Purpose <p>This study aimed to examine the relationship and differences between healthy eating, orthorexia nervosa tendencies and early maladaptive schemas.</p> Methods <p>A cross-sectional online survey was conducted on a sample of Hungarian adults. One thousand twelve participants completed measures assessing healthy orthorexia, orthorexia nervosa tendencies, perceived stress, and early maladaptive schemas. Structural equation modeling was used to determine the relationships among the variables.</p> Results <p>Results indicated significant associations between orthorexia nervosa tendencies and specific early maladaptive schemas, particularly unrelenting standards and defectiveness/shame schemas. Additionally, age, perceived stress, and BMI were found to be associated with orthorexia nervosa tendencies and healthy orthorexia.</p> Conclusions <p>The findings suggest that early maladaptive schemas, especially those related to perfectionism and low self-esteem, may contribute to the development and persistence of high orthorexia nervosa tendencies. More research is necessary to examine these relationships and their potential therapeutic implications.</p> Level of evidence <p>Level V, descriptive cross-sectional study.</p>