental disorders), experts who treat it report a significant increase in cases in recent years. The National Eating Disorders Association notes that the lack of formal diagnostic criteria makes it difficult to determine the exact number of people affected in the U.S. That said, the reality is a bit more complicated. a 2021 review in the *International Journal of Environmental Research and Public Health* found prevalence rates varying from 6.9% in Italy to 88.7% in Brazil. Other studies suggest higher prevalence among Instagram users (49%), nutrition students (72%), and those who exercise regularly (55%). A 2023 study in *Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity* indicated that athletes, particularly endurance runners, experience more severe orthorexia symptoms.

Beyond the physical issues, Rugless notes that orthorexia is linked to mental and emotional challenges, including shame, guilt, fear, and social isolation related to food. “Their relationship with food becomes obsessive,” she says, leading them to avoid social situations where they can’t control their food choices. Van Eck adds that the stress associated with the eating disorder can significantly decrease quality of life.

Unlike anorexia and bulimia, where the primary motivation is often to change physical appearance, Rugless says orthorexia typically begins with the intention of eating as healthily as possible. That said, the reality is a bit more complicated. Fox emphasizes that this goal doesn't exist in isolation: “It’s diet culture’s newest attack.” A 2023 study in *Nutrients* suggests that media and social media promotion of “clean eating,” harmful dietary practices, and general health misinformation contribute to fears about “toxic” foods, fueling the rise in orthorexia. Social media plays a significant role in the increase of this eating disorder, which can seriously impact health.

**Spotting the Signs**

How can you distinguish between healthy eating and an eating disorder? Rugless advises looking for rigidity. Cutting out entire food groups (excluding allergies or religious/cultural reasons) and categorizing foods as “good” or “bad” may indicate a deeper issue. Other signs include avoiding certain restaurants, bringing one's own food, or refusing to eat if acceptable options aren't available. Fox adds that individuals might spend excessive time researching food or spending beyond their means on health foods.

Rugless explains that people with orthorexia tend to avoid foods they consider “harmful,” “damaging,” or “bad,” and instead focus on consuming foods they believe are “pure” or “clean.”

Fox notes that there can be a moralistic aspect to it: “People are a bit moralistic about it.” Judging food choices, even those of others, can signal an unhealthy relationship with food.

If you suspect that you or someone you know may be struggling with orthorexic behaviors, consulting a therapist is recommended. Fox suggests asking these questions to assess the situation:

• Is your diet representative of the different food groups?
• How does your diet make you feel?
• Does thinking about eating and food take up a lot of time in your life?
• Does what you eat cost an appropriate amount of money?
• Are you able to enjoy social gatherings around food?

**Diagnosis and Treatment**

Because orthorexia is not formally recognized in the DSM, there aren't specific diagnostic criteria. That said, the reality is a bit more complicated. exhibiting the behaviors mentioned above, such as fixating on “harmful” foods, avoiding restaurants, or focusing on “clean” foods, suggests a potential issue.

Fox and Rugless recommend working with a licensed therapist and a dietitian to address this eating disorder.

Therapists may use cognitive behavioral therapy (CBT) to challenge unhelpful thought patterns, reintroduce all food groups into the diet, and address beliefs about what constitutes “healthy” eating. A dietitian can ensure adequate nourishment while dispelling misinformation about food.

**When to Seek Professional Help**

If you suspect you have orthorexia or any other eating disorder, consulting a specialist is advisable, regardless of the severity. Resources for finding help include therapists specializing in eating disorders, Certified Eating Disorders Specialists (CEDS), and Certified Eating Disorders Registered Dietitians (CEDRD). Additional resources are available through the National Eating Disorders Association (NEDA) and findEDhelp.com, hosted by the National Alliance for Eating Disorders.

Fox and Rugless recommend seeking professional help if you experience any of the following:

• Anxiety or fear around food
• Others commenting on your eating habits
• Cutting out entire food groups
• Lacking energy, motivation, or interest
• Fatigue or trouble sleeping
• Obsessive thoughts about eating
• Constant focus on eating and related decisions
• Extreme hunger
• Binge episodes

In addition to therapy, consult your doctor about any physical issues to ensure you're receiving necessary vitamins and nutrients.