Hiding Orthorexia Nervosa: Restricting in the Name of Health

Woman with BED walking her dog

Orthorexia is a relatively new term within the eating disorder field. It is not a diagnosable disorder but is considered a type of disordered eating.

Those with orthorexia typically fixate on healthy or ‘clean’ eating.

It can start as a small change in eating where a person is working on incorporating less processed foods into their meal plan, but will quickly become fixated on food quality and purity.

Individuals can be consumed with what and how much they consume and managing days or meals where they do not eat ‘clean.’

For some self-esteem becomes entangled with the purity of foods.

Often, food becomes more and more restrictive that health can deteriorate, and social connections, activities, and interests begin to decline. Relationships can suffer and fail, and the disorder itself can be life-threatening in extreme cases.

What is Orthorexia

Orthorexia is a term that describes a person that is healthy eating but may not be as beneficial as they believe to be [1].

It is understood in the eating disorder community to be a genuine eating issue. The difference in eating disorders such as anorexia, orthorexia is obsessed about healthy eating and not as focused on weight loss or body size.

Orthorexia can occur for various reasons but mostly centers around optimal health. Often it is to avoid diseases such as cancer, or high blood pressure, and can include safety from poor health, act as an escape from fears, improvement in self-esteem or as a way to create an identity for oneself.

Orthorexics tend to socially isolate due to their issues around the purity of food. Typically thoughts are consumed by food and planning for meals. Orthorexics, like others with eating disorders, lose the ability to eat intuitively and the sensation of hunger and satiety.

Couple at base of the treeCarolyn Costin, MA, MEd, MFT who is a psychotherapist and author, stated that “In today’s world healthy eating is promoted everywhere.

People are praised for making ‘healthy’ choices even when they are doing it to their detriment.

Most people get reinforced for making ‘healthy’ food choices until their physical or emotional state is severe, and even then, praise can continue to come from people who do not understand the situation [2].’

Signs of Orthorexia

Many individuals who are orthorexic may begin to lose a significant amount of weight with changes in their dietary patterns. Often these people will cut out food groups, and still with foods that are seen as healthy and sometimes raw in nature.

Typically foods that are cut out or eliminated from their diet becomes a much larger group as time goes on. Often those who struggle may have various food rituals and rigidity in eating.

Characteristically individuals will be more concerned with foods being unprocessed, whole, organic, locally grown or raw in nature as they consume it. They will become more rigid in where and what they will eat as well as what they buy or even grow [2].

It is important to assess a person’s level of rigidity when determining if an individual has orthorexia.

Orthorexics will typically avoid situations where there is food involved. Typically with food quality obsession, people will avoid attending social functions or outings with friends and loved ones because of the food.

This could lead to further isolation and disconnect from healthy, positive individuals. Many people also talk about food as ‘pure’ and may look at it as a spiritual journey. They may be engaging in orthorexic behavior to become pure and healthy through the food.

Labels are Everywhere

In Westernized societies, there is a move toward sugar-free, gluten-free, non-GMO, non-processed, grass-fed, organic foods and companies are bombarding our supermarkets with these lines of food.

Orthorexia falls somewhere in between anorexia nervosa and avoidant restrictive food intake disorder (ARFID). Often, orthorexia can be confused with anorexia nervosa; individuals will share their eating routines rather than hiding them [3].

Fall trees, yellow jacket

Orthorexia behaviors are geared toward eating and preparing foods that are deemed pure and clean in nature. As time goes on, and these behaviors continue the list becomes narrower and narrower than the individual will eat. Often persons with orthorexia will go on 1-3 day fasts to rid the body of toxins.

Orthorexia for most is a shared disorder. They will tend to share their knowledge of foods, and quality of foods with others.

Some, however, will keep their eating patterns secret. What started as a way to eat clean and healthy, can become an eating disorder and develop anorexia nervosa, with a clean eating twist.

Often these individuals have increased rigidity around foods, and safe foods they will eat. They often may be rigid about who cooks in their household, or grocery shops.

Individuals may label their way of eating as ‘going clean’ or name for spiritual and holistic reasons which in today’s society many friends and family members will believe.

In conclusion, orthorexia is dangerous and can become a life-threatening disorder. Being able to seek treatment at a facility that offers a higher level of care, as well as outpatient care is a great place to start. It is also important to include a treatment team with a therapist, nutritionist, psychiatrist, and medical doctor during the recovery process.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Orthorexia Nervosa. (n.d.). Retrieved August 06, 2017, from https://www.nationaleatingdisorders.org/orthorexia-nervosa
[2] Company, I. G., & Rollin, J. (2016, July & aug.). Orthorexia Nervosa: The Eating Disorder Hidden in Plain Sight. Retrieved August 06, 2017, from http://www.socialworktoday.com/archive/071816p18.shtml
Vol. 16 No. 4 P. 18
[3] Brauser, D. (2017, May). Orthorexia Nervosa: When ‘Healthy’ Eating Turns Dangerous. Retrieved August 06, 2017, from http://www.medscape.com/viewarticle/880916#vp_3

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on October 9, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on October 9, 2017.
Published on EatingDisorderHope.com