‘The mindless pursuit of a thin ideal’: A review of the psychosocial drivers of orthorexia and the role of intuitive eating in recovery

The aim of this paper is to synthesise the literature on the psychosocial drivers of orthorexia nervosa (ON). The incidence of ON has increased rapidly since Covid-19, and we wanted to understand what might be contributing to this growth. First, an overview explains what exactly ON is, particularly as it does not yet constitute a formal diagnosis within established frameworks. We consider how its clinical presentation overlaps with other conditions, including anorexia nervosa, obsessive-compulsive disorder, and body dysmorphic disorder, examining both shared features and important distinctions. We then explore the individual-level drivers of ON, including perfectionism and dysfunctional metacognitive beliefs, alongside the broader sociocultural drivers, ranging from the upsurge in healthism and wellness culture to the increased use of social media and the proliferation of clean eating ideologies. Next, we look at the impact of trauma on the increase in disordered eating, and on orthorexia specifically. We then consider interventions that may be effective for ON. Since the condition involves both cognitive and behavioural rigidity around food, effective treatment is likely to require a multidisciplinary approach spanning psychological and nutritional support. We close with a discussion of the role of intuitive eating as a potential framework for ON recovery. By bringing together the psychosocial and trauma-related drivers of ON and an overview of current and emerging treatment approaches, this paper offers counselling psychologists a possible framework for assessing, formulating, and intervening with ON in practice.