Orthorexia Nervosa: What You Need to Know

In the world of eating disorder counseling, orthorexia nervosa is becoming more prevalent. Although not an official eating disorder at this time, it is a condition garnering more attention each year. In 2006, Ursula Philpot, chair of the British Dietetic Association and lecturer at Leeds Metropolitan University, wrote a paper discussing current trends in this area observed by eating disorder treatment professionals. The research described orthorexia nervosa as a fixation on eating foods that only meet a certain quality standard, causing individuals to restrict their diets to the point of starvation.

Philpot was not the first to consider this growing issue. In 1996, a California physician, Steven Bratman, coined the phrase “fixation on righteous eating” to describe the same disorder. Although there is not a formal diagnosis at this time, individuals with this condition display symptoms similar to those suffering with anorexia eating disorder and are entering eating disorder treatment centers for treatment and to achieve true recovery.

What Is Orthorexia Nervosa?

Orthorexia nervosa is a condition that has yet to be fully defined by organizations such as the American Psychiatric Association, however, eating disorder treatment centers are treating more and more cases. An individual with this condition may present with some symptoms similar to those in an individual with anorexia nervosa, a disorder that affects around 0.4 percent of young women in this country and 0.1 percent of young males.

Like anorexia nervosa, orthorexia nervosa involves the obsessive restriction of food. For individuals with anorexia nervosa, that restriction is based on reducing calories. Orthorexia nervosa involves the compulsive need to eat only healthy and pure foods.

On the surface, the description is deceivably positive, but people with orthorexia nervosa take “healthy eating” to an unhealthy extreme. They develop the inability to eat anything they deem not pure to the point of excluding whole food groups and essential nutrients.

Orthorexia Nervosa Versus Following a Balanced Eating Plan

It may be difficult to pick out the signs and symptoms of someone struggling with orthorexia nervosa who require eating disorder treatment. These individuals may compulsively assess what they are putting in their body and begin restricting to the point of removing entire food groups.

Individuals with orthorexia nervosa may do this out of fear of disease or of introducing toxins into their body. They may become overwhelmed with maintaining these restrictions and respond by refusing to eat anything they do not prepare by hand or obsessively checking ingredient labels. They may fail to notice clear signs of health problems, such as extreme weight loss or feeling cold all the time. They may also feel a sense of self-loathing if they eat something on their restricted list.

How Is Orthorexia Nervosa Diagnosed?

Orthorexia nervosa has yet to be officially recognized and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), but in 2016 Thomas M. Dunn for the University of Northern Colorado and Dr. Steven Bratman proposed specific diagnostic criteria for the condition that eating disorder counseling professionals could refer to when working with their clients. Their proposed diagnostic standards include:

  • Compulsive behavior regarding healthy eating that includes affirmative and restrictive practices to promote the best health using exercise and fit body image as indicators of perfect health. In some cases, the diet may focus on concentrated food supplements.
  • Not abiding by dietary restrictions triggers an exaggerated fear of disease along with feelings of anxiety and shame.
  • An escalation of dietary restrictions over time leadingto the elimination of entire food groups along with frequent and extreme cleanses, such as

There is also a diagnosis questionnaire that healthcare and eating disorder professionals may use to detect these symptoms.

What separates orthorexia nervosa from anorexia nervosa? Those with anorexia nervosa fear weight gain and being “fat”. Individuals who meet the criteria for orthorexia nervosa are more concerned with food quality and health. It is not solely a desire to lose weight.

Orthorexia nervosa may co-occur with other signaling behaviors, such as excessive exercise.

What Is Excessive Exercise?

Like orthorexia nervosa, excessive exercise is not a recognized condition. In fact, it is often seen a symptom of another illness, such as anorexia nervosa.

Excessive exercise is characterized by prioritizing workout activity over everything else, such as employment schedules, school and socialization. Other symptoms of excessive exercise may include:

  • Working out despite injury or illness
  • Canceling or avoiding social functions to exercise
  • Adhering to a regimenof extreme exercise

Orthorexia and excessive exercise may co-occur as they are both compulsive obsessions that involve controlling one’s health and body.

What Are the Symptoms of Orthorexia Nervosa?

Like any mental health condition, in order for an individual to receive eating disorder treatment we need to first know the symptoms to look for. According to the National Eating Disorder Association, warning signs of orthorexia nervosa may include:

  • Compulsively checking nutrition labels and ingredient lists on food products
  • Overarching concern about the purity of ingredients
  • Eliminating entire food groups from the diet such as whole grain
  • Inability to consume anything but a narrow list of food they deem “pure”
  • Extreme interest in what others eat
  • Contemplating for days about what food might be available at social events
  • Being distressed if their safe foods are not available to them
  • Following “healthy”lifestyle blogs and social media sites obsessively
  • Somemay be overly concerned with body image and exercise

What Are the Consequences of Orthorexia Nervosa?

