Signs and Symptoms of Orthorexia
Orthorexia is a term that has been around for some time- in 1998 it was the term used to describe an obsession with healthy eating.
Despite how long orthorexia has been acknowledged as a form of disordered eating, it wasn’t acknowledged within the eating disorder field until recent years as a dangerous and prevalent eating disorder.
In fact, orthorexia still isn’t included in the diagnostic statistical manual as a clinical diagnosis.
As eating disorder specialists, we’ve seen firsthand how insidious, dangerous, and consuming orthorexia can be. The American Psychiatric Association does not currently recognize orthorexia as an official eating disorder diagnosis, and it is not included in the DSM as a formally diagnosed mental disorder.
Often starting from a well-intentioned place to be more “healthy”, folks who have a vulnerability to developing an eating disorder (biological, cultural, and psychological vulnerabilities) can easily find themselves in a less stable place. There are currently no formal diagnostic criteria for orthorexia, which makes it challenging for individuals to be officially diagnosed.
Fad diets and new “wellness” trends encourage cutting out food groups, labeling certain foods good or bad, and hypervigilance around what is deemed “healthy” “clean” “healing” or “good” by societal trends are partially to blame.
Further research is needed to better define diagnostic criteria and understand orthorexia's place but treatment in Pennsylvania is available with our team. .
This is one of the reasons why orthorexia can fly under many professionals’ radar- the vast majority of our society views these types of behaviors as a good thing.
Something that we should be doing and how we should be taking care of ourselves by prioritizing our health.
Diet culture promotes restrictive eating habits and unrealistic body standards, which can contribute to the normalization of orthorexic behaviors.
The extreme beliefs and behaviors related to orthorexia are not health-promoting.
In fact, they often result in social isolation, escalating symptoms of depression and anxiety, poor self-esteem, and malnutrition.
In severe cases, orthorexia can lead to medical complications, such as electrolyte imbalances and other serious health issues.
Healthy Eating vs. Orthorexia: Where’s the Line?
Healthy eating is an important part of supporting your overall well-being, but it’s not always easy to know when a focus on nutrition crosses into something more concerning. For many people, healthy eating habits mean enjoying a variety of food groups—like fruits, vegetables, whole grains, lean proteins, and healthy fats—while making balanced food choices that nourish both body and mind. This approach is flexible, inclusive, and supports optimum health without rigid rules or guilt.
Orthorexia nervosa, on the other hand, is an emerging perspective in the field of eating disorders. Unlike healthy eating, orthorexia is defined by an obsession with healthy, “clean,” or “pure” foods, often to the point where it disrupts a person’s life and well-being. While orthorexia nervosa is not yet officially recognized as an eating disorder in the diagnostic and statistical manual (DSM), it shares many features with other eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder. People with orthorexia often develop self-imposed dietary rules, rigid thinking, and may engage in excessive exercise or compulsive behaviors around food preparation and eating.
Proposed diagnostic criteria for orthorexia nervosa include a preoccupation with the nutritional quality of food, spending excessive time thinking about food, and experiencing significant emotional distress if unable to follow strict dietary rules. This can lead to the elimination of entire food groups, such as carbohydrates or dairy, and may result in malnutrition, anxiety disorders, or other serious mental health concerns. The obsession with healthy eating can also impact psychosocial functioning, making it difficult to maintain a healthy relationship with food, friends, and family.
Treating eating disorders like orthorexia nervosa requires a multidisciplinary team approach, often involving health care professionals, registered dietitians, and mental health specialists. Organizations such as the National Eating Disorders Association (NEDA) offer valuable resources and support for those struggling with disordered eating and related mental health conditions.
If you notice warning signs of orthorexia nervosa in yourself or a loved one, know that you are not alone. Specialized treatment can help you rebuild a positive body image, restore a healthy relationship with food, and improve your overall mental health. Reaching out to a qualified health professional or connecting with organizations like NEDA is an important first step toward recovery and well-being.
So, what are the signs of orthorexia?
→ Overly Concerned With Food
People struggling with orthorexia often display obsessive compulsive traits and behaviors, becoming all consumed with healthy eating, fixating on what to eat, how much to eat, what the food consists of, and how to maintain a lifestyle of this type of eating pattern.
Unlike other eating disorders that focus on food quantity, orthorexia is characterized by a preoccupation with food quality and an obsession with clean eating—choosing foods perceived as pure, healthy, or unprocessed. Significant morality is attached to being able to do so.
