Vegetarianism, Veganism and Eating Disorders: When Orthorexia Hides Behind Ethics

Introduction: When quinoa becomes an obsession and tofu a refuge

"I became vegan for the animals, but also for my health, the environment, and then I discovered it was more spiritual..." This accumulation of justifications is something I hear daily in my Parisian practices in the 6th arrondissement, the 17th, and even in Le Raincy. Sometimes, it's the authentic expression of an awakened ethical consciousness. Sometimes, it's the sophisticated mask of orthorexia nervosa that has found in veganism its perfect alibi, its unassailable justification, its social armor.

The numbers are staggering: in 2025, 40% of people suffering from anorexia nervosa, 35% of those affected by bulimia, and up to 58% of orthorexics adopt some form of vegetarianism or veganism. In the general population? Only 2.2% vegetarians and 0.3% vegans. This massive overrepresentation is no coincidence. It reveals the tortuous links between socially valued dietary restriction, obsessive quest for purity, pathological need for control, and desperate search for identity.

My personal journey illuminates my practice: grandson of a baker bearing the surname "Meunier" (Miller - the irony!), who became gluten intolerant during my nutrition studies. I discovered that dietary restrictions - whether ethical, medical, or pathological - profoundly transform our relationship with ourselves, others, and the world. This visceral, embodied understanding allows me to support with unique depth those navigating these troubled waters where sincere conviction and morbid compulsion mix.

Vegetal orthorexia: Anatomy of a modern obsession

Expanded definition and contemporary manifestations

Orthorexia nervosa - a term coined by Steven Bratman who suffered from it himself - refers to the pathological obsession with "pure," "healthy," "ethical," "conscious," "vibrational" eating (add the trendy adjective of the moment). In our post-modern society obsessed with wellness, clean eating, perpetual detox, and self-optimization, orthorexia has become the most socially acceptable, even admired, mental illness.

The multiple faces of plant-based orthorexia in 2025:

The Escalating Purist: First flexitarian ("I'm reducing meat"), then vegetarian ("no more animal flesh"), then vegan ("no animal products"), then raw vegan ("cooking destroys enzymes"), then fruitarian ("only fruits are truly pure"), then breatharian ("air and light are enough")... The escalation has no logical end, only a tragic one.

The Food Moralist: Every bite becomes a political, ethical, spiritual, environmental act. Eating an avocado? "Deforestation and Mexican cartels!" A banana? "Carbon footprint from transport!" Soy? "Amazon deforestation!" Quinoa? "Stealing from Andean populations!" This hyper-conscientization transforms eating into a moral minefield where every choice is potentially guilty.

The Digitally Influenced: Glued to Instagram accounts of "plant-based warriors," YouTubers' "what I eat in a day," TikTokers' "vegan transformation." Every story becomes prescription, every post becomes rule. "Freelee the Banana Girl eats 51 bananas a day, it must be optimal!" Constant comparison fuels chronic dissatisfaction.

The Amateur Scientist: Obsessed with macros, micros, anti-nutrients, food combinations, circadian timing. "Legumes contain inflammatory lectins, nightshades are toxic, oxalates cause stones, gluten is poison even without intolerance..." Over-information becomes decisional paralysis.

The Rigid Identitarian: "I AM vegan" (not "I eat vegan"). Food becomes total identity, business card, tribal belonging. Any questioning becomes existential threat. Flexibility would mean symbolic death.

Deep psychopathological mechanisms

Control as illusion of security

In our chaotic world - climate crises, pandemics, wars, inflation - controlling one's plate gives the illusion of mastering something. Orthorexic vegetarianism offers a reassuring framework: clear rules, defined identity, belonging community, feeling of moral superiority. For someone with underlying anxiety disorders (80% of EDs), it's a tempting refuge.

As I often say: "You're trying to control your plate because you can't control your life. But guess what? Nobody really controls their life, and that's okay."

Purity as misguided spiritual quest

Plant-based orthorexia often roots in a legitimate spiritual quest that goes awry. Dietary purity becomes a proxy for moral, energetic, karmic purity. "A pure body in a pure mind." But this quest is endless: there will always be something purer, more ethical, more conscious. It's vegan Sisyphus, condemned to eternally push their rock of organic kale.

