Many from within the Paleo Community, and other communities as well have declared that the entire concept of Orthorexia is Bullshit as a knee-jerk means to respond to media outlets using the eating disorder to demean adherents of restrictive diets, such as the Paleo or Vegan Diet.  However, it is clear that it is a rising term amongst eating disorder practitioners. Therefore, it merits further inspection, and as a community we must critically examine our beliefs about Orthorexia Nervosa so we don’t make the same intellectually lazy assumptions.  But first, we have to do our due diligence, set emotions aside, and seek first to understand what it actually is. At the very least this offers us a chance to combat these assertions intelligently, at the very best we may save someone’s life.

What is Orthorexia Nervosa, and is it real?

Orthorexia Nervosa, or Orthorexia for short, literally means a “fixation on righteous eating”.  Although Orthorexia is not currently recognized clinically as a legitimate eating disorder, many people may be struggling with symptoms as it is currently classified.  The term Orthorexia Nervosa was first coined by Steven Bratman, MD in 1996 to help his patients entertain the idea that an attachment and obsessive behavior surrounding healthy food may not be as beneficial as they initially presumed it would be. Though Orthorexia Nervosa does not appear in manuals by the American Psychiatric Association,  it is strikingly similar in manifestation, obsession, and disordered thinking as Anorexia Nervosa or Bulimia Nervosa, with the main difference in the focus of the obsession about eating healthily, and not being thin or losing weight. In essence, though not officially recognized, the symptoms are real.

One of the most common symptoms of Orthorexia is the belief that every day, one has a chance to be “right” or be “good” with their diet.  Orthorexia Nervosa typically begins with a desire to eat healthily, but eventually the healthy desire morphs into an obsession and becomes so restrictive that mental health,  physical health, relationships, and even work begin to suffer.

Signs and Symptoms of Orthorexia Nervosa Include:

  • Aggressive thoughts towards others or self surrounding food
  • Anxiety surrounding food
  • Fixation on food quality
  • Self-punishing behavior over food choices
  • Self-esteem, Superiority, and validation from food choices and restriction
  • Identity creation through controlling food
  • Rigidity in beliefs surrounding the “goodness” or “badness” of food choices
  • Polarizing judgments about others who do not adhere to the same diet

What Causes Orthorexia?

Intertwined with the desire for complete control over food choices, Orthorexics also derive a greater sense of self-esteem from having the iron-clad willpower to control themselves, and a superiority complex may ensue.  Because of this, it is possible that individuals with low self-esteem or identity issues may be the most susceptible to orthorexia and compulsions to control food intake as a means to develop a greater sense of self.

Do I Have Orthorexia?

Consider the following questions. The more questions you respond “yes” to, the more likely you are suffering with Orthorexia.

  • Have you put yourself on a nutritional pedestal and wonder how others can possibly eat the foods they eat?
  • Do you identify so strongly with your diet that you will not associate with others who do not eat like you?
  • Do you feel guilt from straying from your diet?
  • Do you punish yourself for straying from your diet?
  • Do you feel self-loathing when you stray from your diet?
  • Do you thrive on 30 day challenges?
  • Do you have trouble being around people who eat differently than you do?
  • Do you binge eat— especially “junk” food— and fast, exercise, or become more strict with your diet afterwards?
  • Do you avoid foods which have never caused you physical harm?
  • Do you restrict foods to the point that it makes you physically ill?

How is Orthorexia Nervosa Treated?

While orthorexia is not a condition your doctor will clinically diagnose, recovery requires professional help.

  • Step 1:  Individual must identify themselves as having a form of disordered thinking around food.
  • Step 2: Individual must seek help of a practitioner familiar with treating eating disorders.
  • Step 3: Individual must identify underlying multi-faceted psychological causes of disordered thinking around food.
  • Step 4: Individual must become more flexible about food as a result of Steps 1-3.


It is not suggested that recovering Orthorexics eat foods previously avoided, but instead develop a better model of what healthy eating is. Because self-esteem is intertwined with Orthorexia, an ongoing pursuit to foster a greater self-esteem and self-identity outside of the diet will be crucial to long-term recovery. If you suspect that you, or a loved one suffers from Orthorexia Nervosa it is imperative that professional help is sought after.

What the Media got FUBAR : When It’s NOT Orthorexia Nervosa

Though Orthorexia Nervosa is considered a serious medical condition and cluster of symptoms, media outlets have used the disorder to erroneously label adherents of restrictive diets —particularly Paleo Dieters and Vegans— for the sheer purpose of garnering click-bait attention.  The unfortunate outcome of this usage is that Orthorexia Nervosa is not getting the attention it requires, and Paleo Dieters and Vegans alike are outright suggesting that the entire concept that Orthorexia is Bullshit.

