Nutritionist with female patient

Orthorexia Nervosa versus Anorexia Nervosa?

Anorexia nervosa is a serious eating disorder that affects between 0.9% and 2.0% of females and 0.1% to 0.3% of males. The disorder creates an extreme fear of weight gain in people who suffer from it. Individuals with anorexia typically restrict the number of calories and types of food they eat.  They also may compulsively exercise, purge, or binge eat. An eating disorder that has some similarities of anorexia is Orthorexia, which means an obsession with proper or healthy eating. Having a concern with the nutritional quality of the food is a healthy behavior, but problems occur when this concern becomes excessive, damaging and disruptive. Individuals with orthorexia become so fixated on what they perceive as healthy eating that they actually damage their own physical and emotional well-being.

What is orthorexia?

Orthorexia turns eating into a pathological activity that becomes entangled with obsessive thinking, compulsive and ritualistic behavior and self-punishment. Individuals with orthorexia often use a diet to achieve a feeling of perfection, purity or superiority. They may feel judgmental towards people who do not follow their same eating patterns and habits. They often spend excessive amounts of time planning and researching “pure” foods, which interferes with participation in normal social activities and interactions. These symptoms are what turns a trendy diet into orthorexia.

Much like other eating disorders, research suggests that orthorexia is based on anxiety and/or depression. It is for this reason that the occurrence of orthorexia is typically accompanied by other eating disorders such as anorexia, bulimia, or binge eating disorder (BED), meaning orthorexia can co-occur with another eating disorder. This means an individual could binge on seemingly healthy foods (vegetables) and then purge the food in order to get rid of the calories. Unlike with some eating disorders, people with orthorexia can hide their disorder by displaying their symptoms in plain sight. At initial glance, people suffering from orthorexia appear to be simply taking care of their physical body, and may even talk about their eating habits. But, this is an illusion.

Some symptoms and warning signs of orthorexia include:

  • Compulsively checking of ingredient lists and nutritional labels
  • Increased concern about the health of ingredients
  • Eliminating an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
  • Inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
  • Unusual interest in the health of what others are eating
  • Spending a lot time thinking about what food might be served at upcoming events
  • Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
  • Obsessively following food and ‘healthy lifestyle’ blogs on Twitter and Instagram
  • Body image concerns may or may not be present

Some eating habits can trigger behavior that resembles orthorexia. However, simply adopting an alternative way of eating, whether based on science or pseudoscience, does not mean someone has orthorexia. For example, some people may restrict certain food groups – Vegan, gluten-free, Paleo diets, and etc., but the adoption of these does not automatically create an orthorexia diagnosis.

Is orthorexia the same as anorexia?

Many of the symptoms and behaviors surrounding orthorexia tend to overlap with anorexia. Yet, in cases of anorexia, people tend to focus more on severely restricting the quantity of food (calorie count). There is a clear and forceful desire to not gain weight. Since orthorexia is a newer diagnosis, it still possesses varying levels of acceptance among eating disorder treatment professionals. Some eating disorder specialists regard orthorexia as a discrete diagnosis like anorexia or bulimia. There are reports that signs of orthorexia are perhaps increasing due to the use of social media to popularize extreme diets and other food-related behavior. Other health professionals, believe that people with orthorexia symptoms are actually suffering from anorexia, due to the similarities such as:

  • A desire to maintain control of life by severely controlling daily food consumption
  • Seeking self-esteem and fulfillment through controlling food intake
  • Citing un-diagnosed food allergies as a rationale for avoiding food
  • Co-occurring disorders such as obsessive compulsive disorder
  • Elaborate rituals about food that may result in social isolation

How are orthorexia and anorexia different?

Obsession with weight is one of the primary signs of anorexia, bulimia, and other eating disorders. But this is not a symptom of orthorexia. Instead, the focus for people with orthorexia is an excessive obsession with the health implications of their dietary choices.

People with anorexia will severely restrict their food intake in order to lose weight. People with orthorexia, however, strive to feel pure, healthy and natural. The focus is on quality of foods consumed instead of the quantity. In the end, it is critical that people with eating disorder signs and symptoms seek appropriate clinical advice from a professional with experience treating orthorexia, anorexia as well as other conditions. The obsessive tendencies associated with orthorexia can indicate a co-occurring disorder that should be diagnosed and treated by a psychiatrist.

There are definite similarities as well as differences between anorexia and orthorexia. Both of these eating disorders tend to provide a sense of control and stability around the consumption of food. Again, both eating disorders are dangerous mental illnesses that require professional treatment from a skilled clinician.

Toledo Center for Eating Disorders provides a full range of evidence-based treatment options for both adolescents and adults. We provide individualized treatment plans tailored to meet the specific needs of each client that is applied within the framework of evidence-based treatment principles, and periodically revised as changes occur during treatment. Our professional team works with our clients and their families to set realistic treatment goals and then guide them through the treatment process.  At Toledo Center, we are with you throughout your recovery journey. For additional information or questions about anorexia and orthorexia, please contact our experienced staff.


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