Orthorexia: An Update

Orthorexia is evolving.

I initially described orthorexia nervosa based on patterns I observed while studying and practicing alternative medicine. Most of the people I had in mind were trying to treat or prevent illness by following one or another dietary theory. An overlapping category included those who had “fallen in love” with a theory of diet, whether for reasons of ideology (raw foods), ethics (veganism), philosophy (macrobiotics) or pure gullibility (Blood Type Diet). In all cases, health was the central focus, and food was the medium.

Today, the situation has evolved. I have recently been speaking on orthorexia in Norway and Sweden, and have been discussing it with numerous eating disorder specialists in the US, UK and Australia. I now find that while retaining many of its original features, orthorexia has also acquired some new characteristics. I will discuss these here.



One of the most dramatic changes in orthorexia is its current inclusion of exercise. It would now appear that the majority of people with orthorexia are also exercise enthusiasts of one sort or another, whether they do yoga, run or constantly work out at the gym. For some, exercise is as much a primary focus of their lives as eating, and out of the same motivations.

This all makes good logical sense. Exercise is at least as important as diet for improving health outcomes (and, for the non-overweight, far more important) Thus, any health conscious person would naturally exercise as well, and this seems to be occurring.

An interesting fact is that in the European press exercise is increasingly included as a defining characteristic of orthorexia. However, this is incorrect.  While exercise enthusiasm and even exercise dependence may coexist with orthorexia, the term itself refers to obsession with diet, not with exercise.


Fitness vs. Fitnessh

In my day, to be “fit” meant one could easily walk up a long steep hill without breathing hard; it was an element of health as signified by aerobic capacity and endurance. But, as words will do, the term “fit” has migrated its meaning, and now signifies primarily a certain body type: lean and often muscular, radiating health. This is a significant change, an externalization of the concept of fitness, a merger between “healthy” and “sexy.”

To attain a fit body, one must monitor both exercise and food. Exercise helps reduce fat percentage and it’s the only way to build muscles. Close attention to diet, of course, is necessary to reduce fat percentage, and many people additionally believe that eating healthy food will make them look healthy. Purity of diet thus equals unblemished, glowing, perfect skin.

There have always been dual motivations for going to the gym and eating healthy food: to feel healthy and to look good. But I suspect that the appearance aspect of healthy diet has increased lately, due to celebrity endorsements and millions of Instagram photos. Currently, many people may be orthorexic at least in part for their looks rather than their health.


Anorexia in Disguise

I have resisted accepting this aspect of the evolution of orthorexia, because it cuts against my original concept. But honesty requires me to take note.

In my 1997 orthorexia essay and in posts up until now, I have maintained that while those with anorexia want to be thin, people with orthorexia want to be pure. However, I have been forced by reality to recognize that there is no longer such a hard and fast distinction. It appears that a high percentage of people with orthorexia these days DO have a focus on weight loss, at least to some extent. Because it is no longer socially acceptable for a non-overweight person to count calories, many who would otherwise be anorexic talk about “eating healthy” instead. This only “coincidentally” involves choosing low calorie foods. In Health Food Junkies I called this “covert anorexia,” but I didn’t believe it was common. Now I do.

In part this change is due to that fact that very concept of “healthy” food has become, for many people, indistinguishable from that of “low-calorie” food. This is perfectly reasonable, as maintaining normal body weight is by far the major aspect of healthiness to be found in diet. However, it stands at a quite a remove from the healthfoodism that affected my patients, and it remains quite distinct from ideas in currently significant theories such as macrobiotics, raw foods and paleo. Nonetheless, because it is so common, this conceptual merging of “healthy” and “low calorie” brings anorexia and orthorexia closer together.

Another factor is that anorexia itself (as well as its formal DSM definition) has been evolving.

