Orthorexia nervosa, as I defined it in 1996, indicates an unhealthy obsession with eating healthy food. The term is derived utilizing the Greek “ortho,” which means “right,” or “correct,” and is intended as a parallel with anorexia nervosa. I originally invented the word as a kind of “tease therapy” for my overly diet-obsessed patients. Over time, however, I came to understand that the term identifies a genuine eating disorder.
Please note that I do not, and have never claimed that vegetarianism, veganism, or any other nutritionally sound approach to eating healthy food is in itself a disorder. That would be absurd. Furthermore, I entirely agree that the problem of addiction to junk food is immensely more prevalent than obsession with healthy food. But obesity is far more common than anorexia, and yet anorexia exists and it is a dangerous eating disorder.
Orthorexia arises in a similar way. The standard American diet is unhealthy, and it is a perfectly laudable goal to want to eat healthy food. However, some people who are devoted to healthy eating develop an eating disorder in relation to that focus, just as some people in their quest to avoid obesity become anorexic.
For people with orthorexia, eating healthily has become an obsessive, painful, psychologically limiting and sometimes even physically dangerous disorder, reminiscent of but quite distinct from anorexia. Often, orthorexia seems to have elements of OCD. People with orthorexia may also have a touch of anorexia. But orthorexia is often not very much like typical OCD or typical anorexia. It is usually only a psychological problem, but in rare cases it can be much more severe, even resulting in death via malnutrition.
The primary feature distinguishing orthorexia from anorexia is that while a person with anorexia focuses on weight, a person with othorexia obsesses about purity. Anorexia involves a desire to reduce food intake while orthorexia invokes the desire to cleanse. Both are about control, but whereas an anorexic wants to control body fat, an orthorexic wants to achieve dietary perfection.
Orthorexia is not yet a DSM diagnosis, and I am not sure that it should be. There is a tendency in the modern world to pathologize an increasing number of human behaviors and I have no desire to contribute to this trend. On the other hand, naming has power. I have heard people say, “I want to eat healthfully, but I don’t want to be orthorexic.” Perhaps this is the best possible use of the word.
If you recognize yourself in any of this, perhaps the resources on this site may be helpful. You might also consider reading my somewhat dated but entertaining book, Health Food Junkies. But most of all, if you feel your condition has become too much for you, visit an eating disorder specialist who understands orthorexia.
Steven Bratman, MD