Orthorexia nervosa is a concept first described in 1997 by Bratman and Knight, derived from the Greek words “orthos” (correct) and “orexia” (appetite). It can be translated into Turkish as “proper and appropriate eating.” This concept refers to individuals’ tendency to prefer foods that are perceived as organic, free from additives, and biologically pure (Bratman & Knight, 2000). Although this pattern initially emerges as an intention to eat healthily, it may gradually develop into a pathological condition, becoming a prominent obsession in an individual’s life. Individuals with orthorexia tend to focus excessively on the quality and content of the food they consume, developing persistent and intrusive thoughts about issues such as pesticide residues, hormone use, preservatives, artificial additives, food colorings, and the potential health effects of food packaging materials (Oğur & Aksoy, n.d.). In this process, individuals may invest significant time and effort in obtaining and preparing foods they consider healthy, leading to a rigid and restrictive dietary pattern shaped by food quality rather than quantity.
Risk Factors and Causes
The development of orthorexia nervosa is thought to involve the interaction of individual, environmental, and psychological factors. From an individual perspective, personality traits such as perfectionism, obsessive tendencies, and rigid rule adherence play a significant role in the emergence of orthorexic behaviors (Özsoy, 2017). Individuals with these characteristics may develop an excessive sensitivity toward identifying what is “correct” and “healthy” in nutrition and may struggle to tolerate deviations from self-imposed dietary rules.
From an environmental standpoint, social media, health trends, and the widespread diet culture appear to reinforce these behaviors. Concepts such as “clean eating,” “organic living,” and “detox” are often idealized, potentially contributing to the transformation of healthy eating habits into rigid and restrictive patterns.
Psychologically, individuals with high levels of anxiety and a strong need for control are more prone to developing orthorexia. Such individuals may attempt to manage uncertainty and achieve a sense of internal stability by exerting control over their eating behaviors; however, over time, this may evolve into a maladaptive and dysfunctional pattern.
Relationship Between Orthorexia and Other Eating Disorders
It remains a subject of debate in the literature whether orthorexia nervosa should be considered a distinct eating disorder or a subtype of conditions such as Obsessive-Compulsive Disorder (OCD) or Anorexia Nervosa (Şengül & Hocaoğlu, 2019). While orthorexia shares certain characteristics with anorexia nervosa—such as perfectionism, high anxiety, and a strong need for control—the two disorders differ in their primary focus.
Anorexia nervosa and Bulimia Nervosa are primarily associated with the quantity of food consumed, whereas orthorexia is concerned with the quality of food. Additionally, orthorexia nervosa shows similarities with obsessive-compulsive disorder. Individuals with orthorexia may display ritualistic behaviors related to food preparation and consumption, as well as persistent concerns about contamination or unhealthy ingredients. However, a key distinction lies in the fact that orthorexic thoughts are generally ego-syntonic, meaning they are perceived as appropriate and justified by the individual, unlike the ego-dystonic nature of obsessions in OCD (Şengül & Hocaoğlu, 2019).
Diagnostic Criteria and Assessment
Although there are no standardized diagnostic criteria for orthorexia nervosa, several proposed frameworks exist in the literature. Among these, the criteria suggested by Moroze et al. (2015) provide an important basis for evaluating orthorexic tendencies. These criteria focus on excessive preoccupation with healthy eating, rigid dietary rules, and the impact of these behaviors on an individual’s functioning (Moroze et al., 2015).
Criterion A: An obsessive focus on “healthy eating,” characterized by concerns about food quality and composition. At least two of the following must be present:
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Persistent preoccupation with food purity leading to an unbalanced diet
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Excessive concern about the health effects of food ingredients
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Rigid avoidance of foods perceived as unhealthy
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Excessive time spent on food preparation and research (e.g., more than three hours per day)
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Feelings of guilt and anxiety following perceived dietary violations
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Intolerance toward others’ eating habits
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Excessive financial expenditure on perceived high-quality foods
Criterion B: The obsessive preoccupation results in at least one of the following:
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Impairment in physical health due to nutritional imbalance
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Significant distress or impairment in social, academic, or occupational functioning
Criterion C: The disturbance is not better explained by another mental disorder, such as OCD, schizophrenia, or other psychotic disorders
Criterion D: The behavior cannot be explained by religious dietary practices, medically diagnosed food allergies, or conditions requiring specific diets.
Conclusion
Orthorexia nervosa is a condition in which the pursuit of healthy eating becomes excessive and rigid, ultimately impairing an individual’s quality of life. Therefore, raising awareness and identifying individuals at risk are of critical importance. As with other eating disorders, a multidimensional approach is required in the treatment of orthorexia nervosa. In this context, psychotherapeutic approaches such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT) are considered effective interventions. Additionally, Family-Based Therapy (Maudsley Method) is regarded as an evidence-based approach, particularly in the treatment of eating disorders. Complementary methods such as the Feldenkrais Method, neurofeedback training, and Eye Movement Desensitization and Reprocessing (EMDR) may also be utilized (Şengül & Hocaoğlu, 2019).
In conclusion, behaviors that originate from the intention to eat healthily may, when taken to extremes, negatively affect an individual’s social life, psychological well-being, and physical health. Therefore, increasing awareness of orthorexia nervosa and seeking professional support when necessary are of great importance.
References
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Arusoğlu, G. (2006). Sağlikli beslenme takintisi (ortoreksiya) belirtilerinin incelenmesi, Orto-15 ölçeğinin uyarlanmasi (Doctoral dissertation, M. Sc. thesis, Hacettepe Üniversitesi.(in Turkish)).
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Moroze RM, Dunn TM, Craig Holland J, Yager J, Weintraub P. Microthinking about micronutrients: a case of transition from obsessions about healthy eating to near-fatal “orthorexia nervosa” and proposed diagnostic criteria. Psychosomatics. 2015; 56: 397-403.
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Özsoy, E. V. (2017). Personality traits in eating disorders. International Journal of Social Sciences and Education Research, 3(1), 255-266.
Şengül, R., & Hocaoğlu, Ç. (2019). OrtoreksiyaNervoza nedir? Tanı ve tedavi yaklaşımları. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi, 14(2), 101-104.