There do remain some definite distinctions: People are ashamed of their anorexia, but they flaunt their orthorexia. People with anorexia skip meals; people with orthorexia do not (unless they are fasting). Those with anorexia focus only on avoiding foods, while those with orthorexia both avoid foods they think are bad and embrace foods they think are super-healthy (such as the ubiquitous kale). And when an anorexic person is in treatment, they have no particular objection to being fed with Ensure or Boost except regarding the calories, whereas an orthorexic person would object to the chemicals.

But these differences may be subtle enough that it might be say that , today, the majority of people with orthorexia have orthorexia with anorexic features, or perhaps anorexia with orthorexic features.

To make matters even more mixed up, there are people with orthorexia who purge via vomiting and use of laxatives for the conscious purpose of removing toxins rather than losing weight.

At a deeper level, all these variations amount to much the same thing: giving food far too prominent a place in one’s life.



Everything I have written above is anecdotal. To properly analyze trends in orthorexia, and its evolving relationship to and differences from anorexia, exercise dependence and personal vanity, one needs research. However, up until now there has never been a formal definition of orthorexia, and without such a definition meaningful research is impossible. There is a survey tool in common use, called the ORTO-15, but it was developed without a definition of what it was intended to survey, and I do not believe it is effectively separates people with orthorexia from people who are merely health food enthusiasts.

To remedy these gaps, I have been working with a prominent psychologist of eating disorders, Thomas Dunn, PhD. We shall soon be publishing a set of formal criteria, and offer a survey tool that effectively picks out people who meet the criteria. This will allow formal investigation into the trends I’ve described above.


The Future of Orthorexia

In Norway, I spent time with Finn Skarderud, a prominent psychiatrist on the subject of eating disorders. Several times he said to me, “the body , and conceptions of the body, are fluid.” On my last day there, we discussed what I thought orthorexia would be like in the future. At first, I  simply reiterated what I have often said: in the future there will be new and different diets, and what we call “healthy food” tomorrow will be different than what we think of it now. But upon reflection, I realized this was too limited a view.

To the extent that orthorexia is about the desire to achieve perfect health and to look like a perfect physical specimen, I believe that the focus of orthorexia will shift entirely in coming decades.

The only reason health conscious people obsess about exercise and diet is that they can’t think of anything else that will improve their health. (Some people do add herbal and non-herbal supplements, but conceptually these are just forms of “superfoods” already included in the category of diet.)

However, the sad fact is that these methods don’t actually do very much.

Seriously. Eating fantastic foods (whatever you believe them to be) can’t possibly, even in theory, have more than a few percentage point influence on health and longevity. Exercise is probably a bit more powerful than this, but it too is sharply limited. Add in all the other methods used by Silicon Valley’s current “biohackers” and it still doesn’t amount to much. People who eat perfectly, exercise constantly and take herbal and other supplements still get cataracts, arthritis, wrinkles, cancer, dementia and heart disease. They become old and frail. They die.

In future, however, it is highly likely that we will use entirely new and more powerful means to extend life, enhance health and reverse aging. One thinks of stem cells, DNA modification, smart implants and nano-technology; in other words, effective rather than goofy biohacking. Once it becomes possible to affect health and aging in ways much more powerful than the limp means of food and running, will our current fascination with food fall away, the impulse shift focus? Or will there be those who avoid the new methods, no matter how effective, and seek to cleave closer to nature, no matter how mortal?


Steven Bratman, MD, MPH



Adolescent Girls and Orthorexia

One of the most disturbing manifestations of orthorexia is its common occurrence among girls in early adolescence. A high percentage of the personal communications I receive on this blog involve such young women and their distressed parents. At the fragile physical onset of puberty, these girls are following “healthy food diets” that amount to starvation.

A frequent entry point for orthorexia in this group is ethical veganism. This is a philosophy with much to admire and naturally appeals to any idealistic person. Unfortunately, in a young women this noble impulse can combine with others that are less benign to create an eating disorder.

