Introduction

Orthorexia was introduced to the literature in 1997 by Dr. Steven Bratman, who defined it as an unhealthy obsession with healthy eating and a fixation on food “purity”.The term is derived from the Greek words ‘ortho’, meaning correct, and ‘orexia’, meaning appetite.¹ 

Individuals suffering from orthorexia adhere to rigid dietary rules, obsessively focusing on the quality of food. They categorise foods as "healthy" or "unhealthy", and deviations from their "clean" diet can trigger severe guilt. Typically, their diet excludes chemicals, processed foods, and fried foods, instead opting for organic and/or raw foods.

While eating healthily can be beneficial, an unhealthy obsession with it can lead to severe anxiety, malnourishment, relationship problems, and social withdrawal. In its more severe form, orthorexia can impair an individual’s daily functioning.

What are the symptoms and characteristics of orthorexia?

Following are some of the symptoms and characteristics of orthorexia, categorised into behavioural and physical manifestations:^1,2

Behavioural symptoms

• Rigid adherence to self-imposed dietary rules
• An unusual interest and overly judgemental of others' food choices
• Feeling superior to others because of personal food habits
• High levels of anxiety when “pure” or “clean” foods are unavailable
• Preoccupation with ingredient lists and nutritional labels
• Refusal to eat out or attend social events involving food, resulting in social isolation
• Experiencing intense guilt when consuming foods perceived as “unhealthy”
• Eliminating an increasing number of food groups (e.g. meat, dairy, carbohydrates)
• Spending significant time thinking about meal preparation and nutritional content
• Engaging in extensive food research and following “healthy lifestyle” content on social media
• Losing interest in other activities and hobbies

Physical symptoms

• Weight loss 
• Malnutrition
• Thinning hair or hair loss
• Constipation
• Dehydration
• Difficulty sleeping 
• Decreased concentration 
• Mood swings

How do you get diagnosed with orthorexia?

Despite increasing public interest in orthorexia, it is not formally recognised by either the International Classification of Diseases, Tenth Revision (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Therefore, patients cannot be officially diagnosed with orthorexia. However, the term may be brought up, and the condition may be discussed with patients during consultations.

Generally, healthcare providers consider orthorexia as a variant of anorexia nervosa and obsessive-compulsive disorder (OCD). The key distinction is that orthorexia sufferers are preoccupied with the quality of food rather than the quantity.^4,5

What other conditions present similarly to orthorexia?

The following conditions present similarly to orthorexia:

• Anorexia nervosa
• Bulimia nervosa
• Obsessive-compulsive disorder (OCD)

What are the risk factors for orthorexia? 

Several risk factors can increase the likelihood of developing orthorexia, including:^6,7

• History of perfectionism, OCD, or neuroticism
• History of dieting and/or poor body image
• Family history of eating disorders
• Depression or anxiety
• Low self-esteem
• Exposure to unrealistic societal standards of “ideal” body types
• Misinformation and unscientific claims labelling certain foods as “toxic”
• Social media exposure to “clean” eating trends
• Using food as a means to gain control in an otherwise chaotic life
• Fear of illness leads to the avoidance of all “unhealthy” foods
• Keen interest in health and well-being
• Being a sportsperson with an intense focus on diet

How do you treat orthorexia?

Since orthorexia is not officially recognised in major diagnostic manuals, it is often managed within the framework of recognised disorders like anorexia nervosa or OCD.⁵ A multidisciplinary team consisting of a physician, therapist, and dietician is key in addressing the physical and mental aspects of the condition.

Whilst a physician can help to treat physical symptoms such as anaemia, malnutrition, and amenorrhoea, a dietitian can improve the variety of foods consumed by the patient, ensuring a balanced and nutritious diet.

Psychotherapy can be highly beneficial in treating orthorexia, e.g., the "exposure and response prevention" approach (effective in OCD treatment) can help patients with orthorexia to confront and reduce their fears about certain “unhealthy” foods. Similarly, cognitive behavioural therapy (CBT) can help patients identify and challenge unhealthy eating patterns and distorted beliefs regarding nutrition.^7,8

What is the prognosis for orthorexia?

The prognosis for orthorexia is generally positive. Recovered individuals are likely to continue eating healthy meals, but they often come to understand that food is just one aspect of their lives and that their self-esteem should not be tied to the quality of their diet. Moreover, they learn to let go of their compulsion to control.

How do you prevent orthorexia?

Preventing orthorexia requires challenging societal standards related to idealised body types and healthy diets. It is essential to curb the spread of inaccurate health information, especially on social media platforms.

Healthcare professionals and policymakers must take the initiative to understand and minimise sociocultural risk factors that contribute to the development of orthorexia.

Additionally, it is crucial to promptly address disorders such as OCD and anorexia nervosa in patients to prevent progression to orthorexia.

FAQs

Who is more susceptible to orthorexia?

Orthorexia is prevalent among athletes due to the demands of their profession. Athletes often adhere to strict diets to achieve an athletic body or to optimise performance, which, in turn, increases their risk of developing orthorexia.³

Orthorexia has also been increasingly observed among dietitians and nutritionists. Their work-related preoccupation with food, body shape, and weight increases their risk of developing this condition.

Individuals who use Instagram are also at an increased risk of developing orthorexia due to the image-based nature of the platform. Influencers with large social media following also play a role in prompting orthorexia by normalising unrealistic beauty and dietary standards.

What are the long-term effects of orthorexia?

Following are some of the long-term effects of orthorexia:

• Anaemia
• Nutritional deficiencies
• Hormonal imbalances 
• Extreme weight loss
• Osteoporosis
• Cardiovascular issues
• Gastrointestinal problems
• Kidney problems
• Organ failure
• Decreased quality of life
• Poor work performance
• Impaired cognitive functioning
• Emotional distress
• Anxiety and/or depression
• Social isolation and withdrawal
• Suicidal ideation or self-harming

Summary

Orthorexia is characterised by an obsession with healthy eating, where individuals establish strict dietary rules by categorising foods as "healthy" or “unhealthy”. These individuals struggle to lead a normal life due to the rigid dietary standards they have set for themselves.

People with orthorexia often feel superior to others because of their strict diet and may judge others for their dietary choices. They struggle to enjoy meals prepared by others, preferring to prepare their own meals. They also invest considerable time researching "clean eating" and "healthy lifestyle" practices.

Orthorexia sufferers experience a myriad of symptoms, including anxiety, weight loss, malnutrition, and social isolation. The condition can also impact personal relationships and diminish overall quality of life. Diagnosing and treating orthorexia is not straightforward, as it is not recognised by the DSM or ICD, and no specific treatment exists for the condition.

Healthcare providers typically adopt a multidisciplinary approach, with psychotherapy playing a central role. Increasing exposure to anxiety-inducing foods and cognitive behavioural therapy (CBT) are used to challenge self-imposed dietary habits. Dietitians help to improve the variety of foods consumed, while physicians address physical symptoms such as nutritional deficiencies or hormonal imbalances.