Skip to main content

The experience of orthorexia from the perspective of recovered orthorexics



Orthorexia is a proposed disorder that involves a pathological obsession with healthy eating. The condition has received much attention in popular media in recent years, but more empirical research is needed. Currently, orthorexia is an emerging construct with multiple proposed versions of diagnostic criteria, and there is confusion regarding the exact symptoms and pathology. This qualitative study aimed to explore the experiences of orthorexia from the perspective of recovered persons, as defined by Dunn and Bratman’s 2016 criteria (Eat Behav 21:11–17, 2016).


Eight participants from around the world were interviewed via Skype. These interviews were analysed using a descriptive and interpretive thematic analysis (Elliott and Timulak. A handbook of research methods for clinical and health psychology. Oxford University Press, London, pp 147–159, 2005). Informed consent was obtained from all participants.


Data analysis revealed four domains: (1) strong external influences; (2) psychological effects; (3) interpersonal functioning effects; and (4) classic eating disorder (ED) behaviours and processes. Some symptoms mirrored those seen in EDs and in obsessive compulsive disorder.


Orthorexia negatively impacted participants' physical, psychological, and social health. Additional research exploring valid and reliable screening instruments, body image, and psychological functioning would help to further understand this proposed disorder.

Level of evidence

Level V, qualitative interview study.

This is a preview of subscription content, access via your institution.


  1. Dunn TM, Bratman S (2016) On orthorexia nervosa: a review of the literature and proposed diagnostic criteria. Eat Behav 21:11–17.

    Article  PubMed  Google Scholar 

  2. Elliott R, Timulak L (2005) Descriptive and interpretive approaches to qualitative research. In: Miles J, Gilbert P (eds) A handbook of research methods for clinical and health psychology. Oxford University Press, London, pp 147–159

    Google Scholar 

  3. Bratman S (1997) Orthorexia nervosa. Yoga J. 42–50. Accessed Mar 2020

  4. Bratman S (2017) Orthorexia vs. theories of healthy eating. Eat Weight Disord 22:381–385.

    Article  PubMed  Google Scholar 

  5. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington

    Book  Google Scholar 

  6. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2004) Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon. Eat Weight Disord 9(2):151–157.

    Article  CAS  PubMed  Google Scholar 

  7. Moroze RM, Dunn TM, Holland JC, Yager J, Weintraub P (2015) Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics 56(4):397–403.

    Article  PubMed  Google Scholar 

  8. Setnick J (2013) The eating disorders clinical pocket guide, 2nd edn. Snack Time Press, Dallas

    Google Scholar 

  9. Cena H, Barthels F, Cuzzolaro M, Bratman S, Brytek-Matera A, Dunn T, Varga M, Missbach B, Donini LM (2019) Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eat Weight Disord 24(2):209–246.

    Article  PubMed  Google Scholar 

  10. Park SW, Kim JY, Go GJ, Jeon ES, Pyo HJ, Kwon YJ (2011) Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastinum, pneumothorax, and pancytopenia. Electrolyte Blood Press 9(1):32–37.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Borgida A (2011) In sickness and in health: orthorexia nervosa, the study of obsessive healthy eating. Dissertation, Alliant International University

  12. Saddichha S, Babu GN, Chandra P (2012) Orthorexia nervosa presenting as prodrome of schizophrenia. Schizophr Res 134(1):110.

    Article  PubMed  Google Scholar 

  13. Keys A, Brožek J, Henschel A, Mickelsen O, Taylor HL (1950) The biology of human starvation (2 vols). University of Minnesota Press, St Paul

    Book  Google Scholar 

  14. Håman L, Barker-Ruchti N, Patriksson G, Lindgren EC (2015) Orthorexia nervosa: an integrative literature review of a lifestyle syndrome. Int J Qual Stud Health Well-Being.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ryman FVM, Cesuroglu T, Blood ZM, Syurina EV (2019) Orthorexia nervosa: disorder or not? Opinions of Dutch health professionals. Front Psychol 10:555.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Koven N, Abry A (2015) The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatr Dis Treat 11:385–394.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Zickgraf HF, Ellis JM, Essayli JH (2019) Disentangling orthorexia nervosa from healthy eating and other eating disorder symptoms: relationships with clinical impairment, comorbidity, and self-reported food choices. Appetite 134:40–49.

