Orthorexia nervosa—an obsession with healthy eating—may not be as well-known as other eating disorders such as anorexia nervosa or bulimia nervosa. But according to research published in Federal Practitioner, it may be comparable in prevalence, with approximately 1% of the general population being affected.

Scarff JR. Orthorexia nervosa: An obsession with healthy eating. Fed Pract. 2017;34(6):36–39.

 

While there is no specific therapy for orthorexia, a multidisciplinary approach stressing a balanced diet and possibly incorporating cognitive behavioral therapy, pharmacotherapy, and psychotherapy has been shown to help.

 

What is orthorexia?

The term orthorexia nervosa was coined by Steven Bratman in 1997, according to an article published in the Journal of Eating Disorders.

Vuillier L, Robertson S, Greville-Harris M. Orthorexic tendencies are linked with difficulties with emotion identification and regulation. J Eat Disord. 2020;8:15.

The term “ortho” signifies righteous and “orexia” signifies appetite.

 

There is no officially accepted definition of—or standardized diagnostic criteria for—orthorexia. This poses increased difficulty when attempting to identify how this disorder aligns with diagnostic criteria and subsequently when identifying the number of people affected by the condition.

According to the National Eating Disorders Association, individuals with orthorexia can experience the following symptoms:

Orthorexia. National Eating Disorders Association.

 

• Obsessive checking of nutritional labels and ingredients lists

• Stopping the intake of many food groups such as all carbs, all sugar, all meat, all dairy, and/or all animal products

• Inability to eat anything except a few foods that they consider “pure” or “healthy”

• Feeling anxious when “healthy” or “safe” foods are not available

• Spending hours thinking about foods that might be served at any upcoming event

• Excessive following of healthy lifestyles and food blogs on social media

An article published by the International Journal of Environmental Research and Public Health stated that people with orthorexia symptoms also eliminate products containing preservatives, food flavoring, color additives, genetically modified food, or pesticides from their diet.

Niedzielski A, Kaźmierczak-Wojtaś N. Prevalence of orthorexia nervosa and its diagnostic tools—A literature review. Int J Environ Res Public Health. 2021;18(10):5488.

 

Any deviation from their set norms may result in feelings of guilt, fear, and shame, which may lead to further dietary restrictions.

 

Diagnosing the condition

According to the International Journal of Environmental Research and Public Health, diagnosis of orthorexia utilizes several tools, including:

• Bratman test (using an orthorexia self-test-BOT)

• ORTO-15 questionnaire

• Düsseldorf orthorexia scale

• Eating habits questionnaire

• Barcelona orthorexia scale

• Teruel orthorexia scale

• Orthorexia nervosa inventory

The BOT is a 10-item test that evaluates patients based on a yes/no scale. Answers are assigned either one or 0 points; a score of more than 4 points can indicate orthorexia.

The ORTO-15 questionnaire comprises 15 items. Each answer is assigned one to four points; lower scores are indicative of higher orthorexic behavior. The ORTO-15 scale evaluates behavior concerning the purchase, choice, preparation, and eating of healthy foods. It also helps distinguish between three factors associated with eating behavior: emotional, clinical, and cognitive.

 

Treating orthorexia

Orthorexia does not have a specific treatment approach due to the unavailability of an officially accepted definition, according to the International Journal of Environmental Research and Public Health research.

Cognitive behavioral therapy, along with selective serotonin reuptake inhibitors and pharmacotherapy are other potential treatments. Antipsychotic drugs are recommended to reduce obsessive thinking about food.

Psychotherapy should not just focus on what patients eat, but also on their attitudes about food, how they prepare meals, and how they shop for food. Altering their eating behaviors can help to enrich their diets, as well as increase socializing while eating. Relaxation techniques can also be helpful to reduce anxiety associated with eating.