Perhaps the most powerful complicating factor is simply weight. Veganism (especially of the raw foods variety) just so happens to involve foods that are low in caloric density. A young vegan while only intending to eat healthy and spare animals pain can easily drop her weight to subnormal or dangerous levels. As soon as she does so, she notices (whether consciously or not) that she looks like the excessively thin female images that dominate in the culture. This is emotional heroin.

But it is heroin acting unconsciously. The young women I am talking about do not think much if at all about their weight. It’s all about health. Consciously, they want to become a perfect physical specimen, immune to health problems big and small, whether bloating, or fatigue or leukemia. Deeper within, they are trying to control something that can’t be controlled, the messiness of being human.

Health foodism presents an attractive solution. By concentrating all their attention on food (and perhaps exercise) they can escape the horrible complexities of life.

But food is too small a thing to bear so much soul; these young women take the power that by right belongs to them and give it away to food.  That’s practically the definition of an eating disorder.

Also, fasting makes you high. Fruit and vegetable smoothies are so luminous and pure that they seem to feel the body with radiant health. These girls feel fantastic; their intuition doe not tell them that they are starving themselves to death.

To make matters even more complicated, a part of the teenage girl’s mind wants to starve herself to death; wants, at least, to engage in some desperate self-deprivation. She also wants to be different, special and better. Being a teenage girl is hideously hard.

And she has practically no idea what she is truly feeling. That type of insight only comes to us after another decade or more of screwing up.

Even if she did have the insight, her brain is malnourished and not working properly.

She is in deep water.


Health Food Book Responsibility

The authors of health food books bear some responsibility. Young readers (like readers of any age) tend to believe that because an idea is published it has a greater likelihood of being true. But there is no filter, no requirement of accuracy required for a book to be published. People can write whatever they want.

And they write some seriously crazy things.

One of the most ignorant and harmful (even evil) health food theories I’ve run across states that menstruation is due to impurities in diet. Under the influence of this idea, one young woman with whom I am in contact believes that her amenorrhea may indicate she has attained a higher state of purity. Needless to say, this concept flies in the face of history, biology and common sense. Menstruation is above all things natural — but truly “natural” is messy, scary and often downright weird.  How much emotionally safer it is to pretend it all has to do with impure diet.

I was once the medical director of Prima Publications, a company that published books on alternative medicine. I remember evaluating one book proposal, and phoning the author to complain. “What you write in Chapter 1 — it simply isn’t true,” I said.  I was treated to a long silence before a puzzled voice said, “Yeah. Uh-huh.  I don’t get it. What’s the issue? ”

Of course, conventional medicine is highly imperfect. But at least it has some system for vetting knowledge. The system has many loopholes and failures, but it exists and works to some extent. There is nothing whatsoever to serve this role among alternative diet books. Authors can say anything they want, and people will believe them.

This is especially the case for young people, because alternative health books belong to a paranoid subculture that naturally appeals to person just beginning to learn that authority figures can be totally wrong.

There is, in fact, much to be paranoid about. Big pharma is in fact insidious and dangerous, agribusiness does not in the least have humanity’s best interest at heart, and conventional medicine has made and continues to make many errors. However, in practice what happens that these genuine issues open a door to an unlimited world of imaginary claims, where authors say whatever they want and then shut the door to critique by saying, “Of course they will tell you this is wrong. That’s what they always say.”


Getting Help

It is very difficult for a young girl with orthorexia to even recognize that she has a problem.  But if she does seek help, either at her own initiative or at the instigation of her parents, those she encounters may assume she has anorexia and treat her inappropriately.  For example, they may strongly encourage she consumes “foods” that restore caloric intake such as Boost or Ensure but that, for obvious reasons, will be perceived as refined, processed, chemical-rich and gross. This has a tendency to invalidate the source of the advice for a young person already inclined to distrust that advice.

I earnestly implore eating disorder specialists to listen to their patients and recognize the difference between orthorexia and anorexia, so as to be able to provide help that can be received.

