A patient of mine recently said she’d asked her boyfriend to take her out to a trendy new restaurant. He agreed at first, but soon started texting her detailed questions about the menu. Does it have anything zero-carb, he wanted to know. Is the beef organic? She looked at the menu but couldn’t tell, so she ended up calling the restaurant herself. When she went to her boyfriend with the restaurant’s answers, thinking this would settle the issue, he responded with more questions. Can the chef use butter instead of seed oils? Do they have any bread made with coconut or cassava flour? That’s when she began to wonder if this dinner date would ever really take place.

Those who have been in situations like this — or who, perhaps, occupy the position of the boyfriend in this scenario — may be described as struggling to eat “right,” but such efforts toward correctness can cause problems even as they seek to promote good health. The term orthorexia, coined in 1997 by Steven Bratman in the Yoga Journal, describes this condition, with “ortho” meaning “correct” and “orexis” meaning “appetite.” If the word sounds familiar, it’s because it holds an echo of anorexia, although in this case the fixation is on the quality of the food consumed, not its quantity.

Even if its sufferers are trying hard to eat well, orthorexia can cause health problems. Dunn et al (2016) reports that the fixation on “eating right” can, in extreme cases, lead to malnutrition or to difficulties like alienation from one’s peers or stress within one’s relationship. (As Cena (2019) says, a situation like this needs to cause problems in either occupational or relational functioning to be called a disorder.) Plus, orthorexia can be harder to detect because it’s not easy to diagnose. Currently it lacks formal diagnostic criteria, although questionnaires and screens have been attempted in the past (such as by Donini et al in 2005). The DSM-V categorizes orthorexia as an “unspecified feeding and eating disorder,” rather than a syndrome in its own right. There’s also quite a bit of overlap (according to Pontillo et al, 2022) between orthorexia and obsessive-compulsive disorder, and it’s difficult to know where food-related obsessions and compulsions from a broader........

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