In today’s health-conscious world, eating well is often seen as a virtue. Messages advocating for organic, whole, and "clean" foods are everywhere. While there’s nothing wrong with striving to eat healthily, for some people, this pursuit can become an all-consuming obsession. This is where orthorexia comes in—a lesser-known but increasingly prevalent condition characterised by an unhealthy fixation on healthy eating.

What is Orthorexia?

When a holistic doctor named Dr. Steven Bratman saw an increasing number of patients who were fixated on eating the "right" meals, he first used the term orthorexia nervosa in 1997. "Correct appetite" is the translation of orthorexia, which is derived from the Greek words "orthos" (correct) and "orexis" (appetising).

Unlike other eating disorders, such as anorexia nervosa or bulimia, which focus primarily on the quantity of food consumed and body weight, orthorexia is centred around the quality and purity of food. Individuals with orthorexia often eliminate entire food groups from their diet, like sugar, dairy, meat, or processed foods, believing them to be “toxic” or “unclean.” Over time, their diet becomes increasingly restrictive, and the obsession with “clean eating” starts to interfere with their daily life, social relationships, and mental well-being.

Symptoms and Warning Signs

Recognising orthorexia can be challenging because healthy eating is socially encouraged. Here are some common symptoms and warning signs:

• Obsessive focus on food quality: Constantly reading food labels, researching food origins, and scrutinising ingredients.
• Elimination of entire food groups: Avoiding foods not deemed “pure” or “clean,” such as carbohydrates, fats, or anything processed.
• Guilt or anxiety after eating “bad” foods: Experiencing intense emotional stress after consuming something perceived as unhealthy.
• Ritualised eating habits: Only eating food prepared in certain ways or from specific sources.
• Social isolation: Avoiding meals with friends or family due to fear of “impure” food.
• Self-esteem tied to dietary choices: Feeling superior to others based on dietary discipline or experiencing self-worth through strict adherence to food rules.

Psychological and Physical Impact

While orthorexia may begin with good intentions, it can have serious consequences, both mentally and physically.

Mental Health Consequences

Orthorexia can lead to severe anxiety, depression, and obsessive-compulsive behaviours. The pressure to maintain dietary “perfection” can create a relentless inner critic. Social interactions often suffer, as individuals may avoid gatherings that involve food they don’t deem “clean,” leading to loneliness and isolation.

The rigid thinking patterns involved in orthorexia can also result in black-and-white thinking: foods are either good or bad, healthy or unhealthy, clean or toxic. This mindset can bleed into other areas of life, contributing to extreme perfectionism and low self-esteem.

Physical Consequences

Ironically, in the quest for health, individuals with orthorexia can end up malnourished. This can lead to fatigue, weakened immunity, digestive issues, and even bone density loss. In severe cases, orthorexia may cause significant weight loss and mimic the effects of other restrictive eating disorders.

What Causes Orthorexia?

1. Perfectionism and Control

Many individuals with orthorexia have perfectionist tendencies. They may use their diet as a way to assert control over their lives, especially during times of stress or uncertainty. 

2. Cultural and Social Influence

The wellness industry, social media, and influencer culture have played a significant role in promoting the idea that certain foods are morally superior. Instagram feeds filled with “clean eating” inspiration can reinforce harmful ideals and contribute to disordered eating patterns.

3. Past Trauma or Illness

Some individuals may turn to orthorexia after experiencing a health scare or chronic illness. In an attempt to prevent further health issues, they become excessively focused on food as medicine.

Orthorexia vs. Healthy Eating

It’s important to distinguish between orthorexia and simply making nutritious choices. The difference lies in flexibility and mental attitude:

• A healthy eater may choose a salad, but won’t feel guilty if they occasionally eat pizza.
• An orthorexic individual might feel extreme anxiety, shame, or self-loathing for straying from their food rules.
• Healthy eating is balanced and inclusive, while orthorexia is restrictive and rigid.

Diagnosis and Treatment

Currently, orthorexia is not officially recognised as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which makes it harder to identify and treat. However, mental health professionals increasingly acknowledge it as a form of disordered eating that deserves attention.

Diagnosis

Diagnosing orthorexia typically involves a psychological assessment by a trained clinician. Tools like the ORTO-15 questionnaire are sometimes used to evaluate orthorexic tendencies, although their reliability is debated.

Treatment Options

Effective treatment involves a multidisciplinary approach:

• Cognitive Behavioural Therapy (CBT): Helps individuals challenge and reframe distorted thoughts about food and health.
• Nutrition Counselling: Registered dietitians can guide patients toward a more balanced, flexible relationship with food.
• Mindfulness and Acceptance Techniques: Practices like intuitive eating and mindfulness can help rebuild trust in the body’s natural cues.
• Group Therapy or Support Groups: Sharing experiences in a non-judgmental setting can reduce shame and promote recovery.

Recovery from orthorexia is not about giving up on health; it’s about redefining what health truly means—embracing both physical nourishment and emotional well-being.

How to Prevent Orthorexia

Preventing orthorexia starts with education and awareness. Here are a few practical tips:

• Be sceptical of diet trends
• Practice self-compassion
• Diversify your media intake
• Value mental health as part of wellness

Conclusion

Orthorexia may hide behind the mask of wellness, but its effects can be as damaging as any other eating disorder. As society becomes more aware of this condition, it's crucial to promote a more compassionate, balanced approach to nutrition. Healthy eating should enhance our lives, not control them.

If you or someone you know struggles with an obsessive focus on food purity, seeking help is not a sign of weakness. 

Contributed By: Dr. (Prof.) R. K. Suri, Clinical Psychologist and Life Coach, &. Ms. Riya Rathi, Counselling Psychologist.

References

• National Eating Disorders Association. (n.d.). Orthorexia. Retrieved June 3, 2025, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/orthorexia
• Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: Emerging perspectives. Neuropsychiatric Disease and Treatment, 11, 385–394. https://doi.org/10.2147/NDT.S61665
• McGregor, S., & Linardon, J. (2020). The relationship between eating disorder symptomatology and diet quality in a representative sample of Australian adults. International Journal of Eating Disorders, 53(4), 573–579. https://doi.org/10.1002/eat.23224