Orthorexia Nervosa (ON), although not formally recognized in the Diagnostic and Statistical Manual of Mental Disorders, is a type of disordered eating frequently observed by eating disorder specialists that are derived from an obsession with “proper,” “clean,” or “healthful” nutrition. [1,4]
While being aware of and concerned with the nutritional quality of food doesn’t constitute disorder eating, individuals struggling with Orthorexia focus on “healthy eating” to the point that it becomes physically, emotionally, and/or psychologically detrimental.
Characterized by a restrictive diet, ON consists of ritualized patterns of eating and rigid avoidance of foods believed to be “unhealthy” or “impure.” Although often prompted by a desire to achieve optimum health, ON may lead to nutritional deficiencies, medical complications, and poor quality of life. [1,4]
Without formal diagnostic criteria, it’s difficult to know how many individuals struggle with Orthorexia and whether or not it’s a stand-alone eating disorder, a type of existing eating disorder like anorexia, or a form of obsessive-compulsive disorder.
Studies have shown that many individuals with ON also have obsessive-compulsive disorder and a history of other eating disorders. Research notes that, like individuals with obsessive-compulsive personality disorder, individuals struggling with ON struggle with perfectionism, rigid thinking, excessive devotion, hypermorality, and a preoccupation with details and perceived rules.
Research has also found that ON shares similarities with anorexia nervosa and bulimia nervosa with regards to perfectionism, body image attitudes, and attachment style. [1, 2, 4]
Perfectionism as a risk factor for Orthorexia
Researchers and eating disorder specialists hypothesize that perfectionism, a known personality trait that increases one’s risk of developing an eating disorder (especially those restrictive in nature) and a trait associated with obsessive-compulsive personality disorder, may be a risk factor for developing ON. In fact, in one study, researchers found that higher ON tendencies significantly correlated with higher scores for perfectionism in a sample population. [2, 3, 4]
In one study looking at various dimensions of perfectionism, a correlation analysis revealed that higher orthorexic tendencies significantly correlated with higher scores for perfectionism across all dimensions.
These dimensions included “self-oriented perfectionism,” which reflects having very high standards for oneself (e.g., “I strive to be as perfect as I can be”), “others-oriented perfectionism,” which focuses on having high standards for other people, and “socially prescribed perfectionism,” which reflects feeling that others hold excessively high standards for oneself (e.g., “The better I do, the better I am expected to do”). 
Given these dimensions of perfectionism, it’s easy to see how a tendency toward perfectionism can lead a person to become overly invested in “healthy” or “clean” eating as they work towards achieving the “perfect” diet. In a perfectionistic individual struggling with Orthorexia, developing rigid food rules can be a way to seek perfection with their diet, and not following these rules can be seen as a failure.
Focusing on unattainable nutrition goals can result in a loss of identity, and an individual may begin to lose themselves in ON. Additionally, people who struggle with perfectionism may find themselves driving others away as the rigidity of their thoughts and rules, as well as obsessive or critical thoughts, can interfere with interpersonal relationships.
Know that both perfectionism and Orthorexia are treatable. In fact, researchers in the field have highlighted the importance of addressing perfectionism, stating specifically “interventions and/or experiences that help decrease perfectionism may be key to making full recovery attainable.” 
Sources: National Eating Disorders Association. Learn: What Are Eating Disorders? Orthorexia. Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia on Jan 16, 2020.  Barnes, M.A., Caltabiano, M.L. The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord 22, 177–184 (2017) doi:10.1007/s40519-016-0280-x  Bakalar, J.L., Shank, L.M., Vannucci, A. et al. Recent Advances in Developmental and Risk Factor Research on Eating Disorders. Curr Psychiatry Rep 17, 42 (2015) doi:10.1007/s11920-015-0585-x  Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric disease and treatment, 11, 385–394. doi:10.2147/NDT.S61665  Bardone-Cone, A. M., Sturm, K., Lawson, M. A., Robinson, D. P., & Smith, R. (2010). Perfectionism across stages of recovery from eating disorders. The International journal of eating disorders, 43(2), 139–148. doi:10.1002/eat.20674
About the Author:
Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.
She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a 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 January 28, 2020, on EatingDisorderHope.com
Reviewed & Approved on January 28, 2020, by Jacquelyn Ekern MS, LPC