Orthorexia Nervosa - The Extreme Form of Clean Eating

Healthy Eating vs Obsession

Eating healthy and getting in shape are goals many people share. However, some people take these aims to such an unhealthy extreme that it becomes a dangerous obsession called orthorexia.


Orthorexia is an emerging undiagnosed disorder according to the Neuropsychiatric Disease and Treatment Center. It has been described as an obsession with proper nutrition characterized by a restrictive diet, ritual eating patterns, and a consuming avoidance of all foods believed to be impure.

We are blanketed with headlines and "research" about the (often unfounded or exaggerated) potential healing effects of various "superfoods" and fad diets. Social media feeds overflow with extensive lists of clean foods you should eat (and what you should avoid), as well as information on the damaging effects of consuming genetically modified organisms (GMOs) and non-organic foods. 

This bombardment of information can be helpful but often much of it is inaccurate, overwhelming, and unhelpful—and sometimes it becomes addictive or unsafe, particularly to people with eating disorders. Sometimes, this focus on "healthy" and "clean" eating is taken to an unhealthy extreme.  

What Causes Orthorexia?

Woman looking her meal.
B. BOISSONNET /BSIP / Getty Images

Living a healthy lifestyle that includes a wide variety of macronutrients is essential and encouraged. However, there is a difference between eating healthy and the appropriate mental thinking behind food.  

Orthorexia begins honestly as a desire to adopt a healthy lifestyle through better food choices. A good intention becomes an obsession with food quality and purity. 

According to the National Eating Disorders Organization, those who are eating healthy but develop an unhealthy obsession with it may be suffering from orthorexia nervosa. Orthorexia Nervosa is defined as having a fixation on righteous eating.  

Orthorexia starts out as an innocent attempt to eat more healthfully, but sufferers develop a fixation on food quality and purity. They become consumed with what and how much to eat, and how to deal with slip-ups. An iron-clad will is needed to maintain this rigid eating style.

Maintaining self-esteem is very important for orthorexia sufferers who are said to feel empowered by their ability to control the purity of their food intake. They see each day as a chance to eat right, make pure choices, and rise above others in dietary prowess. If temptation wins, the need to self-punish through stricter eating, fasts, and exercise takes over. 

Orthorexia is a Progressive Disorder

Preliminary studies for diagnosis and population impact are still ongoing. Orthorexia symptoms seem to show an overlap with disorders such as anorexia nervosa, obsessive-compulsive disorder (OCD), and anxiety. 

Anorexia and orthorexia are similar in that they are food restrictive but the fears surrounding food are different. Orthorexia sufferers do not fear to get fat but are considered phobic over foods not believed pure enough to consume. 

Food intake is limited to certified organic and whole foods. Foods not measuring up to orthorexia “clean” standards are typically removed from the diet. The disorder is not only obsessive but progressive in nature.

Entire food groups like dairy or grain are eliminated one-by-one in search of the “perfect” clean, healthy diet. Eliminating essential nutrients from the diet can spiral into malnourishment and severe nutrient deficiencies in extreme orthorexia cases.
Orthorexia sufferers often fail to understand having control over food has become more important than eating healthy. 

Orthorexia is Isolating

A person with orthorexia will begin isolating themselves from social functions and family meals. Anxiety surrounding being unable to eat impure foods becomes stronger than spending time with people.

They would rather be alone than face questions and judgments from those who don't understand their feelings about food. According to the Academy of Nutrition and Dietetics, orthorexia sufferers don’t enjoy food in the same way that someone with a healthy relationship to food does.  

An individual who eats healthy enjoys and sees food as fuel and nourishing for their body. There is no additional thought process or worry about food intake. An orthorexia sufferer typically feels virtuous when they eat foods considered to be good or safe. If they deviate from their self-imposed extreme diet restrictions, it causes anxiety and self-loathing.

Many People Suffer From Orthorexia Symptoms

Orthorexia Nervosa is a term not yet clinically diagnosed as a disorder. However, many people suffer from debilitating symptoms and under the label of orthorexia. Because clean eating diet trends have become more popular, there is more interest in this subject by clinicians and researchers. 

Society has accepted obsessive healthy eating and leanness as commonplace. Behaviors of orthorexia sufferers have been misplaced and even favorably looked upon by those wanting to achieve the same goals. 

Orthorexia sufferers feel empowered by praise while hiding behind the idea they're eating right and healthy. Because of this dilemma, many are unaware just how problematic orthorexia and symptoms can become. 

Clean Eating Stigmas and Orthorexia

Clean eating has become a popular diet pattern centered on proper nutrition. Many individuals have improved their health and fitness using this type of eating which is typically restrictive in nature. It involves a conscious effort to avoid foods considered unhealthy or impure. This can be taken to an extreme or obsessive level where orthorexia can become a potential problem. Eating clean is also shown to come with social stigmas.

According to research, there is substantial evidence showing people are judged based on their eating behaviors. For example, individuals eating low-fat diets are considered more attractive, positive, and mindful compared to those consuming a high-fat diet. Other opinions of people eating low-fat diets considered them high-strung, unhappy, anti-social, and self-centered. 

Studies indicate mixed attitudes toward those who eat healthily, but suggest potential social repercussions for their clean eating behaviors. Also, there appears to be a negative opinion of individuals with eating disorders. The negative stigma placed on clean eating and orthorexia symptoms have caused many people to keep quiet about a possible problem. 

One study examining social perceptions required participants to read a brief description of 149 women outlining their lifestyle and eating habits. To fairly evaluate the women, a control group was created explaining their lifestyle but no mention of eating patterns. The volunteers were asked to rate how they felt about each woman. 

Research results indicated less positive attitudes toward those with clean diet patterns compared to the control group. The participants also rated as not interested in being social with the women described as eating clean. Those with an eating disorder were rated less negative than those eating clean compared to the control group. 

It appears there may be negative social ramifications for clean eating behaviors, and especially when it becomes extreme (orthorexia nervosa). According to research, developing a better understanding of the stigma surrounding the different forms of disordered eating is important. It would be a positive step forward to reducing or eliminating the social burdens for those suffering from these conditions.

Recovery is Possible

Orthorexia Nervosa is a serious condition that can have devastating mental and physical side effects. It's difficult to admit having a problem with food phobias. Many orthorexia sufferers remain in denial about their behaviors.

Diving into the mental and emotional side of food behaviors will be necessary to overcome orthorexia. This is best done with a professional skilled in treating eating disorders.

Recovery is possible for orthorexia sufferers willing to take the steps necessary to change. This would include adopting realistic and healthy views of food intake. According to the National Eating Disorders Association, individuals will still eat healthfully, but gain a different understanding of what healthy eating is.

A few of the recovery steps and new views surrounding food include:

  • Food intake doesn’t make you a better person.
  • Self-esteem is not based on the quality of your diet.
  • Your identity shifts away from the food you eat.
  • Your life includes other important things – work, fun, and relationships.
  • You gain a broader definition of who you are rather than food focused.
  • Food is important, but only one small aspect of life.
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