SpringerLink
Log in

Additional Phenotypes of Eating Disorders: Orthorexia Nervosa

  • Living reference work entry
  • First Online:
Eating Disorders

  • 67 Accesses

Abstract

Disordered eating patterns are growing more severe in contemporary society. One such variant to abnormal eating behavior, orthorexia nervosa, reflects a preoccupation with healthy eating, especially quality of food intake, in order to achieve optimum health. Orthorexia nervosa indicates a possible new eating disorder that could be included in the eating disorder classifications in the future. The present chapter aims to provide an up-to-date summary of the state of knowledge on a clinical description of orthorexia nervosa, on proposed diagnostic criteria, on existing similarities and distinctions between orthorexia nervosa and the DSM-5 diagnosis of anorexia nervosa, and on the relationship of orthorexia nervosa with other mental disorders and with psychological disturbances. The chapter also identifies future directions in the field.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • Ambwani, S., Shippe, M., Gao, Z., & Austin, S. B. (2019). Is #cleaneating a healthy or harmful dietary strategy? Perceptions of clean eating and associations with disordered eating among young adults. Journal of Eating Disorders, 7, 17.

    Article  PubMed  PubMed Central  Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders DSM-5. American Psychiatric Publishing.

    Book  Google Scholar 

  • American Psychiatric Association. (2021). Guide to submitting proposals for changes to DSM-5. American Psychiatric Publishing.

    Google Scholar 

  • Awad, E., Salameh, P., Sacre, H., Malaeb, D., Hallit, S., & Obeid, S. (2021). Association between impulsivity and orthorexia nervosa/healthy orthorexia: Any mediating effect of depression, anxiety, and stress? BMC Psychiatry, 21(1), 604.

    Article  PubMed  PubMed Central  Google Scholar 

  • Barnes, M. A., & Caltabianom, M. L. (2017). The interrelationship between orthorexia nervosa, perfectionism, body image and attachment style. Eating and Weight Disorders, 22(1), 177–184.

    Article  PubMed  Google Scholar 

  • Barrada, J. R., & Roncero, M. (2018). Bidimensional structure of the orthorexia: Development and initial validation of a new instrument. Anales de Psicología, 34(2), 283–291.

    Article  Google Scholar 

  • Bartel, S. J., Sherry, S. B., Farthing, G. R., & Stewart, S. H. (2020). Classification of orthorexia nervosa: Further evidence for placement within the eating disorders spectrum. Eating and Weight Disorders, 38, 101406.

    CAS  Google Scholar 

  • Barthels, F., Meyer, F., & Pietrowsky, R. (2015). Orthorexic eating behavior. Ernahrungs. Umschau, 62(10), 156–161.

    Google Scholar 

  • Barthels, F., Meyer, F., Huber, T., & Pietrowsky, R. (2017). Orthorexic eating behaviour as a co** strategy in patients with anorexia nervosa. Eating and Weight Disorders, 22(2), 269–276.

    Article  PubMed  Google Scholar 

  • Barthels, F., Barrada, J. R., & Roncero, M. (2019). Orthorexia nervosa and healthy orthorexia as new eating styles. PLoS One, 14(7), e0219609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Barthels, F., Kisser, J., & Pietrowsky, R. (2021). Orthorexic eating behavior and body dissatisfaction in a sample of young females. Eating and Weight Disorders, 26(6), 2059–2063.

    Article  PubMed  Google Scholar 

  • Bóna, E., Erdész, A., & Túry, F. (2021). Low self-esteem predicts orthorexia nervosa, mediated by spiritual attitudes among frequent exercisers. Eating and Weight Disorders, 26(8), 2481–2489.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bratman S. (1997). Health Food Junkie. Yoga Journal. September/October, pp. 42–50.

    Google Scholar 

  • Bratman, S. (2017). Orthorexia vs. theories of healthy eating. Eating and Weight Disorders, 22(3), 381–385.

    Article  PubMed  Google Scholar 

  • Bratman, S., & Knight, D. (2000). Health food junkies. Orthorexia nervosa: Overcoming the obsession with healthful eating. Broadway Books.

