Table of ContentsView AllTable of ContentsWhat Is Orthorexia Nervosa?SymptomsDiagnosisCausesTreatmentCoping
Table of ContentsView All
View All
Table of Contents
What Is Orthorexia Nervosa?
Symptoms
Diagnosis
Causes
Treatment
Coping
The term “orthorexia nervosa” describes an obsession with healthy, “pure,” or “clean” eating. It was coined as an analogy to anorexia nervosa: “ortho,” meaning right; “orexia,” meaning hunger; and “nervosa” meaning fixation or obsession.
Dr. Stephen Bratman first coined the term in 1997 to describe the obsession with healthy eating he had seen in several of his patients. While he did not originally take the diagnosis seriously, he later discovered that people were experiencing serious health consequences as a result of the condition.
Orthorexia is not merely veganism, a gluten-free diet, or a general appreciation for healthy eating. As long as a diet provides adequate nutrients, it is possible to adhere to a healthy eating plan without having an eating disorder.
Orthorexia commonly begins as an “exuberant” interest in healthy eating that escalates over time and becomes unhealthy and even destructive.
Symptoms of the condition include:
In a 2016 paper in the journalEating Behaviors, Dr. Bratman and his co-author, Thom Dunn, proposed the following diagnostic criteria:
Criteria A
All of the following:
Criteria B
Any of the following:
A 2018 study estimated that the prevalence of orthorexia ranged from from 6% to 90% due to the inability to differentiate healthy eating from more pathological healthy eating.
Research is needed to refine the diagnosis, determine prevalence rates, identify risk factors, and develop treatments. An important first step is developing an assessment tool; a 100-question survey is in development to assess and diagnose orthorexia. Researchers are currently proposing the use of the diagnostic tool ORTO-R, which contains six items from ORTO-15 determined to be the best markers of orthorexia nervosa.
There is little research on the causes of orthorexia nervosa, but it is likely that a number of different factors may be involved. Dr. Bratman has described what he believes are several risk factors for orthorexia:
Studies have also suggested that people in certain professions, particularly in health-related careers, might be more likely to develop orthorexia.
Other Risks
Dr. Bratman reported that the condition of orthorexia has already shown signs of evolution since he first conceived of it.He noted that exercise is now more commonly a part of it than it was in the 1990s. He also reported that incorporating low-calorie foods has also become a bigger part of the healthy eating associated with orthorexia.
In cases where individuals pursue both purity and thinness, there may be an overlap between anorexia nervosa and orthorexia nervosa.
Because it can cause malnutrition, orthorexia nervosa may produce any of themedical problems associated with anorexia nervosaincluding loss of menses, osteoporosis, and heart failure.
Belief System of Orthorexia
Although the behaviors (dietary restriction) and consequences (weight loss, malnutrition, bingeing and/or purging) associated with orthorexia nervosa may look similar to anorexia nervosa or bulimia nervosa, the main difference is in the content of the belief system.
OrthorexiaFocus on healthDoes not hide their behaviorTypically do not skip mealsMay resist treatments not perceived as healthyAnorexiaFocus on weight lossShame, guilt, and attempts to hide their behaviorSkip meals and avoid eatingMay resist treatments for fear of gaining weight
OrthorexiaFocus on healthDoes not hide their behaviorTypically do not skip mealsMay resist treatments not perceived as healthy
Focus on health
Does not hide their behavior
Typically do not skip meals
May resist treatments not perceived as healthy
AnorexiaFocus on weight lossShame, guilt, and attempts to hide their behaviorSkip meals and avoid eatingMay resist treatments for fear of gaining weight
Focus on weight loss
Shame, guilt, and attempts to hide their behavior
Skip meals and avoid eating
May resist treatments for fear of gaining weight
People with orthorexia primarily think about ideal health, physical purity, enhanced fitness, and avoiding disease. In contrast, patients with anorexia consciously focus on weight and restrict foods primarily based on calories.
People are usually ashamed of their anorexia and attempt to hide it, but persons with orthorexia may actively attempt to persuade others to follow the same health beliefs.
Those with anorexia nervosa often forego meals; people with orthorexia typically do not (unless they are intentionally “cleansing”).
