Yixuan Wu (Author), Alice Xu (Mentor)

At first, it seems harmless: a perfectly labeled pantry and a decision to eat clean. You started to develop a strong discipline of having color-coded systems for food choices and memorizing ingredient lists and nutritional values. You get stuck at the organic food store planning what to eat or not to eat for the next several days. You feel pride in saying no to “unhealthy” foods. But how could eating healthy possibly harm you? Somewhere between cutting out sugar and cutting out relationships, food stops being nourishment and becomes a test. This is where orthorexia nervosa lives – not in the desire to eat well, but in the anxiety, rigidity, obsession, and moral weight to pursue health that begin to surround every bite. The harms are often subtle at first, but they accumulate: from nutritional deficiency, chronic anxiety, to social and functional impairment. What makes orthorexia especially difficult to recognize is that it looks like discipline, and the dietary obsession is seen as healthy self-care. Yet even the healthiest intentions can erode mental well-being and social connection when pursued without balance.

Even though orthorexia nervosa is not formally recognized in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), clinicians increasingly argue that it represents a meaningful and clinically significant pattern of disordered eating. The DSM-5 is the primary diagnostic handbook used by psychologists and psychiatrists in the United States to classify and diagnose mental health disorders. Because orthorexia is not currently included as an official diagnosis in this manual, it is sometimes overlooked or mistaken for simply being very health-conscious. However, research suggests that orthorexia involves much more than an interest in nutrition. Koven and Abry define orthorexia as a pathological obsession with “proper” nutrition, marked by restrictive dietary rules, ritualized eating patterns, and rigid avoidance of foods perceived as unhealthy or impure (Koven & Abry, 2015). Importantly, they emphasize that orthorexia is harmful not because someone cares about health, but because the obsession can lead to medical complications and reduced quality of life. Proposed diagnostic features include obsessive focus on food quality, rigid dietary rules, emotional distress when those rules are violated, and functional impairment. Orthorexia is often confusing to categorize: symptoms overlap with anorexia nervosa (restriction), OCD (obsessions/compulsions), and obsessive-compulsive personality traits (perfectionism and rigidity), making it difficult to decide whether orthorexia is its own disorder or part of a spectrum. More recent work supports the idea that orthorexia must be separated into different dimensions rather than treated as one thing. Depa et al. (2019) used the Teruel Orthorexia Scale to distinguish healthy orthorexia (a non-pathological interest in eating well) from orthorexia nervosa (pathological fixation) and showed these dimensions are driven by different motivations. This distinction is important because eating healthy is not inherently problematic, and many people pursue nutritious diets without harm. However, when the pursuit of health becomes rigid, fear-driven, and disruptive to daily life, it can signal a deeper psychological issue that deserves recognition and understanding. 

These patterns often begin with everyday personal decisions about food. On a personal level, orthorexia can feel like certainty and control—especially for people who are vulnerable to rigid thinking styles. Koven and Abry (2015) suggest that executive functioning patterns may contribute to the disorder, particularly cognitive rigidity and poor set-shifting, which refers to difficulty adapting when rules need to change. Once a dietary rule is created—such as eliminating sugar, processed foods, or non-organic ingredients—it often becomes increasingly strict. Instead of loosening the rule when circumstances require flexibility, individuals with orthorexic tendencies may tighten it further because flexibility feels unsafe. Over time, the rules themselves begin to shape daily decisions about what is safe to eat, where one can eat, and even who one can eat with. This pattern raises an important question about why some individuals become especially attached to strict rules around food. One explanation lies in perfectionism, a personality trait that emphasizes high standards and fear of making mistakes. Research supports the role of perfectionism in orthorexia. Barnes and Caltabiano (2017) found that orthorexic tendencies were significantly associated with multiple forms of perfectionism, including self-oriented perfectionism (holding oneself to extremely high standards), socially prescribed perfectionism (believing others expect perfection), and other-oriented perfectionism (expecting perfection from others). Their study also found that higher orthorexia scores were correlated with stronger appearance orientation and overweight preoccupation, suggesting that orthorexia may involve body-related concerns similar to other eating disorders. Importantly, their analysis identified a history of an eating disorder as the strongest predictor of orthorexia nervosa, reinforcing the idea that orthorexia may exist on the same continuum as other disordered eating patterns rather than as a completely separate condition.

While these psychological traits help explain why some individuals become especially vulnerable to rigid food rules, orthorexia does not just develop in isolation of individual choices. It grows in a culture that elevates health to a moral obligation. Messages about what it means to be “healthy,” the foods we are told to fear or avoid, and the lifestyles we are encouraged to admire all influence how those personal decisions are made. Researchers situate orthorexia within the broader framework of healthism—a cultural ideology that frames health as an individual responsibility and moral achievement (Heman et al., 2015). Under healthism, individuals are expected to actively pursue health through discipline, self-control, and lifestyle choices, especially through diet and exercise. This perspective shifts health from being a general state of well-being to something that must be constantly optimized and proven through everyday behaviors. As a result, food choices become moralized: eating “clean” foods is viewed as responsible and virtuous, while consuming processed or indulgent foods may be seen as careless or weak. The effect of healthism is that dietary discipline becomes socially rewarded. People who follow strict diets may receive praise, validation, or admiration for their perceived dedication to health, reinforcing restrictive behaviors. In this environment, individuals may begin to develop an identity of being the “healthy one” and equate their self-worth with how well they follow dietary rules, which can intensify perfectionistic tendencies and anxiety around food. Because these beliefs are widely reinforced through cultural messaging, rigid eating patterns may appear admirable rather than concerning. 