If you are a young woman with orthorexia, don’t just listen to me. Seek the insights of other women, just a little older, who have gone through it and come out the other side.  They have learned a lot about themselves in the process, and can tell you what the road looks like from just a bit further on. Here are some names/links.  I intend to add more.

Jordan Younger

Kaila Prins

Maddy Moon

I also encourage you to contact these authors and see if they will talk to you personally. Maybe your story will resonate with them, and they will reach out.

One last thing:  At some level, you know that what I’m writing here is true.  There is just a louder part that has its finger in its ears and is shouting, “No! No! No!”  You don’t know how to sort out these internal arguments yet.

But you will figure it out, because deep down you are whole and sane.  You will find your way through the haunted forest. It won’t be easy, but eventually you will get where you want to be, and things will start making more sense.


Steven Bratman, MD

PS. If you are a young woman who has recovered from orthorexia, and have a podcast or blog you think might be helpful for adolescent girls with this issue, please use the Contact form on this blog to get in touch with me.  I will add it to this page.


Healthy Eating vs. Orthorexia

Adopting a theory of healthy eating is NOT orthorexia. A theory may be conventional or unconventional, extreme or lax, sensible or totally wacky, but, regardless of the details, followers of the theory do not necessarily have orthorexia. They are simply adherents of a dietary theory. The term “orthorexia” only applies when an eating disorder develops around that theory.

I feel a need to clarify the distinction because I have recently begun to encounter articles on orthorexia that incorrectly equate the two issues. This is partly my fault because my original orthorexia essay devotes some time to deconstructing dietary theories, for reasons that made better sense at the time than they do now.

Another contributing factor to the confusion, is that the research test used in Europe for studies of orthorexia, the ORTO-15, needs some further refinement; as currently structured, it seems to identify members of healthy eating subcultures rather than those who truly have orthorexia. (Researchers are in dialogue to remedy this.)

There even seem to be people who proudly name themselves “orthorexic” because they choose organic, whole, relatively unprocessed foods, free of preservatives, antibiotics and GMOs. I hate to disappoint you folks, but you need to follow a much more restricted diet than that have a chance at the name!

Enthusiasm for healthy eating doesn’t become “orthorexia” until a tipping point is reached and enthusiasm transforms into obsession.

Orthorexia is an emotionally disturbed, self-punishing relationship with food that involves a progressively shrinking universe of foods deemed acceptable. A gradual constriction of many other dimensions of life occurs so that thinking about healthy food can becomes the central theme of almost every moment of the day, the sword and shield against every kind of anxiety, and the primary source of self-esteem, value and meaning. This may result in social isolation, psychological disturbance and even, possibly, physical harm.

To put it another way, the search for healthy eating has become unhealthy.


Diet as Risk Factor

The issues of “theory of healthy diet” and orthorexia are not entirely separate, because it isn’t possible to develop orthorexia without at first adopting a theory of healthy food. However, in many ways, the specific details of the theory are irrelevant. Orthorexia = disordered eating in relationship to [insert any restrictive theory of healthy diet here.]

As a matter of practical fact, some theories present more risk of orthorexia than others. The more restrictive the diet, the more likely it is to set off the psychological factors that lead to an eating disorder.

The basic “clean eating” diet, which focuses on organic whole foods, free of preservatives, antibiotics and GMOs, barely qualifies as a restrictive theory of healthy eating and only occasionally leads to orthorexia. More risk accrues as increasingly practices related to the history of clean eating theories are added, such as detoxes, juice fasts and other “cleanses.”

Similarly, the standard paleo diet is quite mild, and regardless of whether one believes the theory makes sense or not, becoming paleo most often does not lead orthorexia unless further restrictions follow. Simply remember to take a gentle approach with yourself, as Neil Stephenson advises on his popular Paleoista blog.