The obsessive compulsive nature of orthorexia shares similarities with obsessive compulsive disorder, including fixation, rigidity, and intrusive thoughts about food and health. This intense preoccupation with eating food that is considered pure or healthy can negatively impact emotional well-being and overall health.
→ Struggling with Self-Esteem
Self-esteem is gained from the ability to eat clean and/or pure. Oftentimes this escalates into a sense of being better than, or doing better than others because of rigidity and devotion to “healthy” eating and lifestyle.
This pattern of deriving self-worth from strict eating behaviors can increase the risk of developing orthorexia.
→ Tearing Yourself Down When You Slip Up
When a slip-up occurs, folks can quickly fall into a place of self-deprecation and punishment by increasing dietary restrictions and adopting even more restrictive diets, along with more rigid eating patterns, fasting, or exercising to “undo” the unclean foods that have been consumed.
The emotional turmoil that comes along with orthorexia and the expected maintenance of rigid food/movement/lifestyle expectations is real. Someone struggling with this eating disorder is likely to experience significant anxiety, shame, or depression if their plan is not followed.
→ Food Anxiety
Folks struggling with orthorexia often have significant anxiety around certain health conditions and lean on food to treat, cure or prevent illness. A family history of certain illnesses can heighten anxiety about health and food choices.
Persistent anxiety around food and health may be a sign of underlying mental illness.
→ Unintentional Weight Loss
Weight loss is not always a marker of someone with signs of orthorexia, but changes in body mass index may be observed as a result of unbalanced diet or malnutrition. Many people struggling with orthorexia don’t set out to specifically lose weight, but the rigidity that comes along with this eating disorder disrupts their ability to eat a wide variety of foods. This restrictive approach to food intake can lead to reduced food intake and low weight, even though weight loss is not the initial goal, often resulting in weight loss in the desperate pursuit of “health”.
If these symptoms sound familiar to what you’re experiencing, please know that you deserve help and support.
Below are two tools to help you assess if you’re experiencing these signs of orthorexia.
*Please note that these assessments are in no way not meant to self-diagnose. They are tools to help you become curious about your beliefs and behaviors around food. If you are concerned that you have an eating disorder, please contact a professional who can support you*
The Bratman Test
- Do you spend more than 3 hours per day thinking about your diet?
- Is the nutritional value of your meal more important than the pleasure of eating it
- Do you plan your meals several days ahead?
- Has the quality of your life decreased as the quality of your diet has increased?
- Have you become stricter with yourself lately?
- Does your self-esteem get a boost from eating healthy?
- Have you given up foods you used to enjoy in order to eat the right foods?
- Do you feel at peace with yourself and in total control when you eat healthy?
- Does your diet make it difficult for you to eat out, distancing you from family and friends?
- Do you feel guilty when you stray from your diet?
ORTO-R Assessment
- Are your rigid and restrictive dietary choices conditioned by your worry about your health status?
- Would you agree that eating healthy food increases your self-esteem?
- Do you believe that strict consumption of only healthy food may improve your appearance?
- Does eating healthy food change your lifestyle (Frequency of eating out, friends…)
- In the last 3 month did thoughts of food make you feel guilt, ashamed or anxious?
- Does thinking about food excessively worry you for more than 3 hours per day?
If you answered “yes” to some or many of these questions, you could be dealing with orthorexia. Like other eating disorders, if you’re experiencing these signs of orthorexia, your physical and mental health could be at risk. We encourage you to reach out for a formal assessment.
With eating disorder treatment or body image therapy, your symptoms can improve and you can enter recovery to live your life in a way that is in alignment with your values and what is most important to you.
If you’re experiencing signs of orthorexia, then begin eating disorder treatment at Reclaim Therapy!
Here at Reclaim Therapy in Pennsylvania, we believe that if you’re struggling with your relationship with food and your body, you deserve individualized and effective treatment and support.
Orthorexia can be as insidious as it is dangerous. And, we relentlessly believe that you deserve more.
You deserve freedom and peace with food.
In fact, you deserve to reclaim your life from disordered eating
When you’re ready, we’ll be here to support you.
🧡,
Here at Reclaim Therapy, we’re body image, eating disorder, and trauma specialists who provide in-person counseling and online therapy in Pennsylvania.
We have a passion for treating eating disorders and helping people see and feel that recovery is truly possible. We’re passionate about helping our community find freedom from disordered eating and body image issues, binge eating, trauma, EMDR, and grief. We’re ready to help you shape what your recovery can look like!