Orthorexia Nervosa: When the Pursuit of Healthy Eating Impacts Quality of Life
By Virginia Alcalde Davis, LMHC, RDN, CD
Published on September 10, 2026
As a registered dietitian and psychotherapist practicing whole-person care, with specialties in integrative and functional nutrition, disordered eating, and eating disorders, something has become very apparent to me in my clinical practice: how we relate to food can be just as important as what we eat and, in some contexts, perhaps even more important.
Orthorexia nervosa is one of those instances. Eating in ways that support our health can certainly be beneficial, but when the pursuit of “healthy” eating begins to negatively impact our mental health and quality of life, it may no longer be supporting our overall well-being.
Orthorexia nervosa is a term used to describe an obsessive preoccupation with healthy eating, rigid dietary rules, and food-related behaviors that can lead to psychological and social impairment, nutritional deficiencies, and even medical complications. Orthorexia nervosa is not formally recognized as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), and its diagnostic boundaries, particularly its overlap with conditions such as anorexia nervosa and obsessive-compulsive disorder (OCD), continue to be debated.
Orthorexia can also emerge alongside other psychological or health concerns. For some individuals, anxiety about their health or attempts to manage physical symptoms or chronic illness through food may contribute to an increasing focus on what they eat. This can become especially complicated when we consider how frequently we are exposed through the media to rigid, generalized messages about food and nutrition, despite the fact that nutrition needs to be individualized. Individual factors may also play a role, with research suggesting an association between perfectionism and orthorexia. What can begin as seemingly positive changes around food can gradually become increasingly rigid and restrictive in ways that may not even support a person's individual nutritional needs.
So, when does an interest in healthy eating become concerning? Here are five signs of orthorexia that are commonly described in the literature and that I also see in clinical practice:
1. Obsessive Preoccupation With Food Quality
This can involve persistent or intrusive thoughts about healthy eating, food purity, ingredients, or nutritional adequacy. Thinking about food and making the “right” choices may begin to take up a significant amount of mental space.
2. Rigid Dietary Rules
Orthorexia can involve increasingly strict or inflexible rules about what, when, or how someone is allowed to eat. This may include eliminating entire foods or food groups viewed as unhealthy, unsafe, or “impure.” Breaking these self-imposed rules may lead to feelings of anxiety, guilt, or shame, or a perceived need to compensate for what was eaten.
3. Excessive Time Spent on Food-Related Activities
Planning, sourcing, scrutinizing, and preparing food may begin to consume a significant amount of time. Grocery shopping, reading ingredient lists, researching nutrition information, or preparing meals can become stressful or overly time-consuming rather than simply part of everyday life.
4. Impact on Social Life and Relationships
Food rules may make it increasingly difficult to eat at restaurants, attend social gatherings, travel, or eat food prepared by others. Over time, this can contribute to social isolation, conflict with family or friends, or difficulties at work or school.
5. Nutritional Deficiencies or Medical Complications
Despite the intention of eating in a way that supports health, increasingly restrictive eating can sometimes have the opposite effect. Nutritional deficiencies, inadequate nourishment, weight loss, hormonal changes, digestive disturbances, and other medical complications can result when dietary restriction becomes severe.
Ultimately, supporting our health through nutrition is about more than the foods we choose to eat. It also means considering how our relationship with food impacts our mental health, physical health, relationships, and overall quality of life. If your relationship with food has become increasingly rigid, stressful, or consuming, consider reaching out for support. It is possible to eat with your health in mind while also having flexibility, connection to your body, and peace with food.
About The Author: Virginia Alcalde Davis, LMHC, RDN, CD, is a psychotherapist and Registered Dietitian Nutritionist at Baypoint Counseling Center. Her work brings together mental health and nutrition, helping individuals navigate the relationship between emotional well-being, food, and physical health.
Learn more about Virginia Alcalde Davis →
References
Atchison, A. E., & Zickgraf, H. F. (2022). Orthorexia nervosa and eating disorder behaviors: A systematic review of the literature. Appetite, 177, 106134.
Donini, L. M., Barrada, J. R., Barthels, F., et al. (2022). A consensus document on definition and diagnostic criteria for orthorexia nervosa. Eating and Weight Disorders, 27, 3695–3711.
Greville-Harris, M., Vuillier, L., Talbot, C., & Appleton, K. (2026). Perfectionism, obsessive–compulsive symptoms, and health-thinness-cleanliness motivations as primary correlates of orthorexia nervosa. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 31, 49.
Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: Emerging perspectives. Neuropsychiatric Disease and Treatment, 11, 385–394.
Zagaria, A., Vacca, M., Cerolini, S., Ballesio, A., & Lombardo, C. (2022). Associations between orthorexia, disordered eating, and obsessive-compulsive symptoms: A systematic review and meta-analysis. International Journal of Eating Disorders, 55(3), 295–312.
