What is Orthorexia?

Although the concept of orthorexia nervosa has been the subject of a great deal of media attention and is in wide use by eating disorder professionals, it has never been given a satisfactory formal definition. This omission has now been remedied in a newly published article in the journal Eating Behaviors I coauthored with Thom Dunn, Ph.D.

These criteria are intended as a starting point; we anticipate that they will be refined and modified over time. In particular, the references to weight loss remain provisional, pending research into the evolving relationship between orthorexia and anorexia.

Proposed Diagnostic Criteria for Orthorexia Nervosa:

Criterion A. Obsessive focus on “healthy” eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue, but this is conceptualized as an aspect of ideal health rather than as the primary goal.  As evidenced by the following:

1. Compulsive behavior and/or mental preoccupation regarding affirmative and restrictive dietary practices* believed by the individual to promote optimum health.**
2. Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame. 
3. Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy food.

*Dietary practices may include use of concentrated “food supplements.”

**Exercise performance and/or fit body image may be regarded as an aspect or indicator of health.

Criterion B. The compulsive behavior and mental preoccupation becomes clinically impairing by any of the following:

1. Malnutrition, severe weight loss or other medical complications from restricted diet
2. Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet.
3. Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined “healthy” eating behavior

In addition to these criteria, the published article also includes the following paragraph:

Other traits are commonly associated with ON in the literature. While the authors feel that these are not essential to making the diagnosis, they may help confirm it. These include obsessive focus on food choice, planning, purchase, preparation, and consumption; food regarded primarily as source of health rather than pleasure; distress or disgust when in proximity to prohibited foods; exaggerated faith that inclusion or elimination of particular kinds of food can prevent or cure disease or affect daily well-being; periodic shifts in dietary beliefs while other processes persist unchanged; moral judgment of others based on dietary choices; body image distortion around sense of physical “impurity” rather than weight; persistent belief that dietary practices are health-promoting despite evidence of malnutrition.

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