What are the main signs and symptoms of orthorexia nervosa?

The signs and symptoms of orthorexia nervosa are obsessive thought patterns, beliefs, and behaviors surrounding food preparation and consumption — particularly a strong preoccupation with “healthy” or “pure” eating and self-imposed dietary rules — that cause psychological distress and negatively impact other areas of life. ^[1]

Dietary rules might include cutting out entire categories of foods for no reason beyond viewing them as “unhealthy” or “impure” (e.g., gluten, dairy, added sugars, carbohydrates, fats, preservatives, pesticides, oils, animal products). In orthorexia nervosa, beliefs about how foods and ingredients affect health are overvalued, meaning that the believed positive or negative impacts of a food on health are exaggerated. This can lead to extreme anxiety/distress and guilt when “unhealthy” foods are consumed or when “healthy” foods are unavailable.^[1][2]

The dietary restriction that occurs in orthorexia nervosa can lead to weight loss and nutritional deficiencies; however, the relationship between orthorexia nervosa and weight is not clearly understood. Some research suggests that, unlike the eating disorders anorexia nervosa or bulimia nervosa, orthorexia nervosa is not driven by negative body image and a desire for thinness. However, this idea has been challenged, particularly if someone views a smaller body as “healthier”.^[1][3][4]