Healthy eating is more popular than ever, and many people are focusing on eating well and avoiding unhealthy or processed foods to improve their overall health.
While eating a healthy and balanced diet has many benefits, it can sometimes be hard to draw the line between healthy eating behaviors and disordered eating. Healthy eating is often accompanied by messages of “clean eating” and “avoiding toxins.” These messages can add moral value to foods, classifying some as “good and clean” and others as “bad and harmful.”
The obsession with healthy eating is known as orthorexia, and people who suffer from it show many signs of disordered eating. Orthorexia and anorexia have many similarities, but there are some key differences in their underlying factors, symptoms, and types of treatment.
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What Is Orthorexia?
Orthorexia is an approach to eating that extends beyond a healthy approach to a balanced diet. It involves obsessing about the nutrient quality or “purity” of foods and only eating kinds deemed to be good or safe.
Although it is not yet included in the Diagnostic and Statistical Manual for Mental Disorders, orthorexia shares many signs and symptoms with diagnosable eating disorders. For example, someone with symptoms of orthorexia may:
- Obsessively check food labels
- Limit foods or food groups that they may deem “dirty” or “unclean,” such as meat, dairy, carbohydrates, etc.
- Spend significant time and energy anticipating upcoming meals
- Experience significant distress if they don’t have access to “safe” foods
- Feel guilt or shame for eating “impure” foods
- Not function normally in social, academic or work situations
Orthorexia is also often linked with concerns about body appearance or focus on weight loss. While they may fit the criteria of “eating healthy,” these behaviors are extreme and can be all-consuming as well as very distressing.
Interestingly, social media use — particularly sites like Instagram — can increase the risk of orthorexia. Contrary to the actual goals of healthy eating, obsessing about healthy eating can actually decrease overall health and wellbeing.
Characteristics of Anorexia
Anorexia is a serious eating disorder characterized by intense fear of weight gain and severe restriction of food. For a clinical diagnosis of anorexia, a person must meet criteria that include:
- Low body weight or body mass index
- Restriction of energy intake
- Persistent behavior to avoid gaining weight
- Abnormal perception of body size and shape, and an unusual amount of self-identity tied to body and appearance
These symptoms and characteristics of anorexia can be linked with serious short- and long-term health consequences and people who suffer from anorexia can have difficulty functioning in their normal daily lives.
Similarities in Presentation
Since orthorexia and anorexia share similar signs and symptoms, it can sometimes be difficult to distinguish between the two. Both disorders include an excessive focus on diet and food while exerting extreme control over what is eaten.
In general, people with both conditions tend to categorize foods as “good” or “bad.” In addition, the thought of having to deviate from strict food rules is incredibly distressing. People with either condition are usually very focused on losing or maintaining weight loss.
Orthorexia and anorexia are commonly seen in similar groups of people. The groups who are affected by eating disorders are normally people whose body shape, size or function are closely scrutinized. This can include groups like adolescent females, dancers or athletes. Anorexia and orthorexia statistics can help show just how many people are affected.
The lifetime prevalence of anorexia nervosa among adults in the U.S. is estimated to be 0.88%. The exact prevalence of orthorexia is more difficult to track since it is not yet an officially recognized psychiatric disorder. However, estimates suggest that between 6.9% to 57.6% of the general population are affected by orthorexia. Rates might be even higher in certain groups, such as medical students or athletes.
Women make up the majority of the population affected by anorexia, but it’s not yet known whether men or women are more commonly affected by orthorexia. However, eating disorders can certainly affect men and people of all ages. Orthorexia can also be influenced by social media use, which can promote messages regarding the purity of certain foods. Importantly, people with anorexia are also at increased risk of displaying symptoms of orthorexia, even after treatment.
Differences in Motivation: Quality vs. Quantity
The signs and behaviors of orthorexia and anorexia are quite similar. What distinguishes these two conditions is the underlying motivation related to an unhealthy relationship with food.
More specifically, the primary motivator of orthorexia nervosa relates to a desire to be pure, good, clean or healthy. In contrast, anorexia is caused by a drive for thinness and extreme fear of weight gain. While orthorexia can include foods deemed “clean” and healthy, a person with anorexia often aims to avoid or restrict food of any kind.
