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Signs and Symptoms of Orthorexia Nervosa

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Being mindful of what you eat can be a good thing. But being obsessed with the nutritional quality of what you eat could be a sign of orthorexia nervosa (ON). Orthorexia nervosa is a newly designated eating disorder that seems to be growing in prevalence in our health-conscious society. (1)

Signs and Symptoms of Orthorexia Nervosa

Signs of Orthorexia Nervosa

Orthorexia nervosa can be difficult to detect from the outside. Many people who are struggling with orthorexia may present as health-conscious–but excessively. While the intentions behind these actions are often good, what marks the disorder is an intense fixation on this type of lifestyle and extreme distress when it's disrupted.

Medically, “signs” of a disorder are the effects that can be outwardly measured, whether through test results or the observations of doctors or close friends and family. And there are a number of known signs of orthorexia nervosa.

Physical Signs of Orthorexia Nervosa

Orthorexia nervosa was first named an eating disorder in the DSM-5, the latest edition of the manual that lists all known and officially designated mental health conditions. While its official recognition is relatively new, scientists and doctors have compiled a growing list of orthorexia nervosa signs.

An extremely restricted diet drives many of the physical signs of orthorexia nervosa. This can lead to a number of nutritional deficiencies and other health complications. (2,3)

Amenorrhea

A frequent issue for women struggling with nutritional deficiencies and eating disorders, amenorrhea describes the irregularity or overall loss of a period. The difficulty can arise from a number of related signs of an eating disorder. They include low body weight, anemia, and a disrupted endocrine system, which could throw off the hormonal rhythms that keep menstrual cycles regular. (3)

Thyroid Problems

The thyroid dispatches appropriate hormones and maintains the body’s metabolic rate.  The nutritional deficiencies of a limited diet and highly-regimented eating habits a person with orthorexia nervosa may have can severely impair both of these primary functions. (3,4)

Heart Disease

An extremely restricted diet and nutritional deficiencies can also negatively impact the cardiovascular system, 

eventually leading to a number of imbalances resulting in blood pressure changes and other cardiovascular issues, including heart disease. (3,4) 

Emotional and Behavioral Signs of Orthorexia Nervosa

Along with physical signs, orthorexia nervosa can have a number of emotional or behavioral manifestations.

Extremely Restricted Diet

Perhaps the chief sign of orthorexia nervosa, a severely restricted diet is at the heart of the disorder.

The person may start out with good intentions: to eat healthier. But, when taken to extremes, this concern can become unhealthy, eventually consuming enough psychological space to disrupt the person’s lifestyle and relationships. (3)

The restricted diet may start out with small cuts here or there, such as eliminating bread and pasta. But it eventually leads to dismissing entire categories of food, such as all sugar, all carbs, all dairy, all meat, or all animal products. (5) Dietary exclusions like these s may benefit people who have allergies to these foods. But the fixation on the “purity” of a diet in making these choices, as opposed to religious beliefs, or concerns over agricultural sustainability, animal welfare, or other issues, is what characterizes orthorexia nervosa. (3)

When a person’s diet is severely restricted for extended periods of time, it could contribute to the types of nutritional deficiencies that lead to so many of the signs and symptoms of orthorexia nervosa.

Excessive Scrutiny

People struggling with ON typically follow a strictly regimented diet. But, in order to keep up with these demanding, self-imposed rules, the person becomes  hypervigilant of what they consume.

This sign of orthorexia nervosa may present as a compulsive checking of ingredients on a food label, a deluge of recipe-related questions at a restaurant, or a fixation on details, including whether vegetables have been exposed to pesticides, whether dairy products came from hormone-supplemented cows, or whether preservatives were added. (3)

This scrutiny can also be pointed outward. A common sign of orthorexia nervosa is an overly judgmental attitude toward individuals who do not practice such strict diets, which can present as scrutiny or criticism of the eating habits of others. (6)

Obsessive Following of “Healthy Lifestyle” Social Media

Some studies have suggested that people struggling with orthorexia nervosa exhibit feelings of superiority in relation to their diet, with limited tolerance for interacting with others who aren’t similarly-minded. (3) 

In the digital age, people with ON may follow certain “wellness” brands and pages, looking for both reinforcement of and advice about their lifestyle choices. (5)

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Symptoms of Orthorexia Nervosa

In the medical world, "symptoms" are effects that can't be outwardly measured or even detected by another person. They can only be experienced and gauged in severity by the person enduring them.

Due to the complex physical, psychological, and social mechanics behind it, orthorexia nervosa has a number of symptoms that may manifest in many ways.

Physical Symptoms of Orthorexia Nervosa

Once again, the driving factor behind so many orthorexia nervosa symptoms is the restrictive diet that marks the disorder. Nutritional imbalances caused by such diets can lead to many discomforts and difficulties for the person dealing with ON.

