Eating clean, feeling broken: A qualitative meta-synthesis of the lived experience of orthorexia nervosa

Orthorexia nervosa refers to a pathological obsession with healthy eating, yet its classification, causes, and clinical relevance remain contested. This qualitative meta-synthesis explores the lived experiences of individuals with orthorexic behaviors to better understand the psychological, social, and cultural dynamics that sustain this condition. Drawing on thematic synthesis of 16 peer-reviewed, qualitative studies, three major themes emerged: (1) Origins and Motivations for Orthorexic Behavior, highlighting the role of perfectionism, identity, and sociocultural ideals; (2) The Orthorexic Experience and Its Consequences, illustrating the emotional, physical, and social costs of rigid dietary practices; and (3) Individual's Perspectives on Orthorexia as a Disorder, revealing ambivalence toward diagnosis, conceptual confusion, and overlaps with other eating disorders. Findings suggest that orthorexia serves both as a personal coping strategy and a moralized performance of health shaped by contemporary wellness culture. The synthesis reveals how orthorexic behaviors are often normalized, socially reinforced, and deeply tied to individual identity—rendering recognition and recovery particularly challenging. Rather than advocating for diagnostic categorization, this study highlights how orthorexic practices are embedded in broader cultural narratives around health, control, and morality. • Orthorexia is shaped by sociocultural ideals, control needs, and identity reinforcement. • Individuals experience physical, emotional, and social harm despite health-focused intent. • Orthorexia is often normalized, making recognition and intervention difficult. • Participants show ambivalence about diagnosis and recovery. • Sociocultural pressures around health and morality drive orthorexic behaviors.