Orthorexia nervosa

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Orthorexia nervosa /ˌɔrθəˈrɛksiə nɜrˈvsə/ (also known as orthorexia) is an eating disorder[1] characterized by an extreme or excessive preoccupation with avoiding foods perceived to be unhealthy.[2][3] The term orthorexia derives from the Greek ορθο- (ortho, "right" or "correct"), and όρεξις (orexis, "appetite"), literally meaning 'correct appetite', but in practice meaning 'correct diet'. It was introduced in 1997 by Steven Bratman, M.D., to be used as a parallel with other eating disorders, such as anorexia nervosa. Orthorexia nervosa is not considered to be an eating disorder according to the American Psychiatric Association, and is not mentioned as an official diagnosis in the widely used DSM[a]. The term was coined by Bratman[4] who claims that in rare cases, this focus may turn into a fixation so extreme that it can lead to severe malnutrition or even death.[5] Even in less severe cases, the attempt to follow a diet that cannot provide adequate nourishment is said to lower self-esteem as the orthorexics blame themselves rather than their diets for their constant hunger and the resulting cravings for forbidden foods. [6]

In 2009, Ursula Philpot, chair of the British Dietetic Association and senior lecturer at Leeds Metropolitan University,[7] described people with orthorexia nervosa to The Guardian as being "solely concerned with the quality of the food they put in their bodies, refining and restricting their diets according to their personal understanding of which foods are truly 'pure'." This differs from other eating disorders, such as anorexia nervosa and bulimia nervosa, whereby people focus on the quantity of food eaten.[1]


Steven Bratman coined the term "orthorexia nervosa" in 1997 from the Greek orthos, meaning "correct or right", and orexis, meaning "appetite".[8] Literally "correct appetite", the word is modeled on anorexia, meaning "without appetite", as used in definition of the condition anorexia nervosa. Bratman describes orthorexia as an unhealthy fixation with what the individual considers to be healthy eating. The subject may avoid certain unhealthy foods, such as those containing fat, preservatives, man-made food-additives, animal products, or other ingredients considered by the subject to be unhealthy. If the sufferer does not eat appropriately, malnutrition can ensue. Bratman claims orthorexia sufferers have specific preferences about the foods they are eating and avoiding. Products that are preserved with additives can be considered dangerous. Industrial products can be seen as artificial, whereas fruits and vegetables can be seen as healthy.[9] Bratman asserts that "emaciation is common among followers of certain health food diets, such as rawfoodism, and this can at times reach the extremes seen in anorexia nervosa." In addition, he claims that "anorexic orthorexia" can be as dangerous as anorexia. However, he states, "the underlying motivation is quite different. While an anorexic wants to lose weight, an orthorexic does not desire to become thin[9] but wants to feel pure, healthy and natural. Eating disorder specialists may fail to understand this distinction, leading to a disconnect between orthorexic and physician."[5][10]

According to the Macmillan English Dictionary, the word is entering the English lexicon.[11]

Diagnostic criteria[edit]

Although orthorexia is not recognized as a mental disorder by the American Psychiatric Association, and it is not listed in the DSM-5,[12] it is still used as a diagnosis by some practitioners who have documented the damaging results of the condition as they have seen in their practices.[13][14][15]

As of January 2007, only two peer-reviewed studies have been published on the alleged condition.[16][17] In the studies, Donini et al. define orthorexia nervosa as a "maniacal obsession for healthy foods" and propose several diagnostic criteria.[16] Sufferers of orthorexia often display symptoms consistent with obsessive-compulsive disorder and have an exaggerated concern with healthy eating patterns. Like anorexia, however, these obsessive compulsive symptoms may be an effect of starvation rather than a cause of the disorder.[18] A diagnostic questionnaire has been developed for orthorexia sufferers, similar to questionnaires for other eating disorders.[17] Bratman proposes an initial self-test composed of two direct questions: "Do you care more about the virtue of what you eat than the pleasure you receive from eating it?... Does your diet socially isolate you?"[19] Other questions concerning those who may be suffering from orthorexia provided by Davis on the WebMD (2000) website are: Do they spend more than 3 hours a day thinking about healthy foods? When they eat the way they're supposed to, do they feel in total control? Are they planning tomorrow's menu today? Has the quality of their life decreased as the quality of their diet increased? Have they become stricter with themselves? Does their self-esteem get a boost from eating healthy? Do they look down on others who don't eat this way? Do they skip foods they once enjoyed in order to eat the "right" foods? Does their diet make it difficult for them to eat anywhere but at home, distancing them from family and friends? Do they feel guilt or self-loathing when they stray from their diet? If yes was answered to two or more questions, the person may have a mild case of orthorexia.[13]