Gastrointestinal Issues

Gastrointestinal issues are a classic symptom of many eating disorders, including orthorexia nervosa.

Strictly inhibited food choices, especially those based more on pop-science than medical advice, can lead to a number of digestive troubles, including constipation, bloating, acid reflux, gassiness, nausea, and a number of other gastrointestinal issues. (4)

Chronic Fatigue

Chronic fatigue can manifest as an orthorexia nervosa symptom for a number of reasons. Certainly, the nutritional deficiencies caused by a severely restricted diet is one of them. (4) But people struggling with ON may not be consuming enough calories, or be more susceptible to extreme exercise routines, though more evidence is needed to fully support these connections. (3)

Comorbid Conditions

A majority of orthorexia nervosa symptoms are emotional or behavioral, but a number of comorbid—or concurrent—medical or mental health conditions may be driving them.

While much more research into the subject is needed to draw conclusive connections, some studies have identified several psychological conditions considered to be strong indicators or drivers of orthorexia nervosa.

Obsessive-compulsive disorder is frequently found in people struggling with ON, which could also inform the rigid rules and diet associated with the disorder, and the distress caused by any variation on those rituals. (3) Perfectionism—typically considered a trait of OCD—is also common in people with orthorexia nervosa. (3)

People presenting with orthorexia nervosa have also been found to struggle with anxiety disorders at a higher rate, and some studies suggest they may also be more prone to depression. (3)

Emotional and Behavioral Symptoms of Orthorexia Nervosa

Many of the most serious orthorexia nervosa symptoms manifest in a person’s emotional and behavioral reactions. As the disorder progresses, a person may find it more difficult to integrate in society, due to their increasing concern over the purity of their food. (3)

Preoccupation with Food

Indeed, preoccupation with food is a cardinal orthorexia nervosa symptom.

This symptom can lead to undo stress, especially in situations when the food is out of the person’s control, such as when going to a restaurant or catered event. In these cases, a preoccupation may present as someone fixating on the types of food that will be there and what they will or won’t be “able” to eat. (2)

This symptom can also manifest as excessive research into food production and products, following many food-related social media outlets, or planning days around certain eating rituals. (3)

Extreme Distress When Preferred Foods Are Not Available

Coupled with the food preoccupation is the distress many people with ON feel when their dietary requirements cannot be met.

This orthorexia nervosa symptom is typically closely tied to a number of other complex psychological factors, especially the commonly comorbid conditions of obsessive compulsive disorder and anxiety.

The distress often takes the form of extreme feelings of guilt or self-loathing following a transgression from the individual’s diet, and can be followed up by a doubling-down with an even stricter routine, a desire for “self-punishment,” or other rituals, such as a cleanse or fast. (3)

Social Isolation

Sadly, their food fixation puts individuals struggling with ON at a higher risk for social isolation.

This orthorexia nervosa symptom can stem from an increasingly strict diet, which the person may feel can only be met when they exhibit total control over their environment. (3) A tendency toward a feeling of moral superiority when following their routine may also inform this predisposition. (3)

And, eventually, a positive feedback loop may form, whereby a person limits their exposure to outside activities to tend to their increasing food-based needs, which only reinforces the importance of those rules and makes it more difficult for the person to get along in a more relaxed environment. (3)

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When to Get Help for Orthorexia Nervosa

As with most eating disorders, it may be very difficult to get someone struggling with ON to understand the power the condition has over them. And because the disorder centers around the concept of being “healthy,” it may be even more difficult to get someone to think anything is amiss at all.

But despite the type of food consumed, all forms of disordered eating can be dangerous and detrimental. 

Once the disorder disrupts someone’s daily functioning, or causes undue amounts of harm or distress, it’s time to seek help. The good news is, there are many different types of therapy that can help someone make a full recovery from the condition.

If you recognize these orthorexia nervosa signs and symptoms in yourself or someone else, you should seek treatment as soon as possible.

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Frequently asked questions

Resources

  1. Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity. (2013, July). Orthorexia Nervosa in the General Population: A Preliminary Screening Using a Self-administered Questionnaire (ORTO-15).
  2. Federal Practitioner. (2017, July). Orthorexia Nervosa: An Obsession With Healthy Eating.
  3. Neuropsychiatric Disease and Treatment. (2015, February). The Clinical Basis of Orthorexia Nervosa: Emerging Perspectives.
  4. National Eating Disorders Association. (2021). Common Health Consequences of Eating Disorders.
  5. National Eating Disorders Association. (2021). Orthorexia. 
  6. BMC Psychiatry. (2014, February). When Eating Healthy is Not Healthy: Orthorexia Nervosa and its Measurement with the ORTO-15 in Hungary.
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