Perfectionism as self-sabotage

"If I can't be perfectly vegan, I might as well not eat." This all-or-nothing thinking characterizes plant-based orthorexia. A trace of milk in a cookie becomes existential catastrophe. An egg in dough becomes moral betrayal. This rigidity often masks a deep fear of imperfection, of human vulnerability.

I often respond: "Your vegan perfectionism is lazy. It's easier to follow rigid rules than to navigate the nuanced complexity of the real world."

Avoidance disguised as conviction

Vegetarianism can become a sophisticated avoidance strategy:

Social avoidance: "I can't come, they don't serve vegan options"
Family avoidance: "I don't eat at my parents' anymore, they don't understand"
Emotional avoidance: "I'm too busy looking for vegan restaurants to think about my problems"
Caloric avoidance: "Vegetables are so much lighter and more digestible"

Biological impacts and complex nutritional challenges

Specific needs in ED context

Refeeding: Mission impossible in strict plant mode?

Recovery from severe anorexia often requires 3000-5000 kcal/day for several months. Let's see concretely what this represents in plant-based:

Omnivore version:

Breakfast: 2 eggs, 2 buttered toasts, Greek yogurt, fruit = 600 kcal in manageable volume
Snack: Cheese and crackers = 300 easy kcal

Strict vegan version:

Breakfast: Huge smoothie bowl with almond butter, seeds, granola = same calories but triple volume
Snack: Hummus and vegetables = lots of fiber for fewer calories

The problem? A stomach shrunken by restriction physically cannot handle these volumes. I've seen strict vegan patients vomit from overfilling, not from disorder, simply from mechanical impossibility of ingesting necessary volumes.

Critical micronutrients: Beyond B12

Everyone knows about B12, but deficiencies in ED + veganism context are multiple:

Heme vs non-heme iron: Plant iron is absorbed at 5-10% vs 20-30% for animal iron. With pre-existing iron deficiency anemia (75% of anorexics), recovery becomes a marathon.

Zinc and immune system: Bioavailability reduced by 50% in plants due to phytates. Yet zinc is crucial for healing, immunity, mental health.

Omega-3 DHA/EPA: Plant ALA to DHA/EPA conversion is 5-10% maximum. Yet these fatty acids are essential for the brain, already damaged by malnutrition.

Vitamin D3 vs D2: Plant D2 is less effective than animal D3. With bones weakened by amenorrhea, this is problematic.

Creatine and cognition: Absent from plants, when supplemented it improves cognitive functions by 20-30% in vegans. Crucial in post-ED cognitive recovery.

Metabolic adaptation facing multiple restrictions

Refeeding syndrome in plant context

Refeeding syndrome - potentially fatal - is more complex in plant-based:

Plant foods are rich in potassium: increased electrolyte imbalance
High fiber content: slowed absorption, major digestive discomfort
Variable glycemic load: insulin roller coasters
Food volume: painful gastric distension

Compromised metabolic flexibility

A metabolism used to strict veganism + caloric restriction loses its flexibility:

Difficulty digesting concentrated proteins
Impoverished, specialized gut flora
Decreased digestive enzymes
Intestinal inflammation upon reintroduction

Result: even if the person wanted to reintroduce animal products for their health, their body can no longer handle them easily. It's the metabolic trap.

The social dimension: Between community and isolation

The vegan tribe: Support or pressure?

Positive aspects of community

The vegan community can offer:

Powerful sense of belonging
Clear and valued identity
Practical support (recipes, restaurants, tips)
Transcendent common cause
Alternative social network

For someone suffering, it's attractive. "Vegan Facebook groups saved my life" is a phrase I hear.

Possible sectarian drifts

But some groups drift toward:

Competitive purity: "I'm level 5 vegan, I don't eat anything that casts a shadow"
Exclusion of the "imperfect": "If you eat honey, you're not really vegan"
Extreme guilt-tripping: "Every egg is a dead chicken"
Medical misinformation: "Animal proteins cause cancer"
Rejection of medicine: "If you need B12, you're doing veganism wrong"

This community pressure can trap someone who would like to ease up for their health.

Navigating family and friend relationships

Intergenerational conflict

"My grandmother thinks I'll die without meat." "My father says it's a fad that will pass." "My mother hides chicken broth in my dishes."