At the same time, social media can intensify that moral pressure by turning food into performance. It has been found that higher Instagram use—particularly engagement with healthy eating communities—was significantly associated with greater orthorexic symptoms. In their sample, nearly half of the participants following health-food accounts met criteria suggestive of orthorexic tendencies, a rate substantially higher than population estimates. Instagram’s visual format amplifies idealized portrayals of “clean eating.” Algorithms create echo chambers, repeatedly exposing users to similar content and reinforcing narrow standards of dietary purity (Turner & Lefevre, 2017). Therefore, extreme elimination diets can appear normalized and even aspirational. The wellness industry further contributes to this landscape, often promoting detoxes, food elimination, and purity narratives without strong scientific backing. Influencers may lack formal nutritional training, yet their reach is vast. In such a context, cultural reinforcement makes it harder to distinguish discipline from distress, and orthorexia therefore masquerades as self-care. 

Recognizing orthorexia is important because the consequences extend beyond food choices and can significantly affect physical health, psychological well-being, and social functioning. Physically, strict elimination of certain food groups can lead to nutritional deficiencies and medical complications when individuals avoid foods they perceive as impure or unhealthy. Koven and Abry (2015) note that extreme dietary restriction associated with orthorexia can result in malnutrition and reduced overall health despite the intention of pursuing wellness. Psychologically, orthorexia is often accompanied by heightened anxiety, obsessive thinking, and persistent guilt when dietary rules are violated. Because food choices become tied to personal identity and moral value, individuals may experience intense self-criticism or distress when they fail to meet their own rigid standards. This constant mental preoccupation with food can also interfere with concentration and daily functioning. The disorder can also disrupt social relationships. Individuals with orthorexia may avoid restaurants, family meals, or gatherings where they cannot control how food is prepared, leading to isolation and strained relationships. Over time, meals and food preparation may dominate daily life, reducing opportunities for social connection and enjoyment. Being able to understand orthorexia and distinguish it from healthy eating means that treating it as a simple nutrition education may miss the psychological mechanism behind it. Cognitive-behavioral therapy (CBT) is often recommended to address perfectionism, cognitive distortions, and catastrophic beliefs about food. For individuals with significant anxiety or obsessive-compulsive traits, pharmacological support such as selective serotonin reuptake inhibitors (SSRIs) may be helpful in reducing intrusive thoughts and emotional intensity (Koven & Abry, 2015). However, treatment is not about abandoning healthy eating. Recovery is about restoring flexibility: learning to tolerate uncertainty, rebuilding trust around food, and challenging the belief that purity equals safety or worth.

Taken together, current research suggests that orthorexia is not simply a diet trend but a pattern of psychological distress shaped by both individual vulnerabilities and cultural influences. Personal factors such as perfectionism, cognitive rigidity, and a history of eating disorders interact with broader social forces, including healthism and social media reinforcement. Effective interventions must therefore address both dimensions: helping individuals develop more flexible thinking patterns while also recognizing the cultural environments that normalize extreme dietary restriction. Because orthorexia often looks like discipline or dedication to health, it can be difficult for clinicians alone to recognize it quickly—especially since clinicians do not observe the everyday routines, grocery store habits, or social behaviors that reveal how restrictive eating patterns actually affect someone’s life. Instead, the people closest to an individual—friends, family members, roommates, and partners—may be the first to notice warning signs. These signs can include increasing rigidity around food rules, anxiety about eating in social situations, moralized language about “clean” or “pure” foods, or a shrinking lifestyle where meals and food preparation dominate daily thinking. Individuals themselves can also reflect on their relationship with food by asking simple questions: Does eating cause constant stress or guilt? Do dietary rules prevent me from enjoying time with others? Do I feel afraid of breaking food rules even occasionally? Recognizing these patterns matters because orthorexia can quietly harm both physical health and emotional well-being while appearing virtuous on the surface, and raising awareness helps people distinguish between balanced health habits and harmful obsession. Ultimately, health should not be measured by the purity of one’s diet alone. True well-being includes psychological flexibility, social connection, and the ability to enjoy food without fear.

About the Author

Author: Yixuan Wu is a junior at the University of California, Los Angeles (UCLA), majoring in psychology. She is an international student from China. She loves developmental and clinical psychology and hopes to pursue a career as a psychologist or researcher in these fields.

Mentor: Alice Xu is a graduate student in developmental psychology at UCLA. She studies how people build knowledge across development, from young children learning new words to college students developing understanding in complex domains. Her work focuses on understanding the mechanisms that support learning and on designing tools and learning environments that make learning more effective.

References

Barnes, M. A., & Caltabiano, M. L. (2017). The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eating and Weight Disorders, 22(1), 177–184. https://doi.org/10.1007/s40519-016-0280-x

Depa, J., Barrada, J. R., & Roncero, M. (2019). Are the motives for food choices different in orthorexia nervosa and healthy orthorexia? Nutrients, 11(3), 697. https://doi.org/10.3390/nu11030697

Håman, L., Barker-Ruchti, N., Patriksson, G., & Lindgren, E. C. (2015). Orthorexia nervosa: An integrative literature review of a lifestyle syndrome. International Journal of Qualitative Studies on Health and Well-Being, 10(1). https://doi.org/10.3402/qhw.v10.26799

Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: Emerging perspectives. Neuropsychiatric Disease and Treatment, 11, 385–394. https://doi.org/10.2147/NDT.S61665

Turner, P. G., & Lefevre, C. E. (2017). Instagram use is linked to increased symptoms of orthorexia nervosa. Eating and Weight Disorders, 22(2), 277–284. https://doi.org/10.1007/s40519-017-0364-2