Background <p>Obsessive‒compulsive personality disorder (OCPD) is characterized by a rigid need for control, orderliness, and perfectionism, often impairing functionality. Traits such as striving for an "ideal" figure can lead to orthorexic tendencies, characterized by an obsessive focus on healthy eating, which can result in significant social, psychological, and physical complications. This study investigates the presence of orthorexic tendencies in individuals with OCPD and examines whether these tendencies are predicted by metacognition and perfectionism, with a focus on the mediating role of metacognition.</p> Methods <p>The study included 73 patients diagnosed with OCPD through the DSM-5 Structured Clinical Interview (SCID-5-PD) and 73 healthy controls matched by age, sex, and education level. Perfectionism, orthorexia, and metacognition were assessed via the Frost Multidimensional Perfectionism Scale (FMPS), Meta-Cognition Questionnaire-30 (MCQ-30), and ORTO-11 scale. Pearson correlation, linear regression, and mediation analyses were conducted to explore these relationships.</p> Results <p>OCPD patients had lower BMIs and higher scores for perfectionism, orthorexia, and metacognitive activity than did the control group. A negative correlation was found between the FMPS and ORTO-11 scores. MCQ scores were positively correlated with FMPS scores and negatively correlated with ORTO-11 scores. In the mediation analysis, metacognition was found to have a partial mediating effect on the relationship between perfectionism and orthorexia.</p> Conclusion <p>Perfectionism and dysfunctional metacognition significantly contribute to orthorexic tendencies in individuals with OCPD. These findings suggest that metacognitive therapy may effectively address and reduce orthorexic behaviors in this population.</p>