Now that we understand what Orthorexia actually is, lets examine when it’s not Orthorexia Nervosa, and how the media got that fucked up. First, people often avoid specific food items due to issues and concerns they have over quality, sourcing, and even negative reinforcement which manifests physically, or even socially.  For years, nutritionists and journalists have observed an increase in individuals abstaining from specific food items containing ingredients— such as gluten in particular— who have not been diagnosed with Celiac Disease, erroneously labeling those individuals as suffering from Orthorexia Nervosa, a perhaps intellectually lazy assumption on the part of the media.

Undoubtedly, there are individuals who have abstained from foods containing gluten who exhibit symptoms in line with Orthorexia Nervosa. However, according to the latest literature on Non-Celiac Gluten Sensitivity, a significant amount of people who have abstained from eating gluten do exhibit symptoms associated with Celiac Disease, yet do not test positive for Celiac Disease.  In essence, abstention is not a form of Orthorexia Nervosa, but is driven by negative physical reinforcement.

Other times when food control is mislabeled as Orthorexia Nervosa is in the case of the ethical dieter, who eats a diet driven by a specific set of values.  Vegans have long been the target of media attention, and mislabeling as Orthorexics. Often, this is due to research that indicates that some individuals choose a Vegan Diet to mask an eating disorder in a socially acceptable way, as a means to restrict food intake.  However, this is again intellectual laziness, as this phenomenon is true of all of all diets which practice a form of dietary restriction. The food restriction itself is a draw to individuals with a propensity for addiction, obsessive compulsive tendencies, and even low self-esteem. However, and most importantly, Orthorexia Nervosa has nothing to do with the restrictions of the diet itself.  It has to do with the individual’s behavior while adhering to the particular diet, and the way they use the restrictions of the diet to foster disordered thinking and behavior around food.

The Orthorexia is Bullshit contention: Where we fucked up 

Unfortunately, to making the contention that Orthorexia is Bullshit is just as intellectually lazy as the media outlets who have targeted specific dietary modalities as wholesale suffering from the condition. In effect, by suggesting that the disorder doesn’t exist represents an uphill battle for practitioners to climb in getting help for the affected individuals. In fact, there are so many people suggesting that the disorder doesn’t exist that it may present itself as positive feedback for negative behaviors among disordered individuals.

Again, nuance is crucial here. Though it is significantly easier to suggest that the entire Paleo or Vegan Community does not have Orthorexia, we would be amiss to ignore those who have developed disordered eating patterns, masking themselves under our umbrellas. If we are truly interested in promoting health, then we have to also include mental health. One of the most common threads I’ve seen while discussing this subject among other Paleo Dieters is an outright blind-eye towards the long-lasting and negative affects one may experience during the adoption period, or after 30-Day challenges.


Disordered Eating and Dietary Restriction: My Personal Experience

Mom: "How Many Brownies did you eat?" Me: "All of them. And the Skittles in the cushions"

Mom: “How Many Brownies did you eat?”
Me: “All of them. And the Skittles in the sofa cushions”

I’ve said before in other posts and discussions that I developed an eating disorder while on the strictest version of the Paleo Diet for a matter of years. Though I did not seek professional help, it was pretty clear to me that feeling “deprived” of my favorite foods would cause me to go overboard with them once they were within reach. Afterwards, I would feel incredibly guilty, and self-punish. Never having had an eating disorder in my life before, I had to seriously question this new behavior. Introspectively, I recognized that it had stemmed from the feelings of being ‘deprived’, and from labeling some foods “good” and others “bad.” I now believe it to have been classic Orthorexia. Although my physical well-being may have been OK, my mental well-being was not. That period of my life was miserable.

In an effort to combat this newly acquired disordered eating, I began to… well… ease the fuck up on my strict diet. I used to never allow “bad” foods in my apartment. Today, if I have a hankering for cookies I will make them. If I want ice cream, I will buy some. I still abstain from gluten, and make no concessions for it in my diet, but other foods previously labeled as “bad” which do not cause me to suffer serious consequences are welcome. 

The rule for me is not “in moderation”, the rule is that whatever I do, I do to avoid feeling like shit.  If I abstain from brownies or cookies when I want them, I will feel like shit. I will feel deprived. However, if I eat a few, I will be balanced out, feeling happy because I love cookies and brownies. Although if I eat them to the point I feel like shit, it serves as an internal warning to stop.

The Take-Home Message:

It is imperative that we raise awareness about Orthorexia Nervosa for what it is, recognize the signs and symptoms within our own community if we really care about the overall health of individuals, and educate the media who aims to discredit movements through malicious means of mislabeling.


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