Orthorexia nervosa is a condition with some similarities to anorexia nervosa, and unfortunately, with many of the same consequences.

Cardiovascular System

The cardiovascular system consists of the heart, blood and blood vessels. Calorie consumption provides energy to the body systems. Restricting calories forces the body to look elsewhere for energy; muscle tissue in the first source utilized. The heart made up of muscle, and as such, is at risk of deterioration in these individuals. An individual may also experience a drop in blood pressure because there is less fuel to keep the heart pumping properly. With less energy, the heart will beat slower to conserve what fuel it does have available. Additionally, there is the concern of an electrolyte imbalance which can cause the heart to beat with an irregular rhythm. Inpatient eating disorder treatment centers often monitor the cardiac system to detect damage from conditions, such as orthorexia nervosa.

It is important to encourage an individual struggling with an eating disorder to enter an eating disorder treatment program, potentially an inpatient eating disorder treatment if the individual is already severely medically unstable.

Gastrointestinal System

The gastrointestinal system consists of the entire digestive system, including the

  • Esophagus
  • Stomach
  • Intestines

Reduced food intake slows down digestion, which can lead to gastroparesis, a condition that paralyzes part of the stomach. Without normal stomach emptying, an individual can develop:

  • Abdominal pain and bloating
  • Fluctuating blood sugar levels
  • Intestinal blockage
  • Bacterial infections

Constipation is also a side effect of anorexia eating disorder and orthorexia nervosa. Restricted caloric intakes can cause wasting of the muscles in the intestinal tract interfering with their ability to move food properly.


Malnourishment means the body is not getting enough of the essential nutrients required to sustain body functions. This can lead to conditions, such as:

  • Pancreatitis
  • Gastroenteritis
  • Pneumonia

People can also suffer from neurological problems due to malnutrition and restrictive dieting because the brain uses half of all the energy that comes from food.

Daily Discomfort

Not all consequences of orthorexia nervosa are life-threatening. Many can reduce one’s quality of life by causing:

  • Dry skin
  • Brittle hair that may fall out
  • Dehydration
  • Feeling cold all the time
  • Extreme fatigue
  • Dizziness

Those problems can escalate into conditions that are life-threatening. Dehydration, for example, can cause kidney failure. Caloric restriction and dehydration increase the risk of diabetes by making cells resistant to insulin.

Who Is at Risk for Orthorexia Nervosa?

It is not yet clear why some people develop this or any eating disorder, but there are researched risk factors, such as:

  • A family history of eating disorders
  • Other mental health conditions, including obsessive-compulsive disorder
  • History of dieting and starvation practices
  • Chronic stress

Additionally, specific career paths and lifestyle choices may increase the risk of orthorexia nervosa. For example, athletes are often under extreme pressure to maintain a particular weight or body type and may take an extreme path to controlling the foods and liquids they consume.

Certain motivational factors can trigger this eating disorder, such as:

  • Seeking safety from disease
  • Wanting complete control of situations, including one’s health
  • Fear of illness seen in someone else
  • Spirituality or religious reasons,that may include food choices
  • Extreme feelings about eating certain groups of foods, for example meat products

These factors do not define orthorexia nervosa, but have been found as potential risk factors.

What Is the Treatment for Orthorexia Nervosa?

Since orthorexia nervosa is not a clinically recognized condition, there is no established treatment protocol. Eating disorder recovery plans will be created by the treatment team to support each individual on their path to recovery. This path may start with inpatient eating disorder treatment or residential treatment and eventually, a step down to outpatient eating disorder treatment.

The key to any recovery is to provide a safe and supportive environment that addresses the underlying causes of the disorder, helps the client develop skills to combat negative thoughts and behaviors and provides medical, psychiatric, nutrition and clinical care. Treatment components may include:

  • Psychotherapy:A treatment option designed to understand and challenge negative behaviors and thinking patterns
  • Dialectical Behavioral Therapy (DBT):A treatment modality that may include behavioral, cognitive and meditative therapies
  • Medication:In some cases, a doctor may prescribe medications to address co-occurring conditions such as anxiety or depression

Orthorexia nervosa is a specific condition that makes one fixate on eating the “right” foods. Individuals with orthorexia nervosa develop a rigid eating style they will not deviate from even if it affects their overall well-being. Over time, the list of foods they can eat may become more and more restrictive until it compromises their health; unless they seek treatment and eating disorder recovery.

Although not currently a clinically recognized condition, orthorexia nervosa continues to be a concern in this country as people become more conscious of the effect food has on their bodies. With the development of proposed diagnostic criteria, it is possible that soon orthorexia nervosa will officially be added to the growing list of eating disorders; even without formal diagnostic criteria many treatment centers already offer treatment for this disorder and a chance to begin on the path to eating disorder recovery.