Clean eating finds support on social media, but for a small group it becomes a rigid, isolating disorder
STUDY: Keski-Rahkonen A et al, Current Opinion in Psychiatry 2026
STUDY TYPE: Narrative review
FUNDING: Independent
Background
Orthorexia nervosa is a fixation on healthy eating that goes so far as to harm health or functioning. It is a new diagnosis, and hasn’t been validated in DSM-5-TR or ICD-11. This review summarizes research from the past two years, since 2025.
Review
The prevalence is not as high as earlier studies suggested, which found 28% using the ORTO-15 scale. Newer, stricter scales find 0.5% to 1.5% with the disorder and 7.5% to 15% with elevated tendencies.
Groups at higher risk include:
- Dietitians and nutrition or sport science students
- Athletes
- People told to watch their diet, such as those with celiac disease, insulin resistance, or pregnancy
- Heavy users of image-based social media, especially content tagged #cleaneating
- Perfectionism and obsessive-compulsive traits
- Alexithymia (trouble identifying and expressing emotions)
- Autistic traits
Vegan and plant-based diets are linked to orthorexia, though better nutrition knowledge may explain part of that link. Eco-anxiety and pandemic stress also contribute.
Orthorexia often overlaps with anorexia nervosa, depression, and anxiety.
We don’t have much research on treatment. One study of 65 adolescents found psychoeducation reduced orthorexic tendencies. Cognitive behavioral therapy, mindful eating, and intuitive eating are promising but largely untested.
Practice Implications
- When a patient describes strict eating rules, ask what happens when they break one. Guilt, anxiety, social withdrawal, or weight loss point to a disorder.
- Check weight and nutrition, and look for anorexia nervosa, obsessive-compulsive disorder, and autistic traits.
- For treatment, start with psychoeducation and cognitive behavioral therapy (aimed at making food rules more flexible), and ask about the diet and wellness accounts your patient follows.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
