Orthorexia nervosa is characterized by an obsessive focus on eating foods that an individual considers pure, healthy, or clean. Unlike other eating disorders that center on the quantity of food consumed, orthorexia revolves around the perceived quality of food. What may begin as a genuine interest in nutrition gradually becomes a rigid, all-consuming set of dietary rules that dominates a person's thoughts, time, and social life.

Common signs and symptoms include:

• Spending excessive time each day planning, preparing, or thinking about food quality and sourcing
• Progressively eliminating entire food groups without medical justification (e.g., all processed foods, all grains, all cooked foods)
• Intense guilt, anxiety, or self-loathing after eating anything perceived as unhealthy or impure
• Refusing to eat food prepared by others due to distrust of ingredients or cooking methods
• Withdrawing from social events that involve food, leading to increasing isolation
• Tying self-worth and identity to the strictness of one's dietary adherence
• Physical consequences such as unintended weight loss, nutritional deficiencies, fatigue, hair loss, or feeling cold frequently
• A pattern of dietary rules becoming more restrictive over time rather than less

People with orthorexia often do not recognize that their behavior is problematic because their stated goal, eating healthfully, is socially praised. This makes the condition particularly difficult to identify, both for the individual and for those around them.

Orthorexia nervosa is not currently listed as a formal diagnosis in the DSM-5 or ICD-11. However, it is widely recognized by eating disorder specialists and researchers as a distinct pattern of disordered eating. Depending on the presentation, a clinician may diagnose it under Avoidant/Restrictive Food Intake Disorder (ARFID), Other Specified Feeding or Eating Disorder (OSFED), or Obsessive-Compulsive Disorder (OCD), depending on which criteria are met.

Assessment typically involves:

• A detailed clinical interview exploring dietary history, food-related beliefs, and the degree of distress and impairment
• Validated screening tools such as the ORTO-15, the Eating Habits Questionnaire (EHQ), or the Düsseldorf Orthorexia Scale (DOS)
• Medical evaluation for nutritional deficiencies, hormonal imbalances, or other physical effects of a restricted diet

Treatment approaches that have shown effectiveness include:

• Cognitive-behavioral therapy (CBT): Helps identify and challenge rigid, all-or-nothing thinking about food, builds tolerance for flexibility, and addresses the anxiety that drives restrictive eating
• Exposure and response prevention (ERP): Gradually introduces "feared" foods in a structured way, reducing the anxiety associated with eating them
• Nutritional counseling: A registered dietitian works with the individual to restore dietary variety, address deficiencies, and develop a balanced relationship with food
• Family-based or relational therapy: Particularly useful when orthorexic behaviors are affecting close relationships or when family members are inadvertently reinforcing the behaviors

Recovery often involves learning that health is not determined by perfect eating but by a flexible, sustainable, and enjoyable approach to food and life.

Consider seeking professional support if your focus on healthy eating is causing any of the following: persistent anxiety or guilt around food choices, avoidance of meals with friends or family, unintended weight loss, fatigue or other physical symptoms that may stem from nutritional restriction, or a sense that food rules are controlling your life rather than improving it.

It is also important to seek help if people close to you have expressed concern about your eating habits. Individuals with orthorexia are often the last to recognize the problem because their behavior feels virtuous rather than harmful. Listening to the observations of trusted family members, friends, or a healthcare provider can be an important step.

You do not need to meet the criteria for a formal eating disorder diagnosis to benefit from professional guidance. A therapist experienced in disordered eating can help you evaluate your relationship with food and determine whether your habits are supporting your well-being or undermining it. The following resources offer additional information and support:

• National Eating Disorders Association (NEDA): Orthorexia
• Mayo Clinic: Eating Disorders Overview
• NHS: Eating Disorders