Orthorexia (short for orthorexia nervosa) describes an unhealthy fixation on eating only foods you consider “pure,” “clean,” or “perfect,” even when that fixation damages your physical health, mental health, or social life. It isn’t an official DSM-5-TR diagnosis today, but clinicians and researchers increasingly recognize the pattern and have proposed consensus criteria to study and treat it.
What orthorexia looks like
People struggling with orthorexia tend to focus on food quality over quantity. Common signs include: rigid food rules; eliminating entire food groups; intense fear or guilt around “impure” foods; spending hours planning/ sourcing meals; avoiding restaurants or eating with others; and distress if rules are broken. Despite good intentions, these patterns can lead to malnutrition, nutrient deficiencies, hormonal changes, bone loss risk, fatigue, and social isolation.
How it differs from other eating disorders
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Anorexia nervosa is primarily driven by weight/shape concerns and restriction to lose weight; orthorexia is driven by perceived health or purity ideals (though weight loss can occur).
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Orthorexia is not listed in DSM-5-TR (nor ICD-11) at this time, which complicates diagnosis, insurance coding, and prevalence estimates.
Why it happens (risk factors)
Perfectionism, anxiety/OCD traits, past eating-disorder history, certain performance cultures (e.g., sport, dance, wellness professions), and exposure to fear-based nutrition content on social media can all raise risk.
How clinicians assess it
Researchers have proposed criteria (e.g., Dunn & Bratman; a 2022 international consensus), and several questionnaires exist. Importantly, the popular ORTO-15 performs poorly and should not be relied on by itself; newer tools (e.g., EHQ, DOS) are being studied but are still research instruments—not diagnostic tests.
Getting unstuck: evidence-based care
Although controlled trials specifically for orthorexia are limited, clinicians typically adapt proven eating-disorder treatments:
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CBT-ED (and related approaches) to challenge rigid beliefs, reduce all-or-nothing thinking, and rebuild flexible eating.
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Graduated exposure to feared foods with response-prevention (an approach that reduces food-related anxiety in ED care).
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Work with an eating-disorder-specialist dietitian to restore variety, adequacy, and spontaneity with food; plus medical monitoring to check for nutrient deficiencies and other complications.
A quick self-check (informational, not diagnostic)
If you answer “often” or “always” to several of these, it’s worth talking with a professional:
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I avoid events or relationships because the food won’t meet my standards.
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I feel intense guilt, shame, or “contamination” if I eat a “forbidden” food.
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My rules keep multiplying, and my world keeps shrinking.
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I spend so much time planning/curating food that work, school, or joy suffers.
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My health markers or energy have worsened because of my “healthy” diet.
(These reflect common features described in the proposed criteria.)
Practical steps you can try today
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Name the rule → test the rule: write one rigid food rule, then design a small, repeatable experiment to disconfirm it (e.g., add one “off-limits” item in a balanced meal and observe energy, mood, and function).
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Swap morality for curiosity: replace “good/bad” with neutral descriptors (“higher-fiber,” “fun,” “convenient”).
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Widen the lens: include social connection, satisfaction, and flexibility as part of “health.”
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Curate your feed: mute fear-mongering nutrition accounts; follow credentialed RDs/MDs.
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Invite support: loop in a trusted friend or family member when practicing flexibility.
When (and where) to get help
If these patterns feel familiar, reach out to your primary-care clinician, a therapist trained in eating disorders, and a registered dietitian who specializes in EDs. If you’re in immediate crisis or concerned about safety, call/text 988 (U.S.). Many national organizations also offer education, screening tools, and referrals.
Friendly reminder: This post is educational and not a diagnosis. If you’re worried about yourself or someone you love, professional support can help you find a more flexible, joyful relationship with food.
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