Raw foods veganism is on the other extreme, and has a fairly high orthorexic potential. This is a challenging diet to manage safely, and many people who will ultimately develop orthorexia begin as raw foods vegans. Nonetheless, there are also certainly many people who adopt the raw food vegan lifestyle and do not become orthorexic.

A truly extreme diet like fruitarianism is orthorexic by definition — because it does not provide nutrition compatible with health. But with a nutritionally sound diet, what matters is not whether the theory is wrong or right, scientific or unscientific. It’s how it impacts you as a person.

People who get in trouble with theories of healthy eating often have an underlying predilection toward going overboard. As Jordan Younger writes in her excellent piece on Refinery29,  “Those of us who have a tendency toward extremes in other areas are more susceptible to developing it [orthorexia] — especially once we start cutting out entire food groups.“

To clarify, it IS possible to cut out an entire food group without being orthorexic — but a restriction so sweeping as that definitely puts one at risk.


The Tipping Point

Healthy diet turns into orthorexia when a boundary is crossed and a person’s relationship with food begins to impair various essential dimensions of human life. There is no bright line to mark this transition, but it can be recognized as a situation in which the search for a healthy diet has taken on a life of its own and no longer serves the goal of improving health.

Jaime A. Heidel captures this tipping point in her essay “Are you TOO Obsessed with Healthy Eating?” She began following theories of healthy eating in order to address certain personal health conditions. From a physical perspective, she found this effective. However, “somewhere along the line, my desire to keep my conditions under control developed into an obsession of the more questionable variety.”

She describes how “healthy” diet began to take over her life. “My diet became increasingly strict and I found myself feeling agitated and anxious whenever I couldn’t find organic or natural foods.“

Ultimately, she decided she should loosen up a little. “If your desire to eat healthily and avoid chronic disease begins to interfere with your daily living, social activities, and relationships, it may be time to take a step back.” Her conclusion: “While you’re in the process of improving and prolonging your life, don’t forget to live it.”

But even this advice will raise concerns for some people. In a post titled “Is Healthy Eating Doing us More Harm than Good?” popular blogger Kelly at Mummywrites says the same thing, but with a caveat: ” Life is too short to live on extreme diets, stressing about every morsel, but then life really will be short if we don’t look after ourselves!” [my italics]

Perhaps here it is worthwhile gently pointing out that the modern world is so chockful of chemicals that the trace quantity of pesticides and other chemicals in a serving of non-organic food simply doesn’t amount to disaster? The evidence suggesting potential harms caused by pesticides in food indicates at most a tiny fractional percent of an increase in the risk of health problems even when eating non-organic foods day in and day out. If you are afraid that occasionally straying off your perfect diet will give you cancer you might as well cower at home under your blankets.

A friend of mine is afraid of going to Italy because she thinks the leftover radiation from Chernobyl will kill her; in fact, the amount of radiation exposure on the plane trip to Italy is orders of magnitudes higher.

So let’s keep a sense of proportion: If you prefer to eat mostly organic, preservative- chemical- and antiobiotic-free foods (as I do!) and think that many overly processed foods are not foods at all (as I do!) it still doesn’t mean you have to follow those principles 100% of the time. That’s just perfectionism, obsession, orthorexia.

Trying to be perfect will make you crazy, in diet as elsewhere in life.

Lighten up a little. Be gentler with yourself.

To quote Jaime again: While you’re in the process of improving and prolonging your life, don’t forget to live it!

Steven Bratman, MD, MPH




Anxiety and Orthorexia

People who want to eat healthy food don’t become orthorexic unless there is something deeper going on. Often, that deeper something is best described as anxiety.

The most obvious anxiety related to orthorexia is fear of illness. You want to believe that if you are very careful with what you eat, you will be safe from every health problem that scares you, whether its cancer, bloating, blemished skin or depression. But it goes further than that. Whether you are conscious of it or not, somewhere along the line you began to use food as a primary strategy to fend off every kind of anxiety. When you are stressed about relationships, your job, the purpose of life or what your friends think of you; when it is guilt, shame, love or loss that has put you off balance, the magic cure is to eat pure food.