These family conflicts around vegetarianism can:

Reactivate dysfunctional family dynamics
Serve as battleground for adolescent autonomy
Mask other unresolved conflicts
Further isolate the person with ED

Friendships that transform

"My friends don't invite me anymore since I'm vegan." "I can't stand seeing them eat meat." "We have nothing in common anymore."

Orthorexic vegetarianism can become a radical social filter:

Selection of relationships based on dietary practices
Moral judgment of non-vegans
Proselytism that exhausts those around
Chosen solitude "better alone than poorly accompanied"

My integrative and nuanced therapeutic approach

Comprehensive multidimensional assessment

First appointment: 60 minutes of exploration

I always start with the complete story:

Detailed timeline:

"When did you start modifying your diet?"
"What was happening in your life at that time?"
"How did your family react?"
"What changes did you observe (physical, mental, social)?"

Exploration of deep motivations:

"If you had to choose ONE main reason, what would it be?"
"What does being vegan say about you?"
"How would you feel if you weren't anymore?"
"What would you lose/gain?"

Flexibility tests:

"Imagine you're on a desert island with only eggs..."
"If a doctor prescribed eating fish for your health..."
"How would you react to accidental cross-contamination?"
"What happens inside you when I ask these questions?"

Impact assessment:

Impact on social life: "How many outings have you canceled?"
Professional impact: "Are business meals problematic?"
Family impact: "How are family meals going?"
Economic impact: "How much do you spend on specialized foods?"

The PEACE protocol: My 5-phase approach

P - Medical Priority (0-2 months)

Safety first, philosophy later:

Vital stabilization:

Complete nutritional assessment (CBC, ferritin, B12, D, zinc, albumin...)
Critical deficiency correction
Adapted progressive refeeding
Close medical monitoring

Therapeutic negotiation: "I respect your convictions. Let's explore together the vital minimum to keep you safe. Can we find a temporary compromise?"

Proposed options:

"Medical vegetarianism" with eggs/dairy temporarily
Personalized intensive supplementation (sometimes 10+ supplements)
Fortified foods and superfoods (spirulina, nutritional yeast...)
Negotiated "vital exceptions" (bone broth for minerals)

E - Psychological Exploration (2-4 months)

Understanding the functions of vegetarianism:

Functional analysis:

Anxiolytic function: "It reassures me to have clear rules"
Identity function: "This is who I am now"
Social function: "I found my tribe"
Control function: "At least this, I can control"

Work on cognitions:

Identify distortions: "Eating an egg = killing a chick"
Challenge absolutes: "100% vegan or nothing"
Explore nuances: "What if ethics also meant taking care of yourself?"
Develop flexibility: "Perfectly imperfect"

A - Progressive Flexibility (4-8 months)

Introducing flexibility without betraying values:

Supervised experiments:

"95% vegan": harm reduction concept
"Situational veganism": flexible according to contexts
"Health vegetarianism": adjustments according to bodily needs
"Flexi-vegan": term I created to de-dramatize

Progressive challenges: Week 1: Eat a dish where there might be traces Week 2: Accept an invitation without checking the menu Week 3: Taste a non-vegan dish without guilt Week 4: Consciously choose an exception

C - Construction of personal ethics (8-10 months)

Developing YOUR own philosophy:

Clarified values:

Animal welfare AND personal well-being
Environment AND mental health
Ethics AND pragmatism
Conviction AND compassion (toward self)

Personalized rules: "My non-negotiables": 2-3 maximum, really important "My preferences": What I favor when possible "My flexibilities": Where I can adapt "My exceptions": Situations where I let go

E - Emancipation and autonomy (10-12 months)

Living your choices freely:

Self-affirmation:

Assertive communication of choices
Resistance to pressures (vegan AND non-vegan)
Assumption of contradictions
Celebration of imperfect humanity

Positive transmission:

Share without proselytism
Inspire without guilt-tripping
Testify without judging
Live values without imposing them

Specific therapeutic tools developed

My plant-based orthorexia assessment tool:

Score 0-3: Healthy and flexible vegetarianism

Clear but non-rigid ethical choice
Preserved food pleasure
Maintained social life
Good physical/mental health

Score 4-6: Vigilance zone

Beginning of rigidification
Occasional anxiety around "lapses"
Some social avoidances
Fatigue or mild deficiencies

Score 7-10: Probable orthorexia

Extreme rigidity, panic facing traces
Daily food anxiety
Marked social isolation
Significant health impact

Score 11-15: Danger, urgent intervention

Compromised vital restriction
Major psychological distress
Total social rupture
Medical complications

The 3V Journal

Daily note:

Lived: How I experienced my food choices today
Values: How my actions honored/betrayed my values
Vitality: My energy and well-being level (1-10)

This tool allows seeing patterns and correlations.

