Orthorexia is ‘digitally transmitted’ and vying to be recognised as a mental health disorder

Orthorexia is ‘a digitally transmitted condition’ that is ‘vying’ to be recognised as a mental health disorder, an expert has said.

The illness is characterised by a person becoming obsessed with ‘clean eating’, and in the process, may become socially isolated or suffer malnutrition.

But since orthorexia was first coined two decades ago in 1997, it is still not clinically recognised because there are no clear symptoms.

However, Dr Cristina Hanganu-Bresch said whether it is a mental illness or not, the consequences are certainly real.

Writing in the Medical Humanities journal, she said Facebook, Twitter, and more crucially Instagram, have become vectors of the illness.

Orthorexia is ‘a digitally transmitted condition’ that is vying to be recognised as a mental health disorder, a doctor has warned

Research shows people with orthorexia tend to follow social media accounts that portray images of healthy food and fit, tanned bodies. 

Dr Hanganu-Bresch is an associate professor of writing and rhetoric at the University of the Sciences, Philadelphia.

In her report, she said: ‘Orthorexia is a putative new eating disorder vying for a place in the DSM.’

DSM is the Diagnostic and Statistical Manual of Mental Disorders, an influential guidebook used by doctors all over the world.

All eating disorders are serious mental illnesses, eating disorder charity Beat states, and need to be treated quickly.  

Dr Hanganu-Bresch wrote: ‘Orthorexia seems real enough, even though it may be culturally bound and may have an upcoming expiration date.’

Orthorexia nervosa (ON) is loosely defined as an obsession with eating only ‘pure’, natural or organic foods. Some define it as ‘when healthy eating goes too far’. 

People showing symptoms eat more fruit and vegetables, cut out food groups such as white carbohydrates, shop in health food stores and rarely drink alcohol. 


Orthorexia was defined in 1997 by Dr Steven Bratman.

It is not currently recognised in a clinical setting an eating disorder.

If someone visited the doctor with the symptoms, they would not be officially diagnosed with ‘orthorexia’, although the term may be brought up when discussing their illness.

Instead, eating disorders that can’t be diagnosed as anorexia, bulimia, or binge eating disorder might be diagnosed as ‘other specified feeding or eating disorder’ (OSFED).

Orthorexia refers to an unhealthy obsession with eating ‘pure’ food, according to eating disorder charity Beat.

The obsession with eating healthy or clean is often used to cope with negative thoughts and feelings, or to feel in control, like other eating disorders.

Someone using food in this way might feel extremely anxious or guilty if they eat food they feel is unhealthy.

It can also cause physical problems, because someone’s beliefs about what is healthy may lead to them cutting out essential nutrients or whole food groups, leading to malnutrition. 

Orthorexia bears some similarities to OCD and anorexia.  

Eating Disorder Hope list the common behaviours to be aware of:

  • Elimination of entire food groups in attempt for a ‘clean’ or ‘perfect’ diet
  • Severe anxiety regarding how food is prepared 
  • Avoidance of social events involving food for fear of being unable to comply with diet 
  • Thinking critically of others who do not follow strict diets 
  • Spending extreme amounts of time and money in meal planning and food choices 
  • Feelings of guilt or shame when unable to adhere to diet standards 
  • Feeling fulfilled or virtuous from eating ‘healthy’ while losing interest in other activities once enjoyed 

There is an overlap with ON and both obsessive compulsive disorder and anorexia, sharing traits of rituals and intrusive thoughts for the former and perfectionism and guilt over food for the latter.

ON may fall under the umbrella term ‘cyberpathy’ in which information is spread through popular social media accounts, Dr Hanganu-Bresch said.

She noted ON attracts ‘digital donkeys’ who are searching for inspirational health advice. 

‘Orthorexia nervosa and its many proposed avatars (among which are healthy anorexia, organorexia and nutrichondria) could be subsumed under the umbrella of cyberpathies, spread through the “viral” content of popular blogs and Twitter, Facebook and Instagram accounts,’ ‘ Dr Hanganu-Bresch said.

‘Memes, pictures of “healthy” and colourful meals and tan, muscular bodies in yoga, enthusiastic product endorsements and nutrition tips and animal sages are multiplying in unknown numbers, evangelizing the population in the Gospel of health.

‘The confessed orthorexic sufferers have social media accounts filled with thin and glowingly fit bodies, and they sometimes admit that an implicit goal is an ideal (low) body weight.’

A 2017 study by University College London found the prevalence of ON is much higher among social media users – 49 per cent Instagram users surveyed were found to have ON symptoms. 

Writing in the journal The National Library of Medicine, the researchers said Instagram is by far the medium most likely to have that effect compared with other social media platforms such as Twitter because it is ‘the platform of choice for the healthy eating community’.

ON is normally seen among ‘well-off’ people because it often relies being able to afford cleanses, organic juices and a gym membership, Dr Hanganu-Bresch said.

‘It is a disorder of abundance and rigidity, and also a disorder of privilege, both relying on and generating costly practices.’

Holistic physician Steve Bratman was the first to describe ON, writing in a 1997 yoga journal.

He described his own obsession with eating clean and pure and said: ‘Most (orthorexicists) have to resort to iron self-discipline, reinforced by a great sense of superiority over those who eat unhealthy foods.’

Mr Bratman later wrote, 20 years later, that when he coined the term ‘orthorexic nervousness,’ he had no intention of suggesting a new eating disorder.

Much of the research into the condition is anecdotal and there is no clear way of diagnosing it.

Eating disorders charity Beat says ON is not medically recognised because it doesn’t have it’s own specific treatment pathway.

Clinicians have not identified a distinct way to treat it the way they have anorexia, bulimia, or binge eating disorder, for instance.

‘We still don’t know what that is,’ said clinical psychologist Dr Jennifer Mills, an associate professor at York University and co-author of a paper on ON in the September issue of the journal Appetite.

Dr Mills said estimates of prevalence ‘are everywhere’. 

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