Deep down, you know perfectly well this is a lie you tell yourself in order to cope. While food is important for health, the slice of pizza you eat today is NOT going to give you cancer tomorrow, nor will eating the best diet in the world immunize you against illness. Furthermore, diet cannot give you love, friendship, meaning or happiness. Food, in the end, is just stuff you put in your mouth.  

One residential treatment program for orthorexia I recently heard about uses a clever strategy to help people understand how they use food to fend off all forms of anxiety. In this program, the food is served by a chef closely advised by dietitians. The rules of the game are that the chef may not under any circumstances reveal whether the food served in a given meal is organic or not, whether it has preservatives, contains GMOs, etc. In point of fact, the food served in the program is mostly organic and chemical-free, but not 100% of the time, and there is no way for the people who eat the food to know when they are consuming substances that their theory of eating would forbid. (People in the program also keep a journal of how they feel, and it turns out that they do NOT guess correctly when they have eaten “impure” food.)

As you might imagine, for a person with orthorexia this is extremely anxiety-provoking. Not only does it stimulate food-related worries, it removes the possibility of using food purity as a coping mechanism against other forms of worry. And that is the real point: The experience forces participants to begin to develop a range of ways to cope with daily stress, rather than abusing food purity as the answer to every problem. 

You might object that it is truly rational to be concerned about food additives, whether vegetables are organic, and etc. Wouldn’t any sane person would want to eat healthy food? Perhaps yes. But no matter what dietary rule you believe to be correct, it simply can’t be necessary from a health-related perspective to follow it without exception. The quantity of pesticides contained in a single serving of non-organic food is dwarfed by the quantity of chemicals taken in simply by living and breathing in the modern world. You focus on food because it’s something you can control. And that’s perfectly sensible — but only to a point. Past that point further purification of your diet won’t make you healthier; it will only make you more obsessive.

A mostly “pure” diet is good enough. Aiming for 100% is only an excuse not to come to terms with the elephant in the room: Life, in all its messy glory.

— Steven Bratman, MD, MPH

To contact me, leave a comment, or find me on Twitter @StevenBratman

On Purity

Eating clean grabs at you because it stirs the quest for purity. That’s what’s behind the cleanse, the detox, the quest for total avoidance of imperfect food. Orthorexia flows from the same impulse that drove the monks and nuns of the Middle Ages: cleansing from sin.

In dietary purity, one seeks to be physically holy, and holier than others. Just as the monk self-flagellated for sexual desire, the food purist self-punishes for wanting coffee, meat or sugar. “I have befouled myself with non-organic chips, I am unclean. ” Total commitment to a pure food diet is a vow of food chastity, a war against the lower desires of the flesh.

But the search for absolute purity is a rejection of the natural self.  It is as much a war against the body as the crusades of any puritanical religion.

James HIllman, the great Jungian, distinguished between soul and spirit. Spirit is the sky, the air, pure light, vast emptiness, the high you get while fasting. The soul is deeply felt passion, character and joy. To become pure spirit is to become an angel; to become soulful requires embracing the intestinal, sweaty, impure physical reality of human being.

It is a greater, and more difficult thing to be a whole human being than an angel.

Eat healthy food but sometimes give in to desire.

Don’t try to be perfect. Try to be whole.

–Steven Bratman, MD, MPH

To contact me, leave a comment, or find me on Twitter @StevenBratman



What is Orthorexia?

Orthorexia nervosa, as I defined it in 1996, indicates an unhealthy obsession with eating healthy food. The term is derived utilizing the Greek “orthos,” which means “right,” or “correct,” and is intended as a parallel with anorexia nervosa. I originally invented the word as a kind of “tease therapy” for my overly diet-obsessed patients. Over time, however, I came to understand that the term identifies a genuine eating disorder.

