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Data concerning the former are mixed, with some studies suggesting a low degree of association between OCPD and OCD15,16 and others indicating significant and specific associations.17,18 Concerning the latter relationship, there is some evidence that OCPD, rather than OCD, has a close link with eating disorders,19 particularly to anorexia.20 Other research has shown that the presence of OCPD traits positively predicts development of pathological eating habits.21,22 An examination of diagnostic boundaries reveals important points of symptom overlap between orthorexia and anorexia nervosa, obsessive–compulsive disorder (OCD), obsessive–compulsive personality disorder (OCPD), somatic symptom disorder, illness anxiety disorder, and psychotic spectrum disorders. Orthorexia nervosa describes a pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure. Answer some general questions about your eating habits, how you feel about food, and your, your thoughts on "healthy" eating, and other indicators of orthorexia.
However, in these studies, these factors did not collectively explain a large proportion of the variance observed across the ORTO-15 items. With the latter, individuals experience heightened bodily sensations and are intensely anxious about the possibility of an undiagnosed illness, often devoting excessive time and energy to these health concerns. Although the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)23 introduced significant changes to the nomenclature and scope of the somatoform conditions relative to the DSM-IV-TR edition, the potential relevance of orthorexia to these conditions, namely somatic symptom disorder and illness anxiety disorder, is noteworthy. Discussion of cognitive weaknesses in set-shifting, external attention, and working memory highlights the value of continued research to identify intermediate, transdiagnostic endophenotypes for insight into the neuropathogenesis of orthorexia. In this review, we synthesize existing research to identify what is known about the symptoms, prevalence, neuropsychological profile, and treatment of orthorexia. Despite its being a distinct behavioral pattern that is frequently observed by clinicians, orthorexia has received very little empirical attention and is not yet formally recognized as a psychiatric disorder.
This is primarily due to the restrictive nature of their eating habits, which can lead to avoidance of social gatherings involving food, dining out, or participating in shared meals . It is crucial for healthcare professionals to be aware of the potential nutritional consequences of orthorexia and to provide appropriate support and intervention to address both the physical and psychological aspects of the disorder. The fear of consuming "impure" foods can also lead to heightened anxiety and stress surrounding eating, further exacerbating the psychological impact of orthorexia . Individuals with orthorexia often follow restrictive diets, eliminating entire food groups or severely limiting their food choices based on self-imposed criteria for purity and healthiness. Orthorexia, characterized by an obsessive fixation on consuming only "pure" and "healthy" foods, can lead to various nutritional deficiencies and health complications. Feelings of guilt, shame, and failure may arise when individuals deviate from their self-imposed dietary rules, exacerbating anxiety and reinforcing the cycle of obsessive thoughts and compulsive behaviors . or they have only been used in a handful of studies yet Subsequently, the term "orthorexia nervosa" emerged to describe a more severe variant characterized by intense anxiety, distress, and functional impairments related to the rigid pursuit of an idealized and "pure" diet . However, discussions around clean eating also come with debates about the potential for creating rigid eating patterns, promoting unrealistic body standards, and contributing to the stigmatization of certain foods . Disordered eating behaviors have emerged as a critical public health concern, drawing increasing attention from researchers, healthcare professionals, and policymakers.Intermediate endophenotypes may provide better insight into underlying etiology than can symptom-level clinical categories61 which, given the perplexities surrounding the differential diagnosis of orthorexia, will be advantageous for advancing our understanding of orthorexia more quickly. Furthermore, additional mapping of the behavioral and cognitive endophenotypes in orthorexia with experimental neuropsychological methodologies will provide useful clues about proximal biological contributors, in essence providing a "top-down deconstruction"60 of outwardly complex behavior to simpler component processes. To date, most of the research concerning orthorexia has focused on the emotional and physical sequelae of the condition rather than on the underlying brain–behavior relationships. Existing estimates of orthorexia range from 6.9%4 to 57.6%12 in the general population, with rates as high as 81.8% in specific populations.3 Furthermore, it is unclear whether orthorexia is more prevalent among women or men. While it is possible, as Varga et al32 suggest, that cultural differences account for contradictory internal consistency values across samples, it is also possible that the ORTO-15 is simply not a reliable measure of orthorexia. However, the lack of established diagnostic criteria makes it difficult to gauge the appropriateness of any self-report measure, as epidemiological research is predicated on the existence of a gold standard approach for ascertaining true from false positives and true from false negatives. Instead, researchers have relied primarily on a modification of this scale called the ORTO-1531 and, to a lesser degree, the ORTO-1110 and ORTO-11-Hu32 to measure the prevalence of orthorexia in various populations.3,6,32 There is debate, however, as to the reliability and validity of these measures.e.g., the Eating Habits Questionnaire (10) or the Orthorexia Nervosa Inventory (11); cf. However, studies have shown consistently that this instrument has poor psychometric properties, the most prominent of which is its low internal reliability e.g., (7–9). The large majority of studies on ON have been based on a questionnaire measure called the ORTO−15 (3) or several short versions of it e.g., (4–6).The aims of the present review were (1) to overview previous reviews on literature pertaining to ON, (2) to examine what other psychological conditions and risk factors tend to co-occur with ON, and (3) to discuss the implications for defining ON as a distinct construct. Proper diagnostic recognition, as begun by Moroze et al,5 is a precursory step toward the creation of gold standard assessment instruments needed for appropriate identification