Kate Finn just wanted to rid her body of toxins. That’s the reason she began experimenting with a raw food diet in the first place. She was in her late twenties and wasn’t concerned about body image or size. Her stomach was hurting, and she simply wanted to eliminate anything that could be messing with her digestion. That meant eating the cleanest possible diet.

It wasn’t long before she discovered she was unintentionally losing pound after pound. And then she found it impossible to reverse course and eat anything that wasn’t “pure.” Her list of clean foods—raw fruit, raw veggies, grains and nuts—didn’t provide the calories she needed to stabilize her weight. People were starting to stare as she got thinner and thinner. To make matters worse, her stomach started to hurt again.

Finn knew she had a problem and eventually contacted alternative medicine practitioner Dr. Steven Bratman. He’d famously coined the term “orthorexia” in 1997 to describe a fixation on eating only healthy food: Ortho comes from the Greek, meaning correct and true.

Finn had periods where she seemed to be in recovery, but she wasn’t really. “I still think about food a lot,” she confessed to a reporter from The Guardian who interviewed her as a specimen of American food faddism. At 37, Finn finally agreed to be hospitalized, but when a relative came to pick her up, it was too late. She was found dead from heart failure, brought on by starvation from her orthorexic diet. In her diary, her family read about how scared and helpless she felt—and also about the health food gurus she’d been following.

Finn was one of the rare fatal orthorexia-related cases Dr. Bratman encountered in his years practicing holistic medicine. He documented several more in his book, Health Food Junkies: Overcoming the Obsession with Healthful Eating, which he published in 2000, years before Finn’s death.

What it is; what it’s not

In talking about orthorexia, it’s important to understand what it’s not. It’s not vegetarianism, veganism, gluten free, dairy free, the Keto, Paleo, Whole30 diets, or any other system of eating, however particular it may be. Food allergies are real, and much evidence suggests that our health care system, and the environment, would be better off with more vegetarians in the world. The standard American diet—with its apt acronym SAD—is notorious for making people overweight, unhappy, and dead. It’s not wrong for people to want to find a better, healthier way to eat.

Where a special interest in diet transitions from a hobby or passion into a problem is when it devours the rest of your life (pun intended). Any health-focused diet can become orthorexic with the right combination of perfectionism and obsession.

One sign of trouble is if your eating habits become tied to your self-esteem. In our culture, healthy eating is considered virtuous, but an orthorexic mindset takes things further: finding and following the purest diet becomes a potential path to holiness, so to speak. In his book, Dr. Bratman explains that the self-denial, discipline, and commitment required for an extreme eating lifestyle can make people feel good about themselves. There’s a sense of being one of the elite: the few, the proud, the sugar free.

The dark side of that mentality? The shame that can crush you when, in a moment of weakness, you break one of your dietary rules. I’m not talking about the sense of sheepishness that accompanies minor misbehavior like buying Halloween candy when it’s on sale at the beginning of October, only to return to the store a few weeks later to pay the now inflated price for candy because of the crumpled, half empty bags in the pantry that whisper: I was meant to bring joy to small costumed children. But then you ate me.

No, I’m talking about the guilt and self-loathing that follows a serious personal failure. Slipping up on an extreme diet guideline can make an orthorexic person feel like they’ve become a hypocrite and committed a crime, or perhaps a sacrilege. The inevitable reaction? Do penance—with an even stricter adherence to the rules—and return to the “one true way” of eating.

One of the key features of an eating disorder is that it assigns food a job to do that it just can’t live up to. People eat for both fuel and for pleasure, but it’s not possible to become a more enlightened person based solely on what we do—or don’t—put in our mouths. A distorted role for eating is one way orthorexia can become a daily, even hourly, source of torment for people who are desperate to triumph over their taste buds and be “good.”