Please note that I do not, and have never claimed that vegetarianism, veganism, or any other nutritionally sound approach to eating healthy food is in itself a disorder. That would be absurd! Nor do I think that people who pay close attention to labels on the foods they mean to purchase are demonstrating a psychological problem (as some web articles on orthorexia would appear to imply.) Finally, I entirely agree that the problem of addiction to junk food is immensely more prevalent than obsession with healthy food.

Nonetheless, it is possible to have an unhealthy obsession with healthy food.

Anorexia is the parallel. Obesity is by far the biggest lifestyle-related health issue today, and every reasonably health-conscious person does what is necessary to achieve and maintain a normal BMI. Still, for various psychological reasons some people go overboard and become anorexic. Similarly, any reasonably health conscious person would wish to minimize intake of preservatives, pesticides, antibiotics and all the other garbage that pollutes our food supply. However, some people who are devoted to healthy eating go overboard and develop an eating disorder in relation to that focus, just as some people in their quest to avoid obesity become anorexic.

For people with orthorexia, eating healthily has become an extreme, obsessive, psychologically limiting and sometimes physically dangerous disorder, related to but quite distinct from anorexia. Often, orthorexia seems to have elements of OCD, as does anorexia. Some people with orthorexia may in fact additionally have anorexia, either overtly or covertly (using pure food as a socially acceptable way of reducing weight.) But orthorexia is usually not very much like typical OCD or typical anorexia. It has an aspirational, idealistic, spiritual component which allows it to become deeply rooted in a person’s identity. It is most often only a psychological problem in which food concerns become so dominant that other dimensions of life suffer neglect. In rare cases, however, it can be much more severe, even resulting in death via malnutrition.

The primary feature distinguishing orthorexia from anorexia is that while a person with anorexia focuses on weight, a person with orthorexia obsesses about purity. People with anorexia possess a distorted body image in which they see themselves as fat regardless of how thin they really are, whereas those with orthorexia constantly struggle against feelings of being unclean or polluted by what they have eaten, no matter how carefully they monitor their diet. Both conditions involve control, but whereas an anorexic seeks continually to reduce weight, an orthorexic feels compelled to achieve ever great heights of dietary perfection; to feel entirely clean, pure and transparent. Sometimes people recovering from anorexia “graduate” to orthorexia, keeping their disordered eating habits and moving the focus from weight to purity.

Although widely discussed by eating disorder experts, orthorexia is not yet a DSM diagnosis, and I am not sure that it should be. There is a tendency in the modern world to pathologize an increasing number of human behaviors and I have no desire to contribute to this trend. On the other hand, naming has power. I have heard people say, “I want to eat healthfully, but I don’t want to be orthorexic.” Perhaps this is the best possible use of the word.

Do you have orthorexia? Ask yourselves these questions: Do you turn to healthy food as a primary source of happiness and meaning, even spirituality? Does your diet make you feel better than other people? Does it interfere with relationships or work, friends or family? Do you use pure foods as a sword and shield to ward off anxiety, not just about health problems but about everything that makes you insecure? Do foods help you feel in control more than really makes sense? Do you have to carry your diet to further and further extremes to provide the same kick? If you stray even minimally from your chosen diet, do you feel a compulsive need to cleanse? Has your interest in healthy food expanded past reasonable boundaries to become a kind of brain parasite, controlling your life rather than furthering your goals?

Food, no matter how pure, cannot fill the space in your soul that longs for love and spiritual experience. If you are trying to use it for this purpose, you may have gone astray on your journey.

Perhaps the resources on this site may be helpful, including my occasional blog posts. You might consider reading my book, Health Food Junkies. But most of all, if you feel your condition has become too much for you to manage on your own, visit an eating disorder specialist who understands orthorexia.


Steven Bratman, MD

To contact me, leave a comment, or find me on Twitter @StevenBratman