    Article  PubMed  Google Scholar 

  18. Barnes MA, Caltabiano ML (2017) The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eat Weight Disord 22(1):177–184.

    Article  PubMed  Google Scholar 

  19. Koven NS, Senbonmatsu R (2013) A neuropsychological evaluation of orthorexia nervosa. Open J Psychiatr 3(2):214–222.

    Article  Google Scholar 

  20. Gramaglia C, Brytek-Matera A, Rogoza R, Zeppegno P (2017) Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviours in clinical and non-clinical samples. BMC Psychiatry 17(1):75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Varga M, Thege BK, Dukay-Szabó S, Túry F, van Furth EF (2014) When eating healthy is not healthy: orthorexia nervosa and its measurement with the ORTO-15 in Hungary. BMC Psychiatry.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Segura-García C, Papaianni MC, Caglioti F, Procopio L, Nisticò CG, Bombardiere L, Ammendolia A, De Fazio P, Capranica L (2012) Orthorexia nervosa: a frequent eating disordered behaviour in athletes. Eat Weight Disord 17(4):226–233.

    Article  Google Scholar 

  23. Tomsa R, Istfan N, Jenaro C, Flores N, Belén M, Bermejo G (2012) Body image screening questionnaire for eating disorder early detection: a Romanian replication. Procedia Soc Behav Sci 33:423–427.

    Article  Google Scholar 

  24. Oberle CD, Samaghabadi RO, Hughes EM (2017) Orthorexia nervosa: assessment and correlates with gender, BMI, and personality. Appetite 108(1):303–310.

    Article  PubMed  Google Scholar 

  25. Arusoğlu G, Kabakci E, Köksal G, Merdol T K (2008) Orthorexia nervosa and adaption of ORTO-11 into Turkish. Turk Psikiyatri Derg 19(3): 283–291. Accessed Mar 2020

  26. Fidan T, Ertekin V, Işikay S, Kırpınar I (2010) Prevalence of orthorexia among medical students in Erzurum, Turkey. Compr Psychiatry 51(1):49–54.

    Article  PubMed  Google Scholar 

  27. Turner PG, Lefevre CE (2017) Instagram use is linked to increased symptoms of orthorexia nervosa. Eat Weight Disord 22(2):277–284.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Oberle CD, Lipschuetz SL (2018) Orthorexia symptoms correlate with perceived muscularity and body fat, not BMI. Eat Weight Disord 23(3):363–368.

    Article  PubMed  Google Scholar 

  29. Brytek-Matera A, Donini LM, Krupa M, Poggiogalle E, Hay P (2015) Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. J Eat Disord.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Eriksson L, Baigi A, Marklund B, Lindgren EC (2008) Social physique anxiety and sociocultural attitudes toward appearance impact on orthorexia test in fitness participants. Scand J Med Sci Sports 18(3):389–394.

    Article  CAS  PubMed  Google Scholar 

  31. Bratman S, Knight D (2000) Health food junkies: overcoming the obsession with healthful eating. Broadway, New York

    Google Scholar 

  32. Donini LM, Marsili D, Graziani MP, Imbriale M, Cannella C (2005) Orthorexia nervosa: validation of a diagnosis questionnaire. Eat Weight Disord 10(2):28–32.

    Article  Google Scholar 

  33. Aksoydan E, Camci N (2009) Prevalence of orthorexia nervosa among Turkish performance artists. Eat Weight Disord 14(1):33–37.

    Article  CAS  PubMed  Google Scholar 

  34. Ramacciotti CE, Perrone PE, Coli A, Burgalassi C, Conversano G, Massimetti L, Dell’Osso (2011) Orthorexia nervosa in the general population: a preliminary screening using a self-administered questionnaire (ORTO-15). Eat Weight Disord 16(2):127–130.

