Leading a healthy lifestyle can certainly improve your quality of life, however sometimes it can have the opposite effect if overdone. You may be wondering what the line is between healthy eating patterns and unhealthy eating patterns. We hope that this blog post can help provide you with more information on disordered eating, its signs, as well as eating disorder treatment. We will also be specifically talking about orthorexia in this blog. 

What is orthorexia?

Orthorexia lacks awareness compared to some of the other more recognized eating disorders. It is not included in the DSM-5, which is the handbook used to diagnose mental health conditions, so it lacks formal diagnostic criteria, but many clinicians still recognize it and work with clients to provide eating disorder treatment. According to researchers, Nancy S Koven and Alexandra W Abry, Orthorexia involves an obsession with proper nutrition. It is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods that are believed to be impure or unhealthy. While being mindful of the nutritional quality of the foods you eat can be beneficial, those with orthorexia are so fixated on eating healthy that it starts to cause them distress in their daily lives. Some behaviors associated with orthorexia can include:

  • Compulsive checking of ingredient lists and nutritional labels
  • Obsessive following of food blogs and fitness influencers on social media
  • Fear of eating unhealthy foods and distress when healthy food options are not available
  • Cutting out food groups (gluten, dairy, animal products, sugar)
  • Unusual interest in the health and eating habits of those around them

Although the term ‘orthorexia’ was coined in 1996, the eating disorder is not fully understood which may be part of the reason it has not been included in the DSM-5 as its own mental health diagnosis. Some eating disorder therapists and professionals believe it is a component of other mental health conditions such as anorexia nervosa and obsessive-compulsive disorder. However, others argue it should have its own diagnostic criteria and treatment. Unlike anorexia or bulimia, orthorexia may or may not be based on a desire to be thin or lose weight. It can be more so based on a desire to maintain a healthy lifestyle through controlling the quality of food eaten. Oftentimes, those struggling with orthorexia base their self-worth on their ability to lead a healthy lifestyle and when they deviate from it, they experience a great deal of distress. Individuals with orthorexia tend to struggle more with the quality of food over quantity, however quantity is still viewed as important. 

Orthorexia and exercise addiction oftentimes occur together. Both are similar in that there is an obsession with being healthy and it is difficult to distinguish between normal behaviors and unhealthy behaviors. Many people who struggle with orthorexia and exercise addiction also struggle with perfectionism and giving up control. Signs that someone might be addicted to exercise include:

  • Exercising when tired, sick, or injured
  • Experiencing significant distress when missing a workout
  • Avoiding social interactions in order to exercise
  • Exercising more if you ate a lot or missed a previous workout
  • Eating significantly less if you cannot workout that day

Those with exercise addiction experience very similar negative effects to those struggling with orthorexia. Exercise addiction can also lead to additional physical consequences such as injuries, weight loss, and missed periods and weakened bones in females. It is important to note though that eating disorders look different in all shapes and sizes. Eating disorders do not always go hand-in-hand with weight loss and weight loss is not always an indicator of an eating disorder. As with orthorexia, exercise addiction can be treated with eating disorder therapy by a therapist who specializes in eating disorders. 

What are the negative effects of orthorexia?

There are several different ways orthorexia can negatively impact you including physically, psychologically, and socially. Some physical effects can include anemia and malnutrition due to restrictive eating as part of eating a “clean” diet and cutting out food groups. Malnutrition can lead to digestive problems such as bloating and constipation, as well as hormonal and electrolyte imbalances. This eating disorder can also harm your mental health as it can cause a deterioration of your self-worth because it is rooted in strictly following a pure lifestyle. The guilt experienced when you “cave” to a craving can lead to anxiety, depression, or poor body image. Other negative psychological effects include the mental exhaustion that comes with the constant preoccupation of food throughout each day. This can impair a person’s social life by engaging in behaviors such as spending hours researching, measuring, and preparing future meals. It can cause a person to become socially isolated when they do not attend events that cater foods that do not meet their high standards of health. Someone with orthorexia can start to compare their diet to those around them which can evoke a feeling of superiority above others. 

orthorexia eating disorder healthy eating


Eating disorder treatment: How to get diagnosed with orthorexia?

If you think you may have orthorexia, it is important to see a psychologist or therapist that specializes in eating disorders. Eating disorder therapists are trained in assessing and screening for eating disorders. The screening may be done with questionnaires that you fill out or a verbal assessment of thoughts and behaviors surrounding food. 

While orthorexia is a relatively new eating disorder, it is possible to use this term to label an eating pattern despite there not being universally recognized criteria for the disorder. A few diagnostic tools have been developed for orthorexia such as the Bratman Orthorexia Test (BOT), OTR-5, and the Eating Habits Questionnaire (EHQ). All three tests have their limitations though. A two part diagnostic test has been created by Bratman, the clinician who coined the term ‘orthorexia,’ to more simply distinguish orthorexia from healthy eating habits. To meet the criteria for orthorexia, you must (1) experience an obsessive focus on healthy eating and (2) it must disrupt your daily life. The first one involves compulsive thoughts and behaviors centered around food, dietary restrictions, and anxiety when ‘rules’ are broken. The second involves medical issues, difficulty with daily functioning, and decreased self-worth or body image. Sometimes people find it beneficial to be able to use the label orthorexia to categorize a pattern of thoughts and behaviors. It can allow you to better understand yourself and your provider to better treat your condition. However, some people prefer not to have a label on their eating habits. It is completely up to the individual and what they think is best for them. 

Eating disorder therapy for orthorexia:

Regardless of whether you have a diagnosis or not, eating disorder treatment can be very helpful. It is important to know that everyone is deserving of professional care, even if you lack a diagnosis. Eating disorder treatment is a recommended for eating disorders such as  bulimia, anorexia, and binge eating disorder, and orthorexia is no different. 

If you are unhappy with your eating patterns and feel overwhelmed, the psychologists at Best Within You Wellness & Therapy are here to help you. You do not have to go through this alone. If you are struggling with your eating habits or body image and feel like you could benefit from one-on-one help, please reach out to one of the licensed psychologists at https://bestwithinyou.com/ to schedule a free consultation. You can also learn more about the eating disorder therapy we provide. 

If you want to learn more about orthorexia, and eating disorder treatment here are some additional resources: 





Thank you to Marcella Peach, a University of Georgia Psychology Major and Best Within You Therapy & Wellness Intern, for this blog post.