The motivating factors and causes of orthorexia and anorexia are quite different, but both can lead to extreme obsessions with food and an inability to participate normally in social settings.
Treatments for eating disorders can include a combination of psychological, behavioral and nutritional counseling. There are many treatment strategies for eating disorders, and patients with both anorexia and orthorexia may benefit from one or multiple treatments, including:
- Cognitive-behavioral therapy
- Behavioral and food-based interventions (i.e., broadening the range of “acceptable” foods)
- Psychoeducation to unpack beliefs about food
The success of treatment for orthorexia and anorexia may differ based on the type of eating disorder. For example, medication may be more successful in anorexia, but might be considered “unnatural” or inappropriate by someone with orthorexia. For this reason, it is important to discuss the range of treatment options with a professional.
Key Differences Between Orthorexia and Anorexia
Both orthorexia and anorexia include disordered eating behaviors and an obsession with food and appearance, and both are disruptive to a person’s ability to function optimally. Although they share many similarities, there are several key differences between orthorexia and anorexia.
Some of these differences include:
- Anorexia is a recognized psychological condition, whereas orthorexia is not yet recognized in the DSM-5
- Orthorexia is motivated by a desire to be pure; anorexia is driven by a desire for thinness
- People with orthorexia are not always underweight or driven to be extremely thin, and anorexia is characterized by severely low weight or significant weight loss
- Treatment strategies may differ, based on differences in underlying beliefs about food
Although the two disorders may appear to be similar, these key differences can impact eating disorder prognosis and treatment. Discussion with a professional can help to differentiate between anorexia and orthorexia and find the most appropriate course of treatment.
If you or someone you care about is experiencing symptoms of anorexia or orthorexia and a co-occurring substance use disorder, contact The Recovery Village today to discuss treatment options. We have facilities located throughout the U.S., and we can help you find a treatment plan that works well for your situation.
Dunn, Thomas; Bratman; Steven. “On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.” Eating Behaviors, December 18, 2015. Accessed June 12, 2019. Gramaglia, Carla; et al. “Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviors in clinical and non-clinical samples.” BMC Psychiatry, February 21, 2017. Accessed June 12, 2019. Duncan, Alexis; Ziobrowski, Hannah; Nicol, Ginger. “The Prevalence of Past 12‐Month and Lifetime DSM‐IV Eating Disorders by BMI Category in US Men and Women.” European Eating Disorders Review, January 27, 2017. Accessed June 12, 2019. Koven, Nancy; Abry, Alexandra. “The clinical basis of orthorexia nervosa: emerging perspectives.” Neuropsychiatric Disease and Treatment, February 18, 2015. Accessed June 12, 2019. Turner, Pixie; Lefevre, Carmen. “Instagram use is linked to increased symptoms of orthorexia nervosa.” Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, March 1, 2017. Accessed June 13, 2019.
Dunn, Thomas; Bratman; Steven. “On orthorexia nervosa: A review of the literature and proposed diagnostic criteria.” Eating Behaviors, December 18, 2015. Accessed June 12, 2019.
Gramaglia, Carla; et al. “Orthorexia and anorexia nervosa: two distinct phenomena? A cross-cultural comparison of orthorexic behaviors in clinical and non-clinical samples.” BMC Psychiatry, February 21, 2017. Accessed June 12, 2019.
Duncan, Alexis; Ziobrowski, Hannah; Nicol, Ginger. “The Prevalence of Past 12‐Month and Lifetime DSM‐IV Eating Disorders by BMI Category in US Men and Women.” European Eating Disorders Review, January 27, 2017. Accessed June 12, 2019.
Koven, Nancy; Abry, Alexandra. “The clinical basis of orthorexia nervosa: emerging perspectives.” Neuropsychiatric Disease and Treatment, February 18, 2015. Accessed June 12, 2019.
Turner, Pixie; Lefevre, Carmen. “Instagram use is linked to increased symptoms of orthorexia nervosa.” Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, March 1, 2017. Accessed June 13, 2019.