What Is Orthorexia? Symptoms & Treatment Options, From Experts

Trigger warning: This article discusses obsessive dieting and disordered eating. Those who struggle with an eating disorder can visit the National Eating Disorders Association for support. 

In a world filled with "What I eat in a day" videos, it's difficult to distinguish between a passion for healthy eating and an obsession with it.

"Orthorexia nervosa is an eating disorder that involves a fixation on healthy eating and ritualistic behavior," explains Rafaat W. Girgis, M.D., a board-certified psychiatrist at Moment of Clarity, a mental health treatment center.

The term "orthorexia nervosa" was coined by physician Steven Bratman in 19971, and it translates to "right" or "correct" (ortho) and "appetite" (orexis) in Greek. In essence, orthorexia is a severe obsession with eating healthy. 

Orthorexia is more common among younger people, affecting between 6.9% and 45.5% of adolescents and young adults2. The wide range is due to discrepancies in different studies, suggesting that this eating disorder calls for more organized research to assess prevalence accurately. However, the presence of orthorexia does seem to be steadily increasing in recent years, likely for reasons we'll touch on in a bit.

The thing is, "healthy" eating looks different for everybody. One person could see a very restrictive vegan diet as healthy; others a raw meat diet, some a low-carb diet, and so on—which makes this eating disorder difficult to identify. 

"[Orthorexia] often just looks like healthy eating. The signs of rigidity, obsessiveness about disease, and health are often unrecognized," adds registered dietitian and founder of Real Nutrition Amy Shapiro, R.D.

Say two people were on a road trip and had to stop for a meal at a diner. Both people may be healthy eaters in their day-to-day and prefer minimally processed natural foods. However, the person struggling with orthorexia will likely feel much more guilt and anxiety surrounding the diner food—even if it's the only option.

That person with orthorexic tendencies may feel the urge to skip the meal altogether for the sake of preserving their clean eating patterns, while the other person may be able to consume the healthiest option they find on the menu without lasting shame or anxiety about how it will impact them. In essence, people who struggle with orthorexia never allow for imperfection when it comes to their diet, and if they have to for any reason, intense emotional discomfort follows.

This same situation can be applied to events like birthdays, holidays, and other celebrations where available food items may not be as healthy as one is used to.

Many people assume orthorexia is similar to anorexia, but it's actually quite different. "Orthorexia revolves around quality, not quantity," Girgis says. 

He adds, "Unlike those with anorexia nervosa or bulimia nervosa who seek to be thinner, patients with orthorexia focus on ritualistic beliefs that healthfulness of food is the primary goal rather than losing weight." 

That being said, multiple eating disorders can exist at once, and they can overlap with other mental health conditions. "Orthorexia can overlap with other conditions like anorexia and bulimia, obsessive/compulsive disorder, anxiety, and depressive disorders as well," Girgis says. 

If reading about extremely rigid food choices has you thinking, "That sounds familiar," it could be due to the fact that social media outlets like TikTok and Instagram are filled with health advice from people struggling with orthorexia. 

The hard part: "Oftentimes you will not see credentialed individuals showing their entire day, maybe a meal or their supplements or their exercise routine that day," Shapiro says. This can perpetuate unrealistic standards and leave the viewer to assume their entire day should look like what they see on the screen.

"My go-to treatment for eating disorders or obsessive-compulsive disorders is always going to be cognitive behavioral therapy (CBT)," Girgis says. 

This method helps the patient to identify the thoughts and feelings that directly affect their behaviors. Once you teach someone how to challenge and change negative thinking about food, their self-image and food behavior can then improve as well. 

If you are on social media of any kind, it's a good idea to curate your feed to only include positive, helpful information. 

This could mean unfollowing someone who preaches disordered eating, skipping videos that promote strict diets, or taking a break from social media altogether. 

As many therapists will tell you, the power of a support system is truly unmatched. Surround yourself with trusted friends and family who support you on the journey to healing your relationship with food. 

Finally, accept that healing from an eating disorder takes a great amount of time and effort—in other words, it won't happen overnight. 

As for anyone not personally struggling with disordered eating, it's equally important to monitor your own comments, social media posts, etc., and make sure you're not contributing to a negative diet culture when possible or propping up those who do—knowingly or unknowingly. 

As Shapiro says, "We need to educate people on the seriousness of this as many people just confuse this type of behavior as 'gold standard nutrition' or 'great willpower.'"