The Carrot Meditation

An exercise I created:

Hold a carrot, really look at it
Think of its journey: seed, earth, sun, water, farmer, transport...
Feel gratitude for this complexity
Eat it consciously, without moral label
Observe: neither "good" nor "bad", just food

This exercise deprograms food moralization.

Detailed clinical cases and testimonials

Marie, 28: From vegan anorexia to serene flexibility

Story: "I started vegetarianism at 16, 'for the animals'. Actually, my anorexia was starting and it was the perfect excuse. At 18, strict vegan. At 20, raw vegan. At 22, hospitalization at 32kg for 1m70. Doctors wanted to force me to eat meat. I preferred to die."

Therapeutic work (18 months):

Phase 1: Stabilization with adapted veganism + massive supplementation
Phase 2: Exploration of anorexia/veganism link in therapy
Phase 3: Progressive introduction of local organic eggs "for my health, not against animals"
Phase 4: Work on identity beyond veganism
Phase 5: Construction of personal "benevolent vegetarianism"

Today: "I eat vegetarian 90% of the time, sometimes wild fish. I'm no longer 'Marie the vegan' but 'Marie doing her best'. My BMI is stable at 20, I no longer have amenorrhea, and most importantly, I can share a meal without calculating."

Thomas, 35: Hidden male orthorexia

Story: "Male, athletic, vegan. The perfect combo to hide my orthorexia. 'I'm vegan for performance' I said while swallowing 40 supplements a day. Actually, I had a panic fear of aging, dying, losing control. Veganism gave me the illusion of immortality."

Therapeutic work (12 months):

Deconstruction of the "vegan = optimal health" myth
Work on fear of death and aging
Experimentation with different dietary protocols
Cognitive therapy on distortions
Reconstruction of non-compensatory sports practice

Today: "I eat varied, mostly plant-based but without dogma. Sometimes a post-workout omelet, sometimes tofu. My body chooses, not my obsessional mind. My sports performance? Better than when strictly vegan. My mental state? Incomparably more serene."

Sophia, 42: Vegan mother, anorexic daughter

Complex story: "I raised my daughter vegan. At 14, she developed severe anorexia. Guilt eats at me. Did I cause her disorders? She now uses veganism as a weapon. 'You taught me killing animals is wrong, why should I eat now?'"

Family work (ongoing):

Family therapy to untangle parental vegetarianism and ED
Work on maternal guilt
Support for daughter with respect for family heritage
Negotiation of dietary "ceasefire"
Construction of new dynamics

Current state: "We're progressing. My daughter accepts compromises for her health. I accept that my vegetarianism may have been rigid. We're learning together that love can take different forms, including that of a therapeutic omelet."

Conclusion: Toward an embodied and compassionate food ethic

Vegetarianism, veganism, can be magnificent, ethical, healthy choices. They can also become sophisticated masks for serious eating disorders. The boundary is sometimes thin, often blurred, always unique to each person.

In my Parisian consultations - whether in the calm of the 6th, the effervescence of the 17th or the diversity of Le Raincy - I welcome these questions without preconceived judgment. My role is neither to convert to vegetarianism nor to dissuade from it, but to accompany each person toward nutrition that truly nourishes: body, heart, soul, values, relationships.

Plant-based orthorexia is real, underdiagnosed, and potentially fatal. It deserves attention, understanding and specialized treatment. But with adapted support, it's possible to maintain a food ethic while regaining flexibility, pleasure and health.

Because in the end, isn't the most beautiful ethic one that includes compassion toward oneself? Doesn't the greatest respect for life include respect for ONE'S OWN life? Isn't true purity accepting our magnificently imperfect humanity?

Living and eating are two sides of the same coin. Lighten your relationship with food and free yourself from what doesn't serve you!

📚 SOURCES -

Tree illustration balance eating disorders plant-based ethics health Paris

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