Orthorexia

What is Orthorexia Nervosa? 

The term “orthorexia nervosa” (ON) was first used by Steven Bratman in 1997 to describe a pathological fixation on the consumption of appropriate and healthy food. “Orthos” means “accurate, straight, right, valid or correct” and “orexis” means “hunger or appetite” (Brytek-Matera, 2012). A person with ON initially wants to improve his/her own health, treat a disease or lose weight, but eventually their diet becomes the most important part of their life. They become extremely selective about their food choices regarding the food’s purity, origin, presence of artificial ingredients and additives, preservatives, etc. (Chaki et al., 2013).

How Prevalent is Orthorexia Nervosa?

Very few studies have been conducted to determine the worldwide presence of ON. Studies that have examined prevalence are inconclusive.

  • In the general population, 57.5% were diagnosed with ON using a self-administered questionnaire called the ORTO-15. Most were females (Ramacciotti et al., 2011).
  • The overall prevalence of ON was 6.9% in Italy with higher rates among males compared to females (Donini et al., 2004).
  • Athletes are at a higher risk of ON because they exert a high degree of control over their diets to maximize athletic performance. The prevalence of ON is 31% in female athletes and 41% in male athletes (Farooq & Bradbury, 2016).
  • Nutrition students in Germany show higher levels of dietary restraint, but disinhibition and orthorexia nervosa did not differ between nutrition students and students in other fields of study (Korinth et al., 2009).
  • Among dietitians in Austria, 12.8% showed four or more symptoms of orthorexia nervosa (Kinzl et al.,2005).
  • Among performance artists, the highest prevalence is among opera singers (81.8%), ballet dancers (32.1%), and symphony orchestra musicians (36.4%) (Aksoydan & Camci, 2009).

What are the Risk Factors for Orthorexia Nervosa?

What begins as exuberant interest in healthy food eventually turns into an eating disorder in susceptible individuals. Individuals who present with the following are at higher risk for ON. 

  • Adoption of a highly restrictive dietary theory
  • Parents assign extreme importance to food
  • Childhood illness involving diet and/or digestive issues
  • Medical problems that can’t be addressed by medical science
  • Traits such as OCD, perfectionism, and extremism
  • Fear of disease  (Bratman, 2016)

What are the Diagnostic Criteria for Orthorexia Nervosa?

ON has not been officially recognized as a disorder by the Diagnostic and Statistical Manual of Mental Disorders – V (DSM-V), so valid diagnostic criteria is controversial (Chaki et al., 2013). Aspects of ON overlap with anorexia nervosa and bulimia nervosa, such as food and eating preoccupation, restrictive eating, health-related consequences, and cognitive distortions (Brytek-Matera et al., 2015). However, there are significant similarities between ON and obsessive-compulsive disorder (OCD), such as obsessional anxiety that leads to ritualistic behaviors with meal planning and preparation. It has been shown that individuals with higher OCD tendencies have higher ON tendencies (Poyraz et al., 2015). Because ON does not involve low self-esteem, poor body image, preoccupation with weight loss, or the quantity of food consumed like other eating disorders, it is questioned if ON should be classified as OCD rather than an eating disorder (Brytek-Matera, 2012).

Scarff (2017) has proposed the most recent diagnostic criteria for orthorexia nervosa:

Criterion A. Obsessive focus on “healthy” heating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relation to food choices perceived as unhealthy; weight loss may ensue as a result of dietary choices, but this is not the primary goal. As evidenced by the following:

  1. Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health.
  2. Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame.
  3. Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy eating.

Criterion B. The compulsive behavior and mental preoccupation become clinically impairing by any of the following:

  1. Malnutrition, severe weight loss or other medical complications from a restricted diet.
  2. Intrapersonal distress or impairment of social, academic, or vocational functioning secondary to beliefs or behaviors about healthy diet.
  3. Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined “healthy” eating behavior.

What are the Treatment Options for Orthorexia Nervosa? 

Treatment options are similar to those offered for other eating disorders and addictive behaviors in general. This may include cognitive behavior therapy that teaches the person how to replace obsessive thoughts with healthier alternatives, and/or gradual-exposure therapy reintroducing “forbidden” foods one by one. Treatment involves a multi-disciplinary treatment team of professionals that may include a physician, therapist, and dietitian (Haupt, 2011).

Last update: 18 March 2021

Ask Yourself...

What is your definition of “health" and "healthy eating," and where does your definition derive from? 

How do you think society and the media has shaped your idea of what foods or eating patterns are considered “healthy?”

Is society’s focus on “clean eating,” “detoxing,” and “natural foods” problematic? Why or why not?

\