Orthorexia

Reviewed by Amy Baker Dennis, PhD, FAED

Although not formally recognized in the Diagnostic and Statistical Manual DSM-5 TR, awareness about orthorexia is on the rise. The term ‘orthorexia’ was coined in 1997 and means an obsession with proper or ‘healthful’ eating.1 Although being aware of and concerned with the nutritional quality of the food you eat isn’t a problem in and of itself, people with orthorexia become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being and experience health consequences such as malnutrition and/or impairment of psychosocial functioning.2

Without formal diagnostic criteria, it’s difficult to get an estimate on precisely how many people have orthorexia, and whether it’s a stand-alone eating disorder, a type of existing eating disorder like anorexia nervosa, or a form of obsessive-compulsive disorder.3 Studies have shown that many individuals with orthorexia also have obsessive-compulsive disorder.4

Warning Signs and Symptoms of Orthorexia5


  • Compulsive checking of ingredient lists and nutritional labels
  • An increase in concern about the health of ingredients
  • Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
  • Unusual interest in the health of what others are eating
  • A feeling of superiority around their nutrition and intolerance of other people’s food behaviors and beliefs6
  • High levels of perfectionism6
  • Spending hours per day thinking about what food might be served at upcoming events
  • Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
  • Obsessive following of food and ‘healthy lifestyle’ blogs on social media7,8
  • Body image concerns may or may not be present
  • Psychosocial impairments in different areas of life9

Health Consequences10


Like anorexia nervosa, orthorexia involves restriction of the amount and variety of foods eaten, making malnutrition likely. Therefore, the two disorders share many of the same physical consequences.

Learn more about health consequences.

Treatment Considerations5,11,13


There are currently no clinical treatments developed specifically for orthorexia, but many eating disorder experts treat orthorexia as a variety of anorexia nervosa and/or obsessive-compulsive disorder. Thus, treatment usually involves a multidisciplinary team approach which includes a physician, therapist, and dietitian. During the treatment process, psychotherapy is utilized to increase the variety of foods eaten and exposure to anxiety-provoking or feared foods, as well as weight restoration as needed.

Learn more about treatment here.

Learn more about finding treatment providers in your area here.

Sources


[1]Bratman, S., & Knight, D. (1997). Health food junkie. Yoga Journal, 136, 42–50.

[2] Dunn, T. M., & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating behaviors, 21, 11–17. https://doi.org/10.1016/j.eatbeh.2015.12.006

[3] Sanzari, C. M., & Hormes, J. M. (2023). U.S. health professionals’ perspectives on orthorexia nervosa: clinical utility, measurement and diagnosis, and perceived influence of sociocultural factors. Eating and weight disorders: EWD, 28(1), 31. https://doi.org/10.1007/s40519-023-01551-6

[4]Pontillo, M., Zanna, V., Demaria, F., Averna, R., Di Vincenzo, C., De Biase, M., Di Luzio, M., Foti, B., Tata, M. C., & Vicari, S. (2022). Orthorexia Nervosa, Eating Disorders, and Obsessive-Compulsive Disorder: A Selective Review of the Last Seven Years. Journal of clinical medicine, 11(20), 6134. https://doi.org/10.3390/jcm11206134

[5] Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: emerging perspectives. Neuropsychiatric disease and treatment, 11, 385–394. https://doi.org/10.2147/NDT.S61665

[6] Harris, M., Smithson, J., & Karl, A. (2020). What are people’s experiences of orthorexia nervosa? A qualitative study of online blogs. Eating and weight disorders : EWD, 25(6), 1693–1702. https://doi.org/10.1007/s40519-019-00809-2

[7] Scheiber, R., Diehl, S., & Karmasin, M. (2023). Socio-cultural power of social media on orthorexia nervosa: An empirical investigation on the mediating role of thin-ideal and muscular internalization, appearance comparison, and body dissatisfaction. Appetite, 185, 106522. https://doi.org/10.1016/j.appet.2023.106522

[8] Greville-Harris, M., Smithson, J., & Karl, A. (2020). What are people’s experiences of orthorexia nervosa? A qualitative study of online blogs. Eating and weight disorders : EWD, 25(6), 1693–1702. https://doi.org/10.1007/s40519-019-00809-2

[9] Cena, H., Barthels, F., Cuzzolaro, M., Bratman, S., Brytek-Matera, A., Dunn, T., Varga, M., Missbach, B., & Donini, L. M. (2019). Definition and diagnostic criteria for orthorexia nervosa: a narrative review of the literature. Eating and weight disorders : EWD, 24(2), 209–246. https://doi.org/10.1007/s40519-018-0606-y

[10] Duradoni, M., Gursesli, M. C., Fiorenza, M., & Guazzini, A. (2023). The Relationship between Orthorexia Nervosa and Obsessive Compulsive Disorder. European journal of investigation in health, psychology and education, 13(5), 861–869. https://doi.org/10.3390/ejihpe13050065

[11] Niedzielski, A., & Kaźmierczak-Wojtaś, N. (2021). Prevalence of Orthorexia Nervosa and Its Diagnostic Tools-A Literature Review. International journal of environmental research and public health, 18(10), 5488. https://doi.org/10.3390/ijerph18105488

[12] Gkiouleka, M., Stavraki, C., Sergentanis, T. N., & Vassilakou, T. (2022). Orthorexia Nervosa in Adolescents and Young Adults: A Literature Review. Children (Basel, Switzerland), 9(3), 365. https://doi.org/10.3390/children9030365