of orthorexic individuals,63 and with that will come advances in our understanding of etiology, treatment, and prevention. Lastly, psychoeducation about empirically-validated dietetic science may help disabuse orthorexic patients of false food beliefs.62 However, research indicates that nutrition and health education, while obviously needing to contain objective concepts about nutrients and physiology, should also recognize the deeply emotional aspects of food beliefs and food choices so as to incorporate affective approaches to patient counseling.28 Asking severely orthorexic patients to abandon false food beliefs is really a request to discard a deeply held ideology; as discussed by Lindeman et al,13 ideologies, whether comprised of reality-grounded or magical beliefs, provide structure and order to one’s life, reducing anxiety by providing a means to exert control over the environment. To date, there are no studies of treatment effectiveness for orthorexia, although suggestions for best practices have been offered.After the participants completed an online survey, it was concluded that people with a tendency to avoid risk and threats are at greater risk of ON . After conducting research involving students at the University of Palermo, they found that people diagnosed with ON had greater psychopathological symptoms than other groups . A study conducted at the University of New South Wales in Sydney revealed a significant association between body image and the occurrence of ON among Australian adults. Treatment of ON in people with AN and OCD should focus on developing more flexible eating habits and reducing anxiety related to deviations from "ideal" eating rules.From the remaining works, we excluded studies that described the positive impact of mindfulness practices on health. Although mindfulness practices are beneficial in many mental health contexts, they are incompatible with the compulsive nature of ON, and therefore were excluded in order to maintain clarity in the distinction between therapeutic practices and harmful behaviors. Studies that included only healthy participants and those focusing on mindfulness practices were excluded in accordance with the scope of the review. One search engine, the Wiley Online Library, found 97 publications, 6 of which were about ON and the prevalence of risk factors. Additionally, filters were utilized in order to limit the results to empirical studies, leading to the selection of 34 articles that were relevant to the study. With a focus on risk factors and questionnaire tools for ON identification, we selected 34 articles by reviewing the MEDLINE/PubMed, Wiley Online Library, SpringerLink, and Scopus databases. Adolescents aged 15–21 also display significant orthorexic behaviors, with average ORTO-15 scores around 39.2, highlighting the impact of social and academic pressures .External attention refers to the ability to focus on the external environment, including awareness of one’s social impact on other people. Impoverished set-shifting, or cognitive rigidity, might readily explain the inflexible, rule-bound approach that orthorexic individuals take toward food selection, preparation, and consumption.34 Indeed, an unfortunate positive feedback loop might develop such that one’s exposure to varied, stimulating daily activities declines in order to fulfill time-intensive and complex food rules, prompting yet further decline in set-shifting skills from lack of applicative practice.34 Cognitive inflexibility is also a hallmark feature of anorexia46 and OCD.47 A deeper appreciation of these endophenotypes may generate ideas for novel approaches to both the prevention and treatment of orthorexia and its diagnostic cousins. In other words, we might be better served to shift our research focus away from achieving precise categorical boundaries among orthorexia and related conditions to, instead, continuing to characterize the dimensional endophenotypes that best explain the orthorexic phenomenon, recognizing that such dimensions will likely be transdiagnostic in nature. One study,34 however, used standardized clinical neuropsychological assessment to characterize the cognitive profile of orthorexia, targeting the cognitive domains known to be affected in anorexia and OCD, including attention, verbal long-term memory, visuospatial functioning, and executive functioning,42–45 as candidate areas of inquiry. Although certain items do probe the obsessive nature of food-related cognitions, there is no assessment of compulsive behaviors that one might expect in the syndrome. Based on the flaws in the ORTO-15 as well as the many differences across orthorexia studies in terms of methodology and sample characteristics, a clear picture of the prevalence of orthorexia has yet to emerge.
Prolonged adherence to such restrictive diets can compromise nutritional status, leading to physical health issues like malnutrition, osteoporosis, and weakened immune function 38,39. Societal pressures to conform to these standards and the fear of being judged or ostracized for deviating from them may escalate orthorexic behaviors. Though originating from genuine concern, the fear of falling ill can morph into a consuming obsession that requires careful consideration within the broader context of mental health and balanced nutrition. As this trend continues to evolve, striking a balance between informed nutritional choices and avoiding extreme dietary restrictions remains an ongoing conversation.
Studies have suggested that excessive parental control can lead to anxiety that promotes the development of orthorexia nervosa, which was confirmed in 18% of patients studied . Additionally, it is important to pay attention to children and teenagers who suffer from orthorexia nervosa. Other risk contributors (personality traits, body image, excessive exercising, eating habits, BMI, gender).
As the understanding of orthorexia and orthorexia nervosa continues to evolve, further research employing standardized diagnostic criteria and rigorous methodologies is needed to obtain more accurate and comprehensive prevalence and incidence data for these emerging eating disorders. Whereas eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder are primarily characterized by disturbances in food intake quantity or patterns, orthorexia nervosa centers around the quality and purity of the consumed food . The distinction between orthorexia nervosa and other eating disorders lies in the primary focus and underlying motivations behind the disordered eating behaviors. The term orthorexia nervosa (ON) refers to an obsessive focus on healthy eating (1). Research on the precise causes of orthorexia is sparse, but obsessive-compulsive tendencies and past or current eating disorders are known risk factors.
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