Orthorexia seems to be the most misunderstood of eating disorders. It also seems to be the one that gets the hackles of the health-conscious community up the most, probably because it centers around the idea of healthy eating. Eating healthy, nutrient-rich foods that are beneficial for your body is, obviously, a good idea.

Study after study has been done to support this. Fresh fruits and vegetables, whole grains, seeds, nuts, and all the stuff that makes food enjoyable are great things to focus on when building daily meals. The problem people have with orthorexia lies in the misconception that the existence of an eating disorder stemming from this focus means that anyone who makes health-conscious food choices is insane. Which is, of course, not true.

The difference between orthorexia and everyday healthy eating is one of choice versus fear. When anyone who is not orthorexic chooses to eat a healthy food instead of an unhealthy one, it’s just that: a choice. The person looks at the foods available and makes a conscious decision to have, say, granola instead of sugary cereal or a salad instead of something deep-fried. These decisions are made based on a healthy concern for personal well-being and perhaps a desire to exclude certain chemicals or additives from daily diet. For the orthorexic, healthy food isn’t a choice; it’s a necessity. Orthorexia involves a palpable fear, almost a terror, of consuming foods that are perceived as unhealthy, unclean, or otherwise “bad.” Whereas someone who doesn’t have orthorexia might occasionally choose something processed, fried, or preservative-laden for a treat or as a matter of necessity when nothing else is available, an orthorexic is literally unable to do this.

The fear of becoming contaminated is so strong that it can cause a person to exclude entire groups of foods, some of which may actually be healthy. Restriction may become so severe that it leads to malnourishment, vitamin and mineral deficiencies, and extreme weight loss. It’s okay to be concerned about the effects of chemicals, additives, and other potentially harmful things on our bodies. But when that concern turns into a paralyzing fear that affects daily life, personal relationships and overall well-being, orthorexia rears its ugly head.

Dangerous eating habits can center on any idea; orthorexia happens to revolve around a desire to eat healthy rather than a desire to lose weight or attain a certain body shape. Orthorexics lose sight of why it’s important to eat healthy and become obsessed with the idea of dietary purity to the point where it eclipses nearly everything else in their lives. It’s a dangerous and frightening way to live that bears little resemblance to truly healthful dietary habits.