Orthorexia nervosa – a different lifestyle or a specific eating disorder?

Abstract

Orthorexia nervosa (ON) is considered an obsession with healthy eating, a phenomenon that includes excessive dietary restrictions, which in turn can lead to metabolic dysfunctions. Although the nosological status of this pathology is currently insufficiently determined, ON attracts the interest of mental health specialists due to the possible harmful psychological and biological consequences, its high prevalence in the general population and the difficulty of adequate therapeutic management (low level of insight and lack of evidence-based treatments). Orthorexia nervosa should be distinguished from other mental disorders with which it has a high degree of clinical overlap (obsessive-compulsive disorder, anorexia nervosa, restrictive/avoidant eating disorder etc.), but also from “healthy orthorexia” (this being considered part of a lifestyle focused on eliminating foods labeled as “impure”, “toxic” or “artificial”). The analysis of risk factors for ON highlights the importance of several obsessive-compulsive personality traits (perfectionism, rigidity, self-control), executive dysfunctions, internalization of social models (thinness or perfect health, for example), media pressure, parental and social group influences, belonging to certain professional categories (nutritionists, medical students, athletes) or practicing yoga. Several psychometric instruments for measuring the severity of ON have been developed over the last two decades, but they should be used with caution because not all of them have well-established validity. Also, several sets of diagnostic criteria have been proposed in order to identify the clinical features of orthorexia nervosa and to differentiate these patients from those diagnosed with anorexia nervosa, obsessive-compulsive disorder, somatoform disorders or nonpathological orthorexic behaviors. Finally, some therapeutic suggestions are presented, mainly psychotherapies, but it should be mentioned that they are based on case studies or on the extrapolation of data from trials dedicated to pathologies considered to be related to orthorexia nervosa. In conclusion, because ON is a nosological entity that has only recently been cornered, there is an urgent need to explore psychometric tools with higher specificity and to find more widely accepted diagnostic criteria. Also, no clear, evidence-based therapeutic recommendations could yet be formulated, because no clinical trial focused on the effectiveness of therapeutic interventions in patients with orthorexia nervosa has been conducted.