Finally, when a person with anorexia is in treatment, they have no particular objection to being fed with products such as Ensure or Boost except regarding the calories, whereas a person with orthorexia would object to the chemicals in those supplements.
These distinctions in beliefs may be important. Treatment professionals’ misunderstanding of the concerns of someone with orthorexia may contribute to treatment failure.
Although treatments have not been specifically validated for orthorexia, clinicians have reported that treatments that challenge the dietary theory and build moreflexible eatinghave been successful in the treatment of orthorexia.
If you or a loved one shows signs of orthorexia, please seek help from an eating disorder treatment professional. As with other eating disorders, early intervention increases the chance of a complete recovery and minimizes negative consequences.
Counseling is the mainstay of treatment. Some treatment approaches that may be recommended includecognitive behavioral therapyanddialectical behavior therapy. Medications such asantidepressants and anti-anxiety medicationsmay also be helpful.
If you don’t have a doctor who specializes in eating disorders, speak with your primary healthcare professional first—they can most likely refer you to a specialized doctor. Be sure to discuss behaviors, day-to-day issues, and anything else related to your eating and well-being with your doctor.
Orthorexia Discussion GuideGet our printable guide for your next doctor’s appointment to help you ask the right questions.Download PDFSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
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Often, people with eating disorders cannot recognize the power the condition has over them. In fact, people with orthorexia still believe what they are doing is to be healthy and don’t see it as problematic. They may not even be inclined to speak with a doctor at all.
If your current thoughts and/or behaviors surrounding food is causing distress and/or impacting your daily functioning, then it is advised to seek professional help.
In addition to getting help from a qualified professional, there are also self-help strategies that you can use to help you manage daily life with your condition. Some of these include:
If you or a loved one are struggling with orthorexia nervosa, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.
If you or a loved one are struggling with orthorexia nervosa, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.
For more mental health resources, see ourNational Helpline Database.
4 Steps for Eating Disorder Recovery
7 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunn TM, Bratman S.On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.Eat Behav. 2016;21:11-7. doi:10.1016/j.eatbeh.2015.12.006Dunn TM, Gibbs J, Whitney N, Starosta A.Prevalence of orthorexia nervosa is less than 1 %: Data from a US sample.Eat Weight Disord. 2017;22(1):185-192. doi: 10.1007/s40519-016-0258-8Rogoza R, Donini LM.Introducing ORTO-R: a revision of ORTO-15: Based on the re-assessment of original data.Eat Weight Disord. Published online May 20, 2020. doi:10.1007/s40519-020-00924-5Bratman, SA, Setnick J, Mellowspring A.Orthorexia comes of age: Past, present and future of the most controversial eating disorder. Presentation at IAEDP Symposium; 2016.Koven NS, Abry AW.The clinical basis of orthorexia nervosa: Emerging perspectives.Neuropsychiatr Dis Treat. 2015;11:385-394. doi:10.2147/NDT.S61665Fidan T, Ertekin V, Işikay S, Kirpinar I.Prevalence of orthorexia among medical students in Erzurum, Turkey.Compr Psychiatry. 2010;51(1):49-54. doi:10.1016/j.comppsych.2009.03.001Bratman, Steven A.Orthorexia: An update.Additional ReadingMoroze RM, Dunn TM, Craig holland J, Yager J, Weintraub P.Microthinking about micronutrients: A case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria.Psychosomatics. 2015;56(4):397-403. doi:10.1016/j.psym.2014.03.003Wilson B.Why we fell for clean eating.The Guardian.
