Orthorexia Nervosa

A plate of fruits and vegetablesOrthorexia nervosa is an eating disorder characterized by a fixation on the consumption of healthy foods and the avoidance of those perceived to be unhealthy. Those who have this condition may experience physical and emotional health issues, social isolation, and other issues as a result of their desire to maintain a pure diet.

What Is Orthorexia?

Orthorexia is a term derived from Greek that means “correct eating.” Dr. Steven Bratman coined the term in 1997 to describe an obsession with eating only those foods that the person with the condition considers to be healthy. Though not currently recognized as an official diagnosis in the Diagnostic and Statistical Manual (DSM), the prevalence of orthorexia continues to increase with a corresponding growth in dietary trends and body-conscious health movements.

While those individuals diagnosed with anorexia nervosa are typically concerned with the quantity of food intake, those with orthorexia nervosa focus instead on the quality of the food they eat. Food quality is often determined by a variety of factors, including health benefits, perceived food allergies that may not have been diagnosed, and food preparation and processing methods.

Orthorexia often begins with a genuine desire to live a healthier lifestyle, but this desire often becomes a fixation that can be difficult to control. Those experiencing this condition at its extreme may choose to forgo eating rather than eat foods they have deemed to be unhealthy.

Some foods a person with orthorexia may avoid include:

  • Foods produced using pesticides or genetic modification
  • Fat, sugar, and salt
  • Artificial flavors, colors, or preservatives
  • Animal or dairy products
  • Wheat, corn, and soy

What Causes Orthorexia?

The direct cause of orthorexia is unknown. However, a person may have certain predispositions that can increase the likelihood of developing this condition, such as:

According to Bratman, anxiety is often the strongest underlying cause of orthorexia. This anxiety often starts out as a fear of illness or poor health, but the act of maintaining control over one’s diet might also be used to mask an underlying condition of anxiety.

Signs and Symptoms of Orthorexia

The difference between a person with orthorexia and an individual choosing to adhere to a specific diet is the fixation—considered extreme by some—on foods perceived to be healthy and the limitation in food selection.

An individual diagnosed with orthorexia may:

  • Exhibit a demonstrated and significant concern regarding the relationship between food choices and health concerns such as allergies, anxiety, mood changes, digestive issues, etc.
  • Spend 3 or more hours per day reading about, acquiring, and preparing foods that are perceived as pure and wholesome.
  • Drastically reduce the personal number of acceptable food choices. Some individuals with this condition may consume fewer than 10 different foods.
  • Have significant concern regarding food preparation, such as the washing of food or sterilization of utensils and dishes.
  • Avoid specific foods due to perceived allergies, often without medical advice or diagnosis.
  • Feel guilty or anxious when deviating from personal dietary restrictions.
  • Avoid eating with friends and family who do not adhere to the same diet.
  • Avoid food prepared by someone else.
  • Feel it is possible to maintain control in life by controlling the type of food consumed.
  • Develop elaborate food rituals that can lead to isolation from others.
  • Spend a significant portion of income on food.
  • Feel superior to those who do not adhere to a similar “pure” diet.

How Is Orthorexia Diagnosed?

There are not currently any official diagnostic criteria for this condition. Many therapists and professionals choose to use The Bratman Test for Orthorexia, which indicates orthorexia nervosa in a person who answers “yes” to more than five of the following questions:

  • Do you spend more than 3 hours per day thinking about food and/or diet?
  • Does your self-esteem get a boost from healthy eating?
  • Do you plan meals several days in advance?
  • Do you feel at peace with yourself and in complete control when you follow your dietary rules and eat healthy?
  • Have you given up foods you used to enjoy in order to eat the “right” foods?
  • Have you become increasingly strict with yourself in terms of food?
  • Is the nutritional value of your meal significantly more important than the pleasure of eating it?
  • Has the quality of your life decreased as the quality of your food has increased?
  • Does your diet make it difficult for you to eat out, distancing you from family and friends?
  • Do you feel guilty when you stray from your diet?

Treatment for Orthorexia

Before orthorexia can be treated, those with the condition typically must first admit that their eating may be disordered. Those with orthorexia may have difficulty doing so, because they tend to believe they are simply eating well. Once the problem is recognized, therapists can work with those in treatment to explore any underlying emotional causes driving the condition and help them begin to reestablish a healthy relationship with food.

Some individuals may fear a reincorporation of a certain food into their diet will have potentially devastating effects on their health, and a nutritionist or physician may be able to help with the development of and adherence to a balanced eating plan that works for an individual’s particular needs. Nutritionists can also help those in treatment learn more about the ways certain foods benefit the body, and physicians can address any health issues that may have developed as a result of the condition.

Support groups may also be helpful for some individuals, who may benefit from discussing eating and food issues with others who have experienced similar conditions.


  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association, 2013.
  2. Barclay, R.S. (2015, February 24). Orthorexia: The New Eating Disorder You’ve Never Heard Of. Healthline News. Retrieved from http://www.healthline.com/health-news/orthorexia-the-new-eating-disorder-youve-never-heard-of-022415#1
  3. Bratman, S. (2015, May 17). Anxiety and Orthorexia. Retrieved from http://www.orthorexia.com/anxiety-and-orthorexia
  4. Donini, L.M., Marsili, D., et.al. (2004, June). Orthorexia nervosa: A preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eating Weight Disorders. Vol 9: 151-157. Retrieved from http://www.orthorexia.com/wp-content/uploads/2010/06/Donini-Orthorexia-Nervosa-Dimension-of-the-phenomena.pdf
  5. Kratina, K. Orthorexia Nervosa. NEDA: Feeding Hope. Retrieved from https://www.nationaleatingdisorders.org/orthorexia-nervosa
  6. Orthorexia Symptoms and Effects. Timberline Knolls Residential Treatment Center. Retrieved from http://www.timberlineknolls.com/eating-disorder/orthorexia/signs-effects

Last Updated: 12-4-2015

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