Signs of trouble show up in the world around an orthorexic, too. As the list of foods she is “allowed” to eat grows ever shorter, her social circle contracts, too. Managing an ultra strict diet often means eating alone. Think of the role food plays in family traditions, holidays, and friendships. A woman with orthorexia can struggle with anxiety when confronting a menu at a networking lunch, or feel separated from her loved ones when she has to bring her own food to a family wake. Everything from participating in a meal train to attending a bridal shower can become a reminder of loneliness instead of a time for connection. Social isolation is not only painful, it can have negative effects for health, an ironic consequence given that orthorexia often has its roots in a desire to be as healthy as possible. At that point, “you don’t have a life—you have a menu!” Dr. Bratman writes.

Renee McGregor is a registered dietitian who has worked for decades with professional athletes, Olympic teams, and regular people alike to provide nutritional insight and manage eating disorders. She is the co-founder of #TRAINBRAVE, an awareness campaign for eating disorders among athletes, and sits on the International Task Force for Orthorexia. Her Trainbrave podcast debuted earlier this year.

“While healthy eating is important, any relationship with food that creates anxiety is not healthy,” she told me.

Athletes are at a greater risk of eating disorders, perhaps in tandem with their often tremendous commitment to do whatever hard work seems necessary to achieve at the highest level possible. But McGregor points out that orthorexia is not a phenomenon limited to people dedicated to peak athletic performance.

“Orthorexia can impact anyone who has low self worth, an unmanaged perfectionist mindset, and a tendency to be obsessive, compulsive,” she says. “It develops as a form of coping mechanism. It provides a means to contain and numb difficult feelings. . . . So what can start out as a way of wanting to improve themselves, or feel better, can soon turn into a behavior, while bringing temporary relief, that becomes compulsive and detrimental to health.”

Her website features a quiz both women and men can take if they’re considering whether to find help for a problem with orthorexia. The questions illustrate the wide impact orthorexia can have on the whole person, from, “Do you fear eating food away from home?” to, “Is your sleep quantity or quality poor?”

“Recovering from orthorexia means having a healthy attitude towards food and eating,” McGregor says. “It’s about getting to a place where you can let yourself off the hook and don’t allow your intrusive thoughts to be your reality; it’s about understanding that you don’t have to get everything in life right. Sometimes we have to make mistakes to learn from them.”

More than a fad diet

It’s been more than 20 years since the term “orthorexia” was first coined. Since then, the phrase “clean eating” has become trendy, making the fear of dirty and impure food explicit. Alternative health care has been mainstreamed. Even an establishment stalwart like the Cleveland Clinic has a Center for Integrative & Lifestyle Medicine which promotes Nutrigenomix—essentially, $250 genetic testing to find out which special diet your genes supposedly say you should eat. For an additional $95, a dietitian will actually email you your results to go over them with you (don’t bother billing your insurance). Social media has exploded as an outlet for wellness culture. At the same time, bloggers like The Fit Foodie and Lee From America have been sharing with followers that orthorexia has been part of their experience.

“There is very good evidence for the role Instagram plays in contributing to orthorexia,” McGregor told me. “While I don’t think it causes it, it definitely helps those with orthorexic behaviors to be validated, encouraging individuals to maintain their disorder.

“We look to social media for answers—it is easy to get sucked into the image of ‘health and well-being’ portrayed and buy into this, believing that eating, training, or even living in a certain way will help us to become like those who are promoting it.”

One of the more prominent examples of a blogger performing a diet about-face is Jordan Younger, who amassed 300,000 followers on Instagram as “The Blonde Vegan.” She describes herself as an “extreme-aholic,” someone who dives into any relationship, work project, or lifestyle with fervent gusto. After a bad breakup in her early twenties, she embarked on a five day cleanse and, in her words, “fell head over heels in love with plant-based veganism.” It certainly helped that her new diet seemed to fix the painful stomach troubles that had bothered her for years. In her book, Breaking Vegan, Younger describes how she quickly became obsessed. “In the beginning stages of the diet, veganism became my boyfriend, my best friend, and my confidant. . . . The strict diet helped me feel extraordinary when I was very fearful of being ordinary,” she writes. “Veganism was something I could hold on to—something so clear in its principles, there was no way I could fail.”

Younger’s approach became more and more strict, even as her influencer career grew by leaps and bounds. She moved from short term cleanses to a thirty day cleanse marathon. Eventually, her stomach started to hurt again. Her skin began to turn an orangey shade from eating so many sweet potatoes and carrots. Her hair was thinning and falling out in clumps. She stopped getting her period.