    Article  Google Scholar 

  35. Dunn TM, Gibbs J, Whitney N, Starosta A (2016) Prevalence of orthorexia nervosa is less than 1%: data from a US sample. Eat Weight Disord 22(1):185–192.

    Article  PubMed  Google Scholar 

  36. Gleaves DH, Graham EC, Ambwan S (2013) Measuring ‘orthorexia’: development of the eating habits questionnaire. Int J Educ Psychol Assess 12(2):1–18. Accessed Mar 2020

  37. De Souza QJOV, Rodrigues AM (2014) Risk behaviour for orthorexia nervosa in nutrition students. J Bras Psiquiatr 63(3):200–204.

    Article  Google Scholar 

  38. Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 19(6):349–357.

    Article  PubMed  Google Scholar 

  39. Noble H, Smith J (2015) Issues of validity and reliability in qualitative research. Evid Based Nurs 18(2):34–35.

    Article  PubMed  Google Scholar 

  40. Stice E (2016) Interactive and mediational etiologic models of eating disorder onset: evidence from prospective studies. Annu Rev Clin Psychol 12:359–381.

    Article  PubMed  Google Scholar 

  41. Tong ST, Heinemann-LaFave D, Jeon J, Kolodziej-Smith R, Warshay N (2013) The use of pro-ana blogs for online social support. Eat Disord 21(5):408–422.

    Article  PubMed  Google Scholar 

  42. Vandereycken W (2011) Media hype, diagnostic fad or genuine disorder? Professionals’ opinions about night eating syndrome, orthorexia, muscle dysmorphia, and emetophobia. Eat Disord 19(2):145–155.

    Article  PubMed  Google Scholar 

  43. Kinzl JF, Hauer K, Traweger C, Kiefer I (2006) Orthorexia nervosa in dieticians. Psychother Psychosom 75(6):395–396.

    Article  PubMed  Google Scholar 

  44. Segura-Garcia C, Ramacciotti C, Rania M, Aloi M, Caroleo M, Bruni A, Gazzarrini D, Sinopoli F, De Fazio P (2015) The prevalence of orthorexia nervosa among eating disorder patients after treatment. Eat Disord 20:161–166.

    Article  Google Scholar 

  45. Cartwright MM (2004) Eating disorder emergencies: understanding the medical complexities of the hospitalized eating disordered patient. Crit Care Nurs Clin North Am 16(4):515–530. Accessed Mar 2020

  46. Barthels F, Meyer F, Huber T, Pietrowsky R (2017) Orthorexic eating behaviour as a coping strategy in patients with anorexia nervosa. Eat Weight Disord 22(2):269–276.

    Article  PubMed  Google Scholar 

  47. McInerney-Ernst EM (2012) Orthorexia nervosa: real construct or newest social trend? Dissertation, University of Missouri-Kansas City Accessed Mar 2020

  48. Dakanalis A, Gaudio S, Serino S, Clerici M, Carrà G, Riva G (2016) Body-image distortion in anorexia nervosa. Nat Rev Dis Primers 2:16026. Accessed Mar 2019

  49. Subar AF, Freedman LS, Tooze JA, Kirkpatrick SI, Boushey C, Neuhouser ML, Thompson FE, Potischman N, Guenther PM, Tarasuk V, Reedy J, Krebs-Smith SM (2015) Addressing current criticism regarding the value of self-report dietary data. J Nutr 145(12):2639–2645.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references


This study did not receive any funding or grants.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Lynn McGovern.

Ethics declarations

Conflict of interest

Ms Lynn McGovern declares that she has no conflict of interest. Dr Megan Gaffney declares that she has no conflict of interest. Dr Timothy Trimble declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Trinity College Dublin, Ireland.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Availability of data and material

An aggregated table of anonymised quotes will be available at the Qualitative Data Repository.

Code availability


Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The article is part of the Topical Collection on Orthorexia Nervosa.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 300 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

McGovern, L., Gaffney, M. & Trimble, T. The experience of orthorexia from the perspective of recovered orthorexics. Eat Weight Disord 26, 1375–1388 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Orthorexia
  • ED
  • Diagnostic criteria
  • OCD