    Google Scholar 

  • Brytek-Matera, A. (2012). Orthorexia nervosa – An eating disorder, obsessive-compulsive disorder or disturbed eating habit? Archives of Psychiatry and Psychotherapy, 14(1), 55–60.

    Google Scholar 

  • Brytek-Matera, A. (2021). Vegetarian diet and orthorexia nervosa: A review of the literature. Eating and Weight Disorders, 26(1), 1–11.

    Article  PubMed  Google Scholar 

  • Brytek-Matera, A., Donini, L. M., Krupa, M., Poggiogalle, E., & Hay, P. (2015). Orthorexia nervosa and self-attitudinal aspects of body image in female and male university students. Journal of Eating Disorders, 3, 2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brytek-Matera, A., Fonte, M. L., Poggiogalle, E., Donini, L. M., & Cena, H. (2017). Orthorexia nervosa: Relationship with obsessive-compulsive symptoms, disordered eating patterns and body uneasiness among Italian university students. Eating and Weight Disorders, 22(4), 609–617.

    Article  PubMed  Google Scholar 

  • Brytek-Matera, A., Onieva-Zafra, M. D., Parra-Fernández, M. L., Staniszewska, A., Modrzejewska, J., & Fernández-Martínez, E. (2020). Evaluation of orthorexia nervosa and symptomatology associated with eating disorders among European university students: A multicentre cross-sectional study. Nutrients, 12(12), 3716.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brytek-Matera, A., Pardini, S., Szubert, J., & Novara, C. (2022). Orthorexia nervosa and disordered eating attitudes, self-esteem and physical activity among young adults. Nutrients, 14(6), 1289.

    Google Scholar 

  • Cena, H., Barthels, F., Cuzzolaro, M., Bratman, S., Brytek-Matera, A., Dunn, T., Varga, M., Missbach, B., & Donini, L. M. (2019). Definition and diagnostic criteria for orthorexia nervosa: A narrative review of the literature. Eating and Weight Disorders, 24(2), 209–246.

    Article  PubMed  Google Scholar 

  • Cheshire, A., Berry, M., & Fixsen, A. (2020). What are the key features of orthorexia nervosa and influences on its development? A qualitative investigation. Appetite, 155, 104798.

    Article  PubMed  Google Scholar 

  • Costanzo, G., Marchetti, D., Manna, G., Verrocchio, M. C., & Falgares, G. (2022). The role of eating disorders features, psychopathology, and defense mechanisms in the comprehension of orthorexic tendencies. Eating and Weight Disorders. https://doi.org/10.1007/s40519-022-01417-3

  • Crawford, R. (1980). Healthism and the medicalization of everyday life. International Journal of Health Services: Planning, Administration, Evaluation, 10(3), 365–388.

    Article  CAS  PubMed  Google Scholar 

  • Cuzzolaro, M., & Donini, L. M. (2016). Orthorexia nervosa by proxy? Eating and Weight Disorders, 21(4), 549–551.

    Article  PubMed  Google Scholar 

  • Dell’Osso, L., Abelli, M., Carpita, B., Pini, S., Castellini, G., Carmassi, C., & Ricca, V. (2016). Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive-compulsive spectrum. Neuropsychiatric Disease and Treatment, 12, 1651–1660.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dunn, T. M., & Bratman, S. (2016). On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors, 21, 11–17.

    Article  PubMed  Google Scholar 

  • Dunn, T. M., Gibbs, J., Whitney, N., & Starosta, A. (2017). Prevalence of orthorexia nervosa is less than 1%: Data from a US sample. Eating and Weight Disorders, 22(1), 185–192.

    Article  PubMed  Google Scholar 

  • Håman, L., Barker-Ruchti, N., Patriksson, G., & Lindgren, E. C. (2015). Orthorexia nervosa: An integrative literature review of a lifestyle syndrome. International Journal of Qualitative Studies on Health and Well-Being, 10, 26799.

    Article  PubMed  Google Scholar 

  • Hay, P. (2021). Is orthorexia nervosa a healthy way of being or a mental health disorder? Commentary on He et al. (2020). International Journal of Eating Disorders, 54(2), 222–224.

