Orthorexia - Anxiety about “Health & Fitness”

food restriction orthorexia

All about Orthorexia and it’s Treatment

In recent times, there has been a growing interest in eating healthy and staying fit. An increasing number of people have a desire to eat “pure” or “clean” foods. Many will go to great lengths to change their lifestyle to incorporate elements of exercise and healthy eating: driven by the idea that doing so would improve their health. For the large majority of us, such a conclusion would be quite accurate – swapping pizza and fried chicken for salad and grilled fish, and doing more exercise instead of sitting at home in front of the television, would seemingly benefit our overall health and wellbeing. However, too much of a good thing can come at a cost, to both our physical and mental wellbeing.

Orthorexia is an unhealthy fixation on healthy eating. Although not officially recognised on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), it is similar to other eating disorders where individuals obsess about specific types of food and overall intake. Orthorexia typically starts out as an innocent attempt to eat more healthily. However, individuals with orthorexia become unhealthily fixated on food quality and purity, and start to obsess over what, how and when, to eat, including in what way they will deal with “slip-ups” (typically via stricter eating or more exercise).

Orthorexia is a disorder rooted in food restriction, where the types of food are severely controlled. Individuals who are orthorexic have a tendency to avoid foods that are processed (like refined sugar or white flour), and only consume foods that claim to be organic, natural, raw, or “whole”. People can spend excessive amounts of time, for example four hours a day, reading about and preparing specific types of foods, and experience feelings of guilt after eating food that is deemed “unhealthy”.

Individuals with Orthorexia may obsess about any number of nutritional aspects of food, including, but not limited to the following:

  • Calories
  • Sugar: in particular refined sugar
  • High fructose corn syrup
  • Fat
  • Hydrogenated or partially hydrogenated fat (trans fats)
  • Protein
  • Carbohydrates
  • Glycemic Index (GI)
  • Salt/sodium
  • Fiber
  • Gluten
  • Dairy products
  • Fatty acids
  • Vitamin and mineral content of foods
  • “Whole” or “organic”
  • Genetically modified foods
  • Raw foods

Orthorexia differs from anorexia and bulimia nervosa in that orthorexics do not fear being fat; they eliminate entire groups of foods in the quest for a “perfect” and “clean” healthy diet, whereas anorexics and bulimics obsess about calories, for fear of weight gain.

The causes of orthorexia are as yet unclear; however there has been some discussion on some of the underlying motivations to eat “clean”. Some of these include compulsion for complete control, wanting to be thin, using food to create an identity, safety from poor health, proving their self-discipline and self-control, and improving self-esteem.


Because society has been pushing us to be more aware of our foods and to be healthier, it can be easy to miss some of the signs of orthorexia. At times, we may hide behind the idea that we are simply eating well. Following a healthy diet does not make you orthorexic. However, there are some key characteristics that can be indicative of orthorexia. These include:

  • Excessive concern about food quality
  • Spending excessive amounts of time and attention on food (e.g., reading about, preparing)
  • Eliminating or avoiding foods deemed “unhealthy”
  • Difficulties eating a meal prepared by someone else without attempting to control what is served
  • Looking for ways that food is unhealthy for you
  • Feelings of guilt or self-loathing in the event of a “slip-up”
  • Intrusive thoughts about food
  • Spending time discussing food and attempting to convince others of the “correct” diet
  • Becoming separated or lonely as a result of the need to eat healthily

Despite the belief that orthorexics may have about their diet being “clean” and “healthy”, the diet of orthorexics may actually have nutritional deficits which, in extreme cases, can lead to malnourishment. Additionally, orthorexia can become an isolating disorder as much of our social interaction takes place over food. Orthorexics can find that eating foods that are not considered “pure” to be anxiety provoking, and may limit or avoid social engagements in order to control their food intake and to reduce their distress. Additionally, many orthorexics plan much of their life around food and may lose the ability to eat intuitively – to know when they are hungry, how much food they need to eat, and when they are full. Such behaviours and tendencies can become socially limiting and drastically reduce an individual’s quality of life.

Evidence-based treatment strategies used in the treatment of other eating disorders and Obsessive-Compulsive Disorders (OCD) has been found to be effective in treating orthorexia. Both Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can be highly effective in treatment orthorexia. Using CBT, individuals learn more about nutrition and strategies to challenge their thoughts and beliefs underlying their orthorexia. Exposure is also incorporated into treatment, to enable the gradual reintroduction of foods into your diet, returning to social interactions with others involving food, and limiting the amount of time researching foods. Individuals with orthorexia also learn to accept uncomfortable thoughts and sensations in relation to food and their body. The goal for treatment is on identifying what the underlying cause of the obsession behind healthy eating is and for individuals to become more comfortable with their bodies and health to change their relationship with a variety of foods. Ultimately, treatment will help individuals learn to have a more balanced perspective on food and to be able to enjoy eating.

Author: Dr Daphne S Bryan, DPsyc (Clin); BPsycSci (Hons)

Who we recommend


Adult Therapist

Dr. Daphne Bryan

For adults experiencing excessive concerns around "healthy eating", we would recommend Dr Daphne Bryan, who is one of our skilled clinical psychologists here at Anxiety House. Daphne uses a variety of psychotherapeutic techniques, including: Cognitive Behavioural Therapy, Mindfulness-based therapy, Schema Therapy, and Acceptance, and Commitment Therapy (ACT).


Kratina, K. (2014). Orthorexia Nervosa. Retrieved from http://www.easybib.com/reference/guide/apa/website

Marcason. W. (2013, April). Orthorexia: An obsession with eating “pure”. Retrieved from http://www.eatright.org/Public/content.aspx?id442471029

Quinlan, K. (2013). Orthorexia: Where eating disorders meet OCD. Retrieved from: http://www.ocdla.com/blog/orthorexia-eating-disorders-ocd-1282

Reddy, S. (2014, November). When healthy eating calls for treatment. Retrieved from: http://online.wsj.com/articles/when-healthy-eating-calls-for-treatment-1415654737