Symptoms and theory[edit]

Orthorexia nervosa is characterized by an obsession with avoiding foods perceived to be unhealthy.[20] It is important to differentiate between healthy individuals who choose specific diets for any number of reasons, and those who exhibit obsessive compulsive behavior that leads to an unhealthy condition or lifestyle. What tips the balance from being committed to healthy eating and having orthorexia is the extreme limitation and obsession in food selection. Orthorexics find themselves being unable to take part in everyday activities. They isolate themselves and often become intolerant of other people's views about food and health.[21] This obsession for healthy foods could come from a number of sources such as family habits, societal trends, economic problems, recent illness, or even just hearing something negative about a food type or group, which then leads them to ultimately eliminate the food or foods from their diet.[9]

ON seems to be more common in men than in women and in those with a lower level of education.[16]


Results across scientific findings have yet to find a definitive conclusion to support whether nutrition students and professionals are at higher risk than other population subgroups, due to differing results in the research literature. There are only a few notable scientific works that, in an attempt to explore the breadth and depth of the still vaguely-understood illness, have tried to identify which groups in society are most vulnerable to its onset.[22] This includes a 2008 German study,[23] which based its research on the widespread suspicion that the most nutritionally-informed, such as university nutrition students, are a potential high-risk group for eating disorders, due to a substantial accumulation of knowledge on food and its relationship to health; the idea being that the more one knows about health, the more likely an unhealthy fixation about being healthy can develop. This study also inferred that orthorexic tendencies may even fuel a desire to study the science, indicating that many within this field might suffer from the disorder before commencing the course. However the results found that the students in the study, upon initial embarkation of their degree, did not have higher orthorexic values than other non-nutrition university students, and thus the report concluded that further research is needed to clarify the relationship between food-education and the onset of ON.

Similarly, in a Portuguese study on nutrition tertiary students,[24] the participants' orthorexic scores (according to the ORTO-15 diagnostic questionnaire [25]) actually decreased as they progressed through their course, as well as the overall risk of developing an eating disorder being an insignificant 4.2 percent. The participants also answered questionnaires to provide insight into their eating behaviours and attitudes, and despite this study finding that nutrition and health-science students tend to have more restrictive eating behaviours, these studies however found no evidence to support that these students have "more disturbed or disordered eating patterns than other students"[23] These two aforementioned studies conclude that the more understanding of food one has is not necessarily a risk factor for ON, explaining that the data gathered suggests dietetics professionals are not at significant risk of it.

Media reaction[edit]

The concept of orthorexia as a mental illness has attracted significant media attention.[20][26][27][28]


There has been no investigation into whether there may be a biological cause specific to orthorexia nervosa. It may be a food-centered manifestation of obsessive compulsive disorder, which has a lot to do with control.[9] A 2013 study of college students found that orthorexia severity was negatively associated with self-reported executive functioning.[29] This means that the better the student did with cognitively complex tasks, including planning and decision-making, the less likely the student was to have orthorexia.

See also[edit]



