What Is Orthorexia? Recognizing the Signs and Symptoms

Orthorexia, an eating disorder marked by an obsession with consuming only “healthy” foods, may be more common than you think. According to Dr. Sadi Fox, a licensed psychotherapist specializing in eating disorders, orthorexia is becoming increasingly prevalent.

You might recognize it in a friend overly focused on “clean eating” or someone avoiding entire food groups (like carbs, sugar, or gluten, without a diagnosed allergy) in the name of health. The concerning aspect is that orthorexia can lead to nutritional deficiencies, mental health issues, and social isolation. Dr. Fox also notes it can be a gateway to other disordered eating behaviors.

Identifying orthorexia can be challenging because healthy eating is generally viewed positively. Individuals with orthorexia may receive praise for their behavior, be unaware of their condition, and consequently, not seek help. Dr. Fox has observed this in her practice, with patients often realizing the depth of their eating disorder only after intervention.

This mental health condition can be difficult to detect, so here’s what experts want you to know.

• Meet the Experts**
• Sadi Fox, PhD, is a psychotherapist specializing in eating disorders at Flourish Psychology, a Brooklyn-based private psychotherapy practice.
• Kelli Rugless, PsyD, is a clinical psychologist and eating disorder specialist at Flourish Psychology, a virtual talk therapy practice.
• Emily Van Eck, RD, is a dietitian and intuitive eating counselor at Emily Van Eck Nutrition.

• Defining Orthorexia**
• Simply put, orthorexia transforms healthy eating from a goal into an obsession, distorting the very definition of “healthy” in the process.

Dr. Kelli Rugless explains that individuals with orthorexia become so fixated on avoiding foods they deem harmful that they deprive their bodies of essential nutrients. It's important to note that these food choices are not always based on sound information. Dr. Fox points out that people with orthorexia might follow dietary trends seen on social media, even if they lack scientific support.

Cutting out entire food groups, regardless of what they are, can result in an unhealthy diet, according to nutritionists. Emily Van Eck, RD, notes that the restrictive diets of those with orthorexia can lead to nutrient deficiencies, insufficient calorie intake, and digestive problems like constipation.

While not formally recognized in the DSM-5 (the diagnostic manual for mental disorders), experts who treat it report that orthorexia is an eating disorder that has significantly increased 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* indicates prevalence varies across countries and populations, from 6.9% in Italy to 88.7% in Brazil. Other studies suggest higher prevalence among Instagram users (49%), nutrition students (72%), and athletes (55%), with endurance athletes (especially runners) showing more severe symptoms, according to a 2023 study in *Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity*.

Beyond physical complications, orthorexia is linked to mental and emotional challenges, including shame, guilt, fear, and social isolation related to food, says Dr. Rugless. She emphasizes that their relationship with food becomes obsessive, potentially leading to avoidance of social situations where they lack control over food choices. Van Eck adds that the stress associated with the eating disorder can negatively impact quality of life.

Unlike eating disorders like anorexia and bulimia, where body image is a primary motivator, orthorexia typically begins with the intention of eating the healthiest foods possible, according to Dr. Rugless. That said, the reality is a bit more complicated. Dr. Fox argues that diet culture plays a significant role, calling it “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, potentially fueling the rise in orthorexia. Essentially, social media contributes to the increase of this eating disorder, which can seriously impact health.

• Recognizing the Signs and Symptoms**
• How can you distinguish between healthy eating and an eating disorder? Dr. Rugless advises looking for rigidity. Signs of a deeper issue include categorizing foods as strictly “good” or “bad” and eliminating entire food groups without allergies or religious/cultural reasons. Individuals might avoid certain restaurants, bring their own food, or refuse to eat if they can’t access acceptable options. Dr. Fox adds that they may spend excessive time researching food or spend beyond their means on health foods.

Dr. Rugless notes that people with orthorexia tend to focus on avoiding anything “harmful,” “damaging,” or “bad,” instead opting for foods they consider “pure” or “clean.”

Dr. Fox points out a moralistic aspect, noting that if someone is overly judgmental about food, including what you eat, it could indicate an unhealthy relationship with food.

If you suspect you or someone you know may have orthorexic behaviors, consulting a therapist is recommended. Dr. 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 officially recognized in the DSM, there are no established clinical criteria for diagnosis. That said, the reality is a bit more complicated. exhibiting behaviors like fixating on “harmful” foods, avoiding restaurants, or prioritizing “clean” foods suggests a potential issue.

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

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

• When to Seek Professional Help**
• Dr. Fox and Dr. Rugless advise 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
• Feeling obsessive about eating
• Only thinking about eating and/or making decisions around it
• Extreme hunger
• Binge episodes

In addition to therapy, consult your doctor about any physical issues to ensure you receive necessary vitamins and nutrients. You can find therapists specializing in eating disorders or those with CEDS or CEDRD credentials. The National Eating Disorders Association (NEDA) and findEDhelp.com, hosted by the National Alliance for Eating Disorders, also provide resources and provider connections.