    Article  PubMed  Google Scholar 

  • He, J., Zhao, Y., Zhang, H., & Lin, Z. (2020). Orthorexia nervosa is associated with positive body image and life satisfaction in Chinese elderly: Evidence for a positive psychology perspective. International Journal of Eating Disorders, 54(2), 212–221.

    Article  PubMed  Google Scholar 

  • Koven, N. S., & Abry, A. W. (2015). The clinical basis of orthorexia nervosa: Emerging perspectives. Neuropsychiatric Disease and Treatment, 11, 385–394.

    Article  PubMed  PubMed Central  Google Scholar 

  • Koven, N. S., & Senbonmatsu, R. (2013). A neuropsychological evaluation of orthorexia nervosa. Open Journal of Psychiatry, 3, 214–222.

    Article  Google Scholar 

  • Luck-Sikorski, C., Jung, F., Schlosser, K., & Riedel-Heller, S. G. (2019). Is orthorexic behavior common in the general public? A large representative study in Germany. Eating and Weight Disorders, 24(2), 267–273.

    Article  PubMed  Google Scholar 

  • Malmborg, J., Bremander, A., Olsson, M. C., & Bergman, S. (2017). Health status, physical activity, and orthorexia nervosa: A comparison between exercise science students and business students. Appetite, 109, 137–143.

    Article  PubMed  Google Scholar 

  • Mathieu, J. (2005). What is orthorexia? Journal of the American Dietetic Association, 105(10), 1510–1512.

    Article  PubMed  Google Scholar 

  • McComb, S. E., & Mills, J. S. (2019). Orthorexia nervosa: A review of psychosocial risk factors. Appetite, 140, 50–75.

    Article  PubMed  Google Scholar 

  • Meule, A., & Voderholzer, U. (2021). Orthorexia nervosa – It is time to think about abandoning the concept of a distinct diagnosis. Frontiers in Psychiatry, 12, 640401.

    Article  PubMed  PubMed Central  Google Scholar 

  • Missbach, B., Dunn, T. M., & König, J. S. (2017). We need new tools to assess orthorexia nervosa. A commentary on “prevalence of orthorexia nervosa among college students based on Bratman’s test and associated tendencies”. Appetite, 108, 521–524.

    Article  PubMed  Google Scholar 

  • Moroze, R. M., Dunn, T. M., Craig Holland, J., Yager, J., & Weintraub, P. (2015). Microthinking about micronutrients: A case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics, 56(4), 397–403.

    Article  PubMed  Google Scholar 

  • Obeid, S., Hallit, S., Akel, M., & Brytek-Matera, A. (2021). Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults. Eating and Weight Disorders, 26(8), 2607–2616.

    Article  PubMed  PubMed Central  Google Scholar 

  • Oberle, C. D., Samaghabadi, R. O., & Hughes, E. M. (2017). Orthorexia nervosa: Assessment and correlates with gender, BMI, and personality. Appetite, 108, 303–310.

    Article  PubMed  Google Scholar 

  • Oberle, C. D., Watkins, R. S., & Burkot, A. J. (2018). Orthorexic eating behaviors related to exercise addiction and internal motivations in a sample of university students. Eating and Weight Disorders, 23, 67–74.

    Article  PubMed  Google Scholar 

  • Pauzé, A., Plouffe-Demers, M. P., Fiset, D., Saint-Amour, D., Cyr, C., & Blais, C. (2021). The relationship between orthorexia nervosa symptomatology and body image attitudes and distortion. Scientific Reports, 11(1), 13311.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rania, M., de Filippis, R., Caroleo, M., Carbone, E., Aloi, M., Bratman, S., & Segura-Garcia, C. (2021). Pathways to orthorexia nervosa: A case series discussion. Eating and Weight Disorders, 26(5), 1675–1683.

    Article  PubMed  Google Scholar 

  • Scarff, J. R. (2017). Orthorexia nervosa: An obsession with healthy eating. Federal Practitioner, 34(6), 36–39.

    PubMed  PubMed Central  Google Scholar 

  • Setnick, J. (2013). The eating disorders clinical pocket guide: Quick reference for healthcare providers (second ed.). Understanding Nutrition.