7 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Dunn TM, Bratman S.On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.Eat Behav. 2016;21:11-7. doi:10.1016/j.eatbeh.2015.12.006Dunn TM, Gibbs J, Whitney N, Starosta A.Prevalence of orthorexia nervosa is less than 1 %: Data from a US sample.Eat Weight Disord. 2017;22(1):185-192. doi: 10.1007/s40519-016-0258-8Rogoza R, Donini LM.Introducing ORTO-R: a revision of ORTO-15: Based on the re-assessment of original data.Eat Weight Disord. Published online May 20, 2020. doi:10.1007/s40519-020-00924-5Bratman, SA, Setnick J, Mellowspring A.Orthorexia comes of age: Past, present and future of the most controversial eating disorder. Presentation at IAEDP Symposium; 2016.Koven NS, Abry AW.The clinical basis of orthorexia nervosa: Emerging perspectives.Neuropsychiatr Dis Treat. 2015;11:385-394. doi:10.2147/NDT.S61665Fidan T, Ertekin V, Işikay S, Kirpinar I.Prevalence of orthorexia among medical students in Erzurum, Turkey.Compr Psychiatry. 2010;51(1):49-54. doi:10.1016/j.comppsych.2009.03.001Bratman, Steven A.Orthorexia: An update.Additional ReadingMoroze RM, Dunn TM, Craig holland J, Yager J, Weintraub P.Microthinking about micronutrients: A case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria.Psychosomatics. 2015;56(4):397-403. doi:10.1016/j.psym.2014.03.003Wilson B.Why we fell for clean eating.The Guardian.
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Dunn TM, Bratman S.On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.Eat Behav. 2016;21:11-7. doi:10.1016/j.eatbeh.2015.12.006Dunn TM, Gibbs J, Whitney N, Starosta A.Prevalence of orthorexia nervosa is less than 1 %: Data from a US sample.Eat Weight Disord. 2017;22(1):185-192. doi: 10.1007/s40519-016-0258-8Rogoza R, Donini LM.Introducing ORTO-R: a revision of ORTO-15: Based on the re-assessment of original data.Eat Weight Disord. Published online May 20, 2020. doi:10.1007/s40519-020-00924-5Bratman, SA, Setnick J, Mellowspring A.Orthorexia comes of age: Past, present and future of the most controversial eating disorder. Presentation at IAEDP Symposium; 2016.Koven NS, Abry AW.The clinical basis of orthorexia nervosa: Emerging perspectives.Neuropsychiatr Dis Treat. 2015;11:385-394. doi:10.2147/NDT.S61665Fidan T, Ertekin V, Işikay S, Kirpinar I.Prevalence of orthorexia among medical students in Erzurum, Turkey.Compr Psychiatry. 2010;51(1):49-54. doi:10.1016/j.comppsych.2009.03.001Bratman, Steven A.Orthorexia: An update.
Dunn TM, Bratman S.On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.Eat Behav. 2016;21:11-7. doi:10.1016/j.eatbeh.2015.12.006
Dunn TM, Gibbs J, Whitney N, Starosta A.Prevalence of orthorexia nervosa is less than 1 %: Data from a US sample.Eat Weight Disord. 2017;22(1):185-192. doi: 10.1007/s40519-016-0258-8
Rogoza R, Donini LM.Introducing ORTO-R: a revision of ORTO-15: Based on the re-assessment of original data.Eat Weight Disord. Published online May 20, 2020. doi:10.1007/s40519-020-00924-5
Bratman, SA, Setnick J, Mellowspring A.Orthorexia comes of age: Past, present and future of the most controversial eating disorder. Presentation at IAEDP Symposium; 2016.
Koven NS, Abry AW.The clinical basis of orthorexia nervosa: Emerging perspectives.Neuropsychiatr Dis Treat. 2015;11:385-394. doi:10.2147/NDT.S61665
Fidan T, Ertekin V, Işikay S, Kirpinar I.Prevalence of orthorexia among medical students in Erzurum, Turkey.Compr Psychiatry. 2010;51(1):49-54. doi:10.1016/j.comppsych.2009.03.001
Bratman, Steven A.Orthorexia: An update.
Moroze RM, Dunn TM, Craig holland J, Yager J, Weintraub P.Microthinking about micronutrients: A case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria.Psychosomatics. 2015;56(4):397-403. doi:10.1016/j.psym.2014.03.003Wilson B.Why we fell for clean eating.The Guardian.
Moroze RM, Dunn TM, Craig holland J, Yager J, Weintraub P.Microthinking about micronutrients: A case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria.Psychosomatics. 2015;56(4):397-403. doi:10.1016/j.psym.2014.03.003
Wilson B.Why we fell for clean eating.The Guardian.
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