A new study has examined orthorexia, an unhealthy preoccupation with eating in a way that feels perfectly "clean" or "healthy", in people with obsessive-compulsive personality disorder (OCPD). OCPD involves a rigid need for control, order and perfectionism, and the researchers wanted to know whether these traits make orthorexic patterns more likely, and what role unhelpful thinking about one's own thoughts, known as metacognition, might play.
The study, led by Kılıçaslan, compared 73 people diagnosed with OCPD against 73 healthy controls matched for age, sex and education. Participants completed measures of perfectionism, orthorexia and metacognition. Those with OCPD scored higher on all three, and had lower BMIs than the control group. Higher perfectionism was linked to more orthorexic tendencies, and metacognition itself was tied to both: more of these unhelpful thinking patterns went with higher perfectionism and lower orthorexia scores. When the researchers looked more closely, metacognition partly explained why perfectionism was associated with orthorexic behaviour, rather than perfectionism acting alone.
The authors suggest this points to metacognitive therapy as a potentially useful approach for orthorexic patterns in people with OCPD, since the issue is not simply about food choices. It often sits alongside rigid beliefs about the need to control one's own thoughts and worries.
If perfectionism, or rigid rules around food, order or control, are affecting your wellbeing, a psychologist can help you work through it.
Background concepts, defined
Obsessive-compulsive personality disorder is marked by rigidity, an intense need for order and control, and perfectionism, meaning a tendency to set excessively high standards and to be highly self-critical when they are not met. Orthorexia refers to an obsessive preoccupation with eating purely or correctly, to the point of causing distress or impairment. It is not yet a formal diagnosis in the DSM-5.
The study also examines metacognition, which concerns not what a person thinks but how they think about their own thinking. It covers beliefs such as needing to monitor one's thoughts constantly, or regarding one's worries as uncontrollable. Dysfunctional metacognitive beliefs of this kind are already linked to anxiety and obsessive-compulsive problems in other research, which makes them a natural candidate for explaining orthorexic tendencies as well.
What the study did
The researchers compared 73 people diagnosed with OCPD, using a structured clinical interview known as the SCID-5-PD, a standardised diagnostic tool based on DSM-5 criteria, against 73 healthy controls matched for age, sex and education. Everyone completed three questionnaires: the Frost Multidimensional Perfectionism Scale, the Meta-Cognition Questionnaire-30, and the ORTO-11, which screens for orthorexic tendencies, where lower scores indicate stronger tendencies. The team then applied correlation, linear regression and mediation analysis, a statistical approach testing whether one variable, here metacognition, helps explain the pathway between two others, in this case perfectionism and orthorexia.
What it found
Compared with controls, the OCPD group had lower BMI along with higher scores for perfectionism, orthorexic tendencies and dysfunctional metacognitive activity. Higher perfectionism scores were associated with lower ORTO-11 scores, meaning more perfectionism accompanied stronger orthorexic tendencies. Metacognition scores followed a similar pattern, correlating positively with perfectionism and negatively with ORTO-11 scores, so more dysfunctional metacognitive beliefs tracked with both.
The central result came from the mediation analysis. Metacognition partially mediated the relationship between perfectionism and orthorexia. In plain terms, some of the link between being highly perfectionistic and developing orthorexic eating patterns runs through these unhelpful beliefs about one's own thoughts, though not all of it.
Why it matters
The finding suggests orthorexic eating in OCPD is connected to a broader pattern of rigid, self-monitoring thought styles rather than being an extension of wanting to be healthy carried too far. The authors propose metacognitive therapy, an approach targeting beliefs about thinking itself, as a potentially useful avenue for orthorexic behaviours in this population, alongside addressing perfectionism directly.
Limits worth knowing
This was a cross-sectional study, meaning everyone was assessed at a single point in time. It shows these factors are statistically linked and cannot establish that perfectionism or metacognition causes orthorexia. The findings also come from people already diagnosed with OCPD, so how far they extend beyond that group is unclear. The abstract reports no effect sizes, so the practical strength of these links cannot be judged from it alone.
If perfectionism, rigid food rules, or intrusive worry about getting things right are affecting your wellbeing, a psychologist can help you work through it.