It was actually Jamie Graber, then-owner of Gingersnap’s Organic, a raw vegan cafe in New York, who gently raised the alarm, at a meeting to plan a meet-and-greet event for Blonde Vegan readers. The restaurateur listened intently as Younger described her diet and then, seemingly out of the blue, asked if she menstruated regularly.

“The concern on her face when I said I hadn’t had a period in six months hit me hard, kind of like waking up from a long, confused slumber,” Younger writes. “I prided myself on prioritizing health and was doing everything in my power to live as purely as possible, yet here I was ignoring a huge sign from my body.”

Graber suggested Younger eat a piece of freshwater fish from a trustworthy, macrobiotic eatery called Souen. The fish was the only non-vegan item on the menu. Younger picked it up to-go and went home to eat in privacy, confronting a wave of anxiety: what if the fish had hormones and artificial fillers? How could she be sure it was fresh? What if she instantly gained weight or her stomach revolted? Working up her courage, she sent a photo of the meal to her mom and best friend Katie, who quickly texted back their encouragement. “A thin, flaky piece of pink fish, juicy and tempting, giving me a writhing panic attack and a thrill all at once,” as Younger describes it.

“It almost sounds silly, two grown women congratulating another grown woman on eating food that satiates her, but if only I could convey to you how badly I needed to hear it,” she adds.

The fall-out after she announced her dietary change was intense: Younger switched her handle to “The Balanced Blonde” and weathered an avalanche of negative reaction from some of her readers. Elle magazine quoted Marcus Antebi, the founder of the raw vegan chain Juice Press: “Basically what Jordan is saying is that the diet is too hard for her. Having a clean diet is an extraordinary thing. Having a crappy diet is mediocre.” A clear echo of the distorted “eat to be elite” ethos.

It’s important to point out that part of the impetus for Younger to find a more balanced approach to eating came from Graber, who at that time was a voice within the vegan community. Many people can improve their health or get genuine satisfaction from following a non-standard diet that seems rigid or bizarre to people outside diet culture. But it’s only when extremism sends one’s quality of life into a swan dive, or when a person wants to quit and discovers they can’t, that a disorder is at play.

Hope for the hungry

Orthorexia is not officially in the Diagnostic and Statistical Manual of Mental Disorders, or DSM. This handbook is the gold standard for describing and diagnosing mental health conditions, including eating disorders. The concept of orthorexia is still so new that more research has to be done before it can be included in the manual, and that means sometimes women looking for help can struggle to find practitioners who are comfortable treating them.

“This is changing,” McGregor says. “I’m part of a strong group of academics and clinicians from all around the world who make up the International Orthorexia Task Force. We are working hard doing research and using our findings to provide determinants for the diagnostic criteria to be able to be used for submission to the DSM.”

You can be sure that the diagnostic criteria won’t be “seems weird” or “this is ridiculous.” Offering a judgmental critique of someone’s diet is never a good idea, because for all of us, the food we choose to take into our bodies is as personal as it gets. This is especially the case if you suspect that someone you care about may be in the throes of orthorexia. An extreme eating pattern may be an important part of her identity or one of her only ways to cope with anxiety, stress, or shame. Directly attacking what seems like a lifeline may make your friend or loved one feel she has no option but to choose between you and the diet: she may pick the diet and become that much more isolated. If a diet has begun to threaten her safety, it may be appropriate to intervene immediately to get her help. In less extreme situations, building trust, being generous, and showing her how much you appreciate her as a whole person, and not just a person with the ability to perform a high commitment diet, will keep room in your friend’s life for possible change.

And when she wants to get help, or if you’re the one who has decided you need to heal the way you look at eating?

“Remember that like all eating disorders, it is never really about food or body image,” McGregor notes. “It is always about something more deep rooted, so the best type of support is a combination of psychology and nutrition.” Real talk: your food is not clean, or dirty. And neither are you. You aren’t what you eat. You, beautiful woman, are so much more than your menu.