Raising Awareness for Orthorexia

Girl practicing clean eating

Orthorexia, not a diagnosis but something that is becoming more prevalent in the eating disorder field. It has been around since the late 1990s and early 2000s and presents itself as a lifestyle that involves clean or healthful eating.

It is an obsession with what is in food, avoiding foods that are high in carbohydrates, fats, sugar, or dairy. A person who is an orthorexic may be obsessed with reading all nutritional labels, increased concern over ingredients in foods, and an inability to eat foods that are unhealthy or unclean [1].

A person may feel intense emotions of distress, and concern for self and others and the food they are eating.

Orthorexia is similar to anorexia as there is a restriction of types and amount of food ingested, and malnutrition typically follows.

Orthorexia often has similar physical and health consequences as anorexia. Often orthorexia begins with individuals following very restrictive diets such as vegans and raw food regimens and becomes a starting point for the development of orthorexia [2].

Symptoms of Orthorexia

Orthorexia can present as a significant impairment in a person’s life, where they create a lifestyle of a healthy or clean lifestyle. It can often start with a diet and lead to malnourishment, loss or change in relationships, and potentially a poor quality of life [3].

A person who is struggling with orthorexia may often obsessively read ingredients of foods, check to see if fruits and vegetables are exposed to pesticides, or if dairy products come from hormone-supported cows.

They may begin only to eat organic foods, then cut out food groups that may contain too many chemicals, sugar, or pesticides. The goal of this for the individual is to have an optimal physical health and well-being.

Orthorexic individuals can have nutritional deficiencies because of omitting certain foods from their diet, and long term physical effects are similar to that of anorexia. Some symptoms can include osteopenia, anemia, hyponatremia, testosterone deficiency and bradycardia [3].

Besides physical consequences, psychological ones are also present. Many people will feel intense frustration when food practices are interrupted or stopped, possible disgust or refusal to eat if the food ‘purity’ is contaminated, and guilt and shame if they eat foods that are not on their ‘safe’ list of foods.

Connection to Other Disorders

Orthorexia is also connected to anxiety and OCD, and many researchers feel that it may be more of an OCD disorder than eating disorder. Most individuals have traits of perfectionism, high anxiety, and a need for control.

Man Struggling with Orthorexia Many individuals show recurrent and intrusive thoughts around food and their health, obsession with contamination and impurity of food, and urges and arrange foods on the plate and practice ritualized eating. With this rigidity, orthorexics may reduce activities that are not food related because of their rigid eating and/or food preparation.

Orthorexic individuals may also become rigid about foods they will eat out of fear for the development of diseases, such as cancer.

Many people will spend an excessive amount of time and energy to researching illness and what food diets or elimination will help with avoiding that disease.

People may read that sugar can carry cancer cells, and then they worry they will develop cancer. Therefore, they start to eliminate all processed sugars from their diet. This can lead to the elimination of more foods as they research and learn about foods and diseases.

Another connection, although research is lacking, there may be a connection between orthorexia and a psychotic spectrum condition. In one study, an adult woman who had orthorexia presented during the prodromal phase of schizophrenia [3].

Theories state that the obsessional aspects of anorexia can lead to delusional thinking the longer the disorder continues, and that malnutrition from the disorder can trigger a psychosis. There is still much research to be done on this front to test these theories.

How to Assess Orthorexia

The ORTHO-15 is an assessment measure that assesses beliefs around orthorexia, food choices, behaviors, and quality of life. Scores below a 40 are considered on the orthorexia spectrum.

With the lack of a diagnosis, however, it makes it difficult to have criteria to gauge this measure with and has brought forth criticisms from the clinician community on its use. Researchers are doing preliminary work to create a new assessment, the Eating Habits Questionnaire (EHQ) that will help with identification of those who might fall into Orthorexia.

Most clinicians use the standard eating disorder questionnaires and anxiety assessments to help identify orthorexia.

Treatment for Orthorexia

Man with orthorexia eating cornOrthorexia typically follows the same treatment as for anorexia. Interventions include a treatment team that includes a medical physician, psychiatrist, therapist, and dietitian. Various individual therapies, group treatment, and peer support groups are used to help the person recover [4].

In conclusion, even though clinical teams have known about orthorexia for over two decades, it is not an official diagnosis. It is treated similarly to that of anorexia and success in recovery is possible.

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. (n.d.). Retrieved July 02, 2017, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia
[2] Orthorexia Nervosa. (n.d.). Retrieved July 02, 2017, from http://www.meeda.me/eating-disorders/orthorexia-nervosa/
[3] Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Retrieved July 02, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340368/
[4]  Hausenblaus, H. (2-14, November 10). Can We Become Addicted to Healthy Eating? Retrieved July 2, 2017, from http://health.usnews.com/health-news/blogs/eat-run/2014/11/10/can-we-become-addicted-to-healthy-eating

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 September 19, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on September 19, 2017.
Published on EatingDisorderHope.com