Orthorexia: what it looks like, what are the causes and how to treat it

Orthorexia: what it looks like, what are the causes and how to treat it


Miraculous diets that promise to lose weight in a short time, detox diets , single-food diets, particular food styles carried out in an attempt to prevent disease and live longer: these are the messages to which we are continually subjected. The media emphasize the therapeutic effects of organic, zero-fat, gluten-free foods , thus giving foods a medicalizing power.

This bombardment of information that should focus on the value of healthy food as a means to eat better and take care of oneself, together with a reality like the current one, in which the Diet Industry has solutions for any problem, unfortunately open up a completely unexpected scenario . Excessive attention to what you eat and adherence to alternative diets become the core of a search for excessive health, hyper-health , a lifestyle that is only apparently healthy. Instead, a new picture is making its way, in reality, already reported by the doctor Steven Bratman in 1997, who defined it as “orthorexia”, [from the Greek, orthos- (correct) -órexis (appetite)].

Orthorexia Nervosa (ON) is mentioned among the “Nutrition and Eating Disorders  of the DSM-5® (American Psychiatric Association, 2013). Orthorexia nervosa shares commonalities with anorexia nervosa and bulimia nervosa and shares similarities with avoidant/restrictive food intake disorder or body dysmorphic disorder. At the moment the ON is not yet associated with a specific diagnostic category. The literature in this regard is still discordant, there are few studies in which specific diagnostic criteria appear.

Orthorexia. What is it?

Orthorexia is an unhealthy attention, a pathological concern for pure and healthy food thinking that this is the way to achieve lasting well-being. The concept of health is taken to the extreme. A sort of food fundamentalism is established to achieve a perfect state of health. We are more concerned with the quality and nutritional properties of food and less with the quantity, as is the case with anorexia and bulimia instead . Some related traits of orthorexia with anorexia and bulimia are: perfectionism, attitudes towards body image and the need to maintain control.

How it looks. Features of this ailment

Orthorexia nervosa is characterized by a series of concerns and beliefs associated with food.

People with orthorexic symptoms have an unusual interest in their health.

In orthorexia, the principles of a healthy, complete and wholesome diet such as the Mediterranean diet fail. They give way to very strict, self-imposed rules that lead to minimizing the variety of foods, to the obsessive avoidance of those uncontrolled foods (such as those rich in preservatives or artificial food additives ) that can damage health and, therefore, to their exclusion even in the absence of allergy or intolerance .

The orthorexic subject carefully plans meals even several days in advance, dedicates more than 3-4 hours a day to choosing the foods to buy, is concerned about the purity of the food, focuses strongly on the preparation and cooking methods , even at the expense of taste and pleasure.

Always in the interest of purity and health, orthorexia sufferers also usually spend large sums of money to buy “quality” food.

People with orthorexia nervosa are also distinguished by their sense of superiority and their position of intolerance towards those who do not have the same eating habits.

Consequences of orthorexia

And it is thus that the selection of “good food” based on quality becomes a set of repetitive and constant thoughts, an obsessive, sometimes maniacal attitude which limits the social sphere, as it exposes us to a lack of control over the food itself and its effect on health.

The sense of conviviality is lost, the working environment can be compromised, everything becomes a discomfort , which leads to personal isolation, in the total conviction of one’s choices.

When the person with orthorexia fails to follow the rules that are imposed, negative emotions such as guilt and anger arise in him . He feels depressed and this leads him to impose new and stricter rules of behavior to follow. He can easily understand how this can increase anguish , shame and anxieties . On the contrary, where he respects the rules, and therefore has control over healthy eating behavior, personal satisfaction appears in him, self-esteem grows and he has a positive perception of his own body image.

Orthorexia sufferers, with the choices they adopt aimed at promoting health, actually undermine not only their emotional and social well-being, but also their physical one. The food restriction to which he undergoes can result in malnutrition , nutritional imbalances and weight loss , with consequent impairment of physical health.

Those suffering from orthorexia

It is not possible to generalize the epidemiological data because the studies in the literature present differences in the methodological choices. The results of studies conducted on the general Italian population have highlighted that the prevalence of ON in Italy is between 6.9% (Donini et al., 2004) and 57.6% (Ramacciotti et al., 2011) . The wide variability of these data can be traced back to the fact that the studies conducted present differences in the methodological choices.
Discordant data also concern gender: according to some studies (Donini et al., 2004; Fidan et al., 2010; Donini et al., 2005) men are more affected than women. While other studies (Arusoğlu et al., 2008) highlight a prevalence of ON in women or no difference(Bağci Bosi, Camur, & Guler, 2007).

How is it treated?

The orthorexic subject is unable to become aware of his problem, he lacks the perception of his disorder.

However, awareness is usually the first step in actively engaging in treatment. Treating orthorexia is not easy because of the sense of superiority that distinguishes the people who suffer from it: in fact, they make their beliefs ideals of inner purity for which they do not recognize a problem in their behavior. Early diagnosis is required for treatment. Family, the school environment or friends could be the first to intervene early if they can recognize some alarm bells such as weight loss , absence of social relationships, food concern.

To treat orthorexia a multidisciplinary approach is essential : doctor, psychologist , nutritionist. This allows you to keep the clinical picture under control, work on emotions and reintroduce eliminated foods by highlighting the real health benefits of food.


Currently having a healthy lifestyle that allows us to achieve an optimal state of health is quite difficult. Today the scenarios that society shows us are opposite and extreme situations: on the one hand the spread of obesity and the diseases connected to it, on the other the orthorexic attitude linked to the need to acquire only health. It is clear that neither of the two attitudes is balanced: in both cases, food is a problem and loses its value as a beneficial tool.

We need to restore a positive value to food, that of emotions, memories, sharing. It is also important to recover that balance that is no longer there. Food cannot and must not be a limit for anyone, it must return to excite.



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