  1. ^ a b Hill, Amelia (16 August 2009). "Healthy food obsession sparks rise in new eating disorder". The Guardian (London). Retrieved 16 October 2010. 
  2. ^ Bratman, Steven (4 June 2009). "What is Orthorexia?". Retrieved 16 October 2010. 
  3. ^ Rochman, Bonnie (12 February 2010). "Orthorexia: Can Healthy Eating Be a Disorder?". Time. Retrieved 4 January 2012. 
  4. ^ http://udini.proquest.com/view/in-sickness-and-in-health-pqid:2428837551/ In Sickness and In Health: Orthorexia Nervosa, the Study of Obsessive Healthy Eating
  5. ^ a b Bratman, Steven (October 1997). "Obsession with dietary perfection can sometimes do more harm than good, says one who has been there". Yoga Journal. Retrieved 16 October 2010. 
  6. ^ Billings, Tom (1999). "Raw Vegan Calorie Paradox—Potential Solutions/Reality Checks". Retrieved 19 October 2010. 
  7. ^ "Supersize vs Superskinny - Expert Profiles - Ursula Philpot". Channel 4. 7 April 2011. Retrieved 19 October 2010. 
  8. ^ S. Bratman, D. Knight: Health food junkies. Broadway Books, New York, 2000.
  9. ^ a b c d Getz, L. (June 2009). "Orthorexia: When eating healthy becomes an unhealthy obsession". Today's Dietitian. Retrieved 2009-10-13. 
  10. ^ Palo Alto Medical Foundation Summary of Eating Disorders
  11. ^ Macmillan English Dictionary entry for Orthorexia Nervosa
  12. ^ Rochman, B. (2010). Orthorexia: Can Healthy Eating Be a Disorder?. TIME.com, Feb 12. Retrieved 2010-02-12.
  13. ^ a b Web MD report: Orthorexia: Good Diets Gone Bad
  14. ^ Orthorexia: Too Healthy? Specialists have coined a new term-orthorexia-to describe an obsessive concern with healthy eating that often leads to social isolation, Psychology Today, Sept/Oct 2004.
  15. ^ Observer Guardian Newspaper, Sept 9, 2001, column reporting on Orthorexia
  16. ^ a b c Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2004). "Orthorexia nervosa: a preliminary study with a proposal for diagnosis and an attempt to measure the dimension of the phenomenon". Eat Weight Disord 9 (2): 151–157. PMID 15330084. 
  17. ^ a b Donini L, Marsili D, Graziani M, Imbriale M, Cannella C (2005). "Orthorexia nervosa: validation of a diagnosis questionnaire". Eat Weight Disord 10 (2): e28–32. PMID 16682853. 
  18. ^ Carlson, N: Physiology of Behavior, 10th ed., page 435. Person Education Inc., 2010
  19. ^ McCandless, David (29 March 2005). "'I am an orthorexic'". BBC News. 
  20. ^ a b Rochman, Bonnie (12 February 2010). "Orthorexia: Can Healthy Eating Be a Disorder?". Time. 
  21. ^ http://www.mayoclinic.com/health/orthorexia/MY00768
  22. ^ Varga, Márta; Dukay-Szabó, Szilvia; Túry, Ferenc; Eric, F. van Furth (2013-04-12). "Evidence and gaps in the literature on orthorexia nervosa". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 18 (2): 103–111. doi:10.1007/s40519-013-0026-y. ISSN 1124-4909. Retrieved 2015-04-17. 
  23. ^ a b "Eating behaviour and eating disorders in students of nutrition sciences". Retrieved 2015-04-17. 
  24. ^ "http://www.nutricionhospitalaria.com/pdf/6695.pdf" (PDF). www.nutricionhospitalaria.com. Retrieved 2015-04-17. 
  25. ^ Donini, Prof L. M.; Marsili, D.; Graziani, M. P.; Imbriale, M.; Cannella, C. (2013-10-18). "Orthorexia nervosa: Validation of a diagnosis questionnaire". Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 10 (2): e28–e32. doi:10.1007/BF03327537. ISSN 1124-4909. Retrieved 2015-04-17. 
  26. ^ McCandless, David (29 March 2005). "I am an orthorexic". BBC News. 
  27. ^ Gray, Emma (26 August 2011). "Orthorexia: Too Much Of A Healthy Thing?". Huffington Post. 
  28. ^ "Orthorexia". No Agenda. 
  29. ^ "A neuropsychological evaluation of orthorexia nervosa". 2013. 
  30. ^ "ICD10 Codes". Psychiatr Online. Retrieved 16 October 2010. 
  31. ^ "APA Diagnostic Classification". BehaveNet. Retrieved 16 October 2010. 
  32. ^ "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence". American Psychiatric Association. Retrieved 16 October 2010.