3 Warning Signs That a Patient Might Be Struggling with Orthorexia

 3d number three 3 symbol with rustic gold metalOur society promotes the concept of “healthy eating,” with an almost religious zeal.  We are constantly bombarded with advertisements and articles pronouncing the importance of eating “whole foods,” alleged “superfoods,” and the latest fads in the “wellness world.”

As a psychotherapist specializing in the treatment of individuals with eating disorders, I have seen the dangers of classifying foods as “good” and “bad.” This “black and white” thinking can contribute to disordered eating, eating disorders and an unhealthy relationship to food. The reality is that all foods can fit into a healthy diet. Additionally, for those with an underlying genetic predisposition, a decision to try to “eat healthier,” can be taken to a dangerously unhealthy extreme.

Orthorexia nervosa is when an individual becomes fixated on “healthy eating,” to the point where it becomes mentally and often physically unhealthy. Orthorexia nervosa is not currently a diagnosis in the DSM-5, however it is believed to be an emerging eating disorder that is on the rise.

Orthorexia Nervosa

 Orthorexia nervosa was coined by Dr. Steven Bratman in 1997 to describe people who have developed an unhealthy obsession with “healthy eating.”  So can you determine if a client’s interest in “healthy eating,” has become a life-threatening eating disorder?

 The following are some red flags that could indicate that your client is struggling with orthorexia.

 1.     Increased fixation on “healthy food.”

 Often orthorexia will begin with someone’s intention to start to “eat healthier.”  However, this is not to say that everyone with this desire will go on to develop an eating disorder. Eating disorders have underlying genetic components, which are then triggered by environmental factors.

According to Bratman, individuals that are struggling with orthorexia often develop an obsessive focus on food choices, planning, preparation, and consumption. Additionally, they might start to develop a heightened belief system around certain foods, as being able to either prevent, cure or cause a variety of health conditions.

Additionally, they typically spend a lot of time thinking about “health” and “nutrition,” to the point where it becomes their primary focus. They may spend hours reading food and nutrition blogs, recipes and articles.

2.     Cutting out food groups and rigid rules, which invoke guilt when “broken.” 

Further, individuals with orthorexia will often begin to develop a series of restrictive “food rules,” which invoke feelings of guilt when “broken.” For instance, someone with orthorexia may state, “I only eat whole grains,” or “I only eat non-processed, organic foods.” Others may develop an obsession with “clean eating,” or “locally sourced foods.”

Individuals with orthorexia often will start to cut out more and more foods from their diet. For instance, they might decide to cut out meat, gluten, carbs, or any foods that they deem to be “unhealthy.” Additionally, there is often a strong sense of “morality” associated with food. For example, those with orthorexia may feel that if they eat a certain way it makes them a “good” person.

 It’s also critical to note that simply enjoying kale, does not mean that someone is struggling with orthorexia. Rather, it’s important to look at someone’s level of flexibility surrounding food. For instance, are they able to eat other types of foods, if their “healthy” foods are unavailable or they are in a particular social setting? If they are unable to do so, or if this causes feelings of extreme anxiety-they could be struggling with orthorexia.

 3.     Withdrawing from social relationships because of anxiety around food.

 Eating disorders are often disorders of isolation, as people who are intensely struggling may begin to withdraw from social relationships because of  anxiety surrounding food.

If an individual’s desire to “eat healthier,” is beginning to impact their relationships or other aspects of their life, this is a sign that they could be struggling with orthorexia. For instance, someone who is struggling may start to avoid parties or eating out with friends and family, as they are unable to control the food that will be served.

 If someone’s interest in “healthy eating” is causing them to become socially isolated, this is one indication that they might be struggling with orthorexia.

 Treatment Considerations

 For the full list of proposed diagnostic criteria for orthorexia, check out this link.

If you believe that a client might be struggling with orthorexia, it is critical that they are able to receive proper treatment and support. If you are not knowledgeable about eating disorders, it is important to receive consultation or supervision from an expert or to refer them out to a specialist.

 Additionally, when working with clients with eating disorders, it is important to utilize a multidisciplinary team. Eating disorders are complex and life-threatening illnesses and clients benefit from having a treatment team, which can include a therapist, registered dietitian, psychiatrist, physician and recovery coach.

 Lastly, it’s important to emphasize to clients that full recovery is possible. With access to treatment and support, individuals with orthorexia can recover, and go on to have full and meaningful lives.


 Bratman, S. (2014, January 23). What is orthorexia? Retrieved from


3 Warning Signs That a Patient Might Be Struggling with Orthorexia

Jennifer Rollin, MSW, LCSW-C

Jennifer Rollin, MSW, LCSW-C is a therapist in private practice in Rockville, Maryland, specializing in working with teens and adults struggling with eating disorders, body-image issues, anxiety, and depression. She writes for The Huffington Post and Psychology Today. Connect with Jennifer at


APA Reference
Rollin, J. (2016). 3 Warning Signs That a Patient Might Be Struggling with Orthorexia. Psych Central. Retrieved on August 10, 2020, from


Scientifically Reviewed
Last updated: 6 Nov 2016
Last reviewed: By John M. Grohol, Psy.D. on 6 Nov 2016
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