Orthorexia nervosa isn’t listed in the DSM, but it has become a highly discussed and increasingly scrutinized pattern of disordered eating. At its core, orthorexia is marked by an intense focus on eating only foods deemed “clean,” “pure,” or “healthy,” often at the expense of flexibility, connection, or overall well-being.
The signs of orthorexia can be difficult to spot, in part because the behaviors are so often praised. But beneath the surface of rigid food rules and wellness perfectionism, there may be deeper patterns of anxiety, shame, and fear. Understanding orthorexia requires looking beyond food choices and asking harder questions about how our culture defines health, and who gets hurt in the process.
Orthorexia: When Healthy Eating Becomes Harmful
Orthorexia has often been described in simplified terms, such as an “obsession with healthy eating,” but that framing doesn’t capture the nuance or harm. More than a desire to eat well, it often involves a rigid belief system around food that becomes increasingly difficult to interrupt. Over time, what may start as a genuine interest in nutrition can narrow into a rule-bound worldview, where food choices are tightly linked to identity, morality, and perceived safety.
Cutting out entire food groups, experiencing guilt or anxiety after eating certain foods, and prioritizing food “rules” over hunger, connection, or quality of life are just a few of the patterns that may indicate orthorexic behavior. Unlike other eating disorders, orthorexia isn’t primarily motivated by a desire for thinness, but that doesn’t mean body image isn’t part of the picture. In fact, a recent review of the literature highlights that orthorexia frequently overlaps with anorexia and bulimia, and may be more common among individuals with current or past eating disorders.
Risk Factors, Overlaps, and the Problem with Linear Thinking
Orthorexia is often positioned as separate from diagnoses like anorexia or bulimia, or described as a “gateway” that may evolve into something more recognizable. But this kind of linear thinking, which frames one set of behaviors as simply leading to another, doesn’t reflect the reality for many people.
Many individuals who exhibit orthorexic patterns have a history of eating disorders, or are living with multiple sets of symptoms at once. A drive for nutritional control can exist alongside body dissatisfaction, calorie tracking, or weight-focused restriction, even when the language used sounds rooted in wellness. Some individuals may turn to orthorexic behaviors after recovering from another eating disorder, while others find themselves navigating overlapping symptoms without clear diagnostic boundaries.
Other risk factors include perfectionism, anxiety, and a high need for certainty or structure. But these aren’t just individual traits, they’re often reinforced by environments that reward discipline, productivity, and self-denial. From athletes and dancers to health professionals and high achievers, orthorexia often appears in people who are praised for these traits, not questioned about them.
Screening Tools, Clinical Gaps, and the Culture That Clouds Them
When symptoms are normalized by culture and blurred by overlapping diagnoses, effective screening becomes even more important—and more difficult. Orthorexia isn’t currently included in the DSM, and no universally accepted diagnostic criteria exist. Tools like the ORTO-15 and the Eating Habits Questionnaire (EHQ) have been used in research, but both have notable limitations. The ORTO-15, for example, has been widely criticized for its poor reliability, while the EHQ is better at identifying health-focused eating behaviors than assessing clinical severity.
Without a standardized framework, clinicians are left to piece together patterns using tools designed for other disorders or relying on personal judgment. This ambiguity can delay care or lead to misclassification, especially when someone’s eating behaviors are praised as disciplined or admirable. In this context, the line between health concern and clinical risk becomes difficult to draw and easy to dismiss.
What Gets Missed in the Name of Healthy Eating
Identifying health-focused eating habits isn’t enough when it comes to orthorexia, because it’s often the emotional distress and functional impairment behind those behaviors that signal something more serious. And this is where the line is often drawn in the medical model, between patterns of behavior and experiences that may appear normative, and those that cause disruption to functioning, psychological, or physical well-being.
That harm can take many forms. Psychologically, orthorexia is often accompanied by guilt, anxiety, isolation, and a loss of flexibility or joy in eating. Physically, the consequences can be equally serious: malnutrition, digestive disruption, hormonal imbalance, fatigue, and other complications common to restrictive eating patterns. These outcomes rarely appear all at once. They build slowly, reinforced by praise, misinformation, and systems that reward control.
This is why how we talk about food matters. The words we use—casually, clinically, culturally—can either reinforce disordered patterns or make space for something more grounded, humane, and whole.
Communication, Curiosity, and Compassion
How we talk about food shapes how we relate to it. Language that labels food as clean vs toxic, or guilty vs “good”, doesn’t just reflect personal preference, it reinforces a system that moralizes eating and triggers shame. Moving toward flexibility means recognizing that food is more than fuel or medicine. It’s also about pleasure, culture, connection, and feeling nourished and whole. Approaching food with curiosity instead of judgment can protect not only physical health, but emotional well-being.
The All Foods Fit framework often receives pushback from those who misinterpret it as nutritionally careless. But that criticism misses the point. All Foods Fit doesn’t mean ignoring allergies, sensitivities, or cultural and personal needs, it means stepping away from strict, external messages about food that dictate what we should consume in the name of health. It’s about letting internal cues, lived experience, and individualized care guide the choices we make. It’s about giving permission to enjoy things like sugar, salt, and fat—things any chef will tell you contribute to the magic and the chemistry of creating something delicious and special.
Mental health is health too, and the way we speak about food and bodies, and how we define success and achievement, will always hold power. We can’t afford to overlook this lens when we talk about orthorexia treatment, because lasting recovery depends on more than what we eat, it depends on how we understand why the rest of it matters.
If you or someone you care about is struggling with an eating disorder, know that help is available, and recovery is possible. Reach out to get started today.