    Google Scholar 

  • Skella, P., Chelmi, M. E., Panagouli, E., Garoufi, A., Psaltopoulou, T., Mastorakos, G., Sergentanis, T. N., & Tsitsika, A. (2022). Orthorexia and eating disorders in adolescents and young adults: A systematic review. Children, 9(4), 514.

    Article  PubMed  PubMed Central  Google Scholar 

  • Strahler, J., Hermann, A., Walter, B., & Stark, R. (2018). Orthorexia nervosa: A behavioral complex or a psychological condition? Journal of Behavioral Addictions, 7(4), 1143–1156.

    Article  PubMed  PubMed Central  Google Scholar 

  • Strahler, J., Wachten, H., Stark, R., & Walter, B. (2021). Alike and different: Associations between orthorexic eating behaviors and exercise addiction. International Journal of Eating Disorders, 54(8), 1415–1425.

    Article  PubMed  Google Scholar 

  • Strahler, J., Wachten, H., Neuhofer, S., & Zimmermann, P. (2022). Psychological correlates of excessive healthy and orthorexic eating: Emotion regulation, attachment, and anxious-depressive-stress symptomatology. Frontiers in Nutrition, 9, 817047.

    Article  PubMed  PubMed Central  Google Scholar 

  • Surís, A., Holliday, R., & North, C. S. (2016). The evolution of the classification of psychiatric disorders. Behavioral Sciences, 6(1), 5.

    Article  PubMed  PubMed Central  Google Scholar 

  • U.S. Department of Health and Human Services, & U.S. Department of Agriculture. (2015). 2015–2020 dietary guidelines for Americans (8th ed.) http://health.gov/dietaryguidelines/2015/guidelines/

    Google Scholar 

  • Vuillier, L., Robertson, S., & Greville-Harris, M. (2020). Orthorexic tendencies are linked with difficulties with emotion identification and regulation. Journal of Eating Disorders, 8, 15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Walker-Swanton, F. E., Hay, P., & Conti, J. E. (2020). Perceived need for treatment associated with orthorexia nervosa symptoms. Eating Behaviors, 38, 101415.

    Article  PubMed  Google Scholar 

  • White, M., Berry, R., & Rodgers, R. F. (2020). Body image and body change behaviors associated with orthorexia symptoms in males. Body Image, 34, 46–50.

    Article  PubMed  Google Scholar 

  • World Health Organization. (2019). International classification of diseases 11th revision. https://icd.who.int/en

  • Zickgraf, H. F., Ellis, J. M., & Essayli, J. H. (2019). Disentangling orthorexia nervosa from healthy eating and other eating disorder symptoms: Relationships with clinical impairment, comorbidity, and self-reported food choices. Appetite, 134, 40–49.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Psychology, University of Wroclaw, Wroclaw, Poland

    Anna Brytek-Matera

Authors
  1. Anna Brytek-Matera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Brytek-Matera .

Editor information

Editors and Affiliations

  1. University College London, London, UK

    Paul Robinson

  2. School of Psychology, Flinders University, Adelaide, SA, Australia

    Tracey Wade

  3. Klinik für Psychiatrie, Psychosomatik, Uniklinik der RWTH Aachen, Aachen, Nordrhein-Westfalen, Germany

    Beate Herpertz-Dahlmann

  4. Department of Psychiatry-IDIBELL, University of Barcelona, Barcelona, Spain

    Fernando Fernandez-Aranda

  5. Dept of Psychological Med IoPPN, Kings College London, London, UK

    Janet Treasure

  6. School of Medicine and Health Sciences, University of North Dakota, Fargo, USA

    Steve Wonderlich

Section Editor information

  1. School of Medicine and Health Sciences, University of North Dakota, Fargo, USA

    Steve Wonderlich MD

  2. Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil

    Angelica Claudino

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Brytek-Matera, A. (2023). Additional Phenotypes of Eating Disorders: Orthorexia Nervosa. In: Robinson, P., Wade, T., Herpertz-Dahlmann, B., Fernandez-Aranda, F., Treasure, J., Wonderlich, S. (eds) Eating Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-97416-9_12-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-97416-9_12-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-97416-9

  • Online ISBN: 978-3-030-97416-9

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation