Orthorexia
Orthorexia Nervosa
Steven Bratman, an American physician, introduced orthorexia nervosa in 1997 for a pattern he had watched arrive repeatedly: dietary restriction adopted to promote health, escalating until it produced social isolation, anxiety, the loss of any ability to eat intuitively, a narrowing of interest in other healthy activities, and in rare cases severe malnutrition or death.
The paradox is the definition. Every restriction is undertaken for a good reason and the accumulation of them is the harm.
Why quality rather than quantity matters
Ursula Philpot, chair of the British Dietetic Association, gave the distinction that separates orthorexia from every other eating disorder. People with it are solely concerned with the quality of the food they eat, refining and restricting according to their own understanding of which foods are truly pure. Anorexia nervosa and bulimia nervosa concern how much.
That single difference propagates through everything else. Body image distortion is present and it is organised around a sense of physical impurity rather than weight. Weight loss occurs and is understood as an aspect of ideal health rather than as the objective.
Which findings separate it from anorexia
Orthorexia does not fall disproportionately on one sex. Studies have found it equally in men and women with no significant difference at all, which is unlike anorexia nervosa and unlike most conditions in this catalogue.
And the personality correlations point somewhere unexpected. Significant positive correlations have been found with narcissism and with perfectionism, and no significant correlation with self-esteem. A condition of dietary restriction that does not track self-esteem is not behaving like an eating disorder, and the moral element in the symptom list follows from the same place: people with orthorexia make moral judgements of others based on dietary choices.
What the proposed criteria require
Thom Dunn and Steven Bratman proposed formal criteria in 2016 in the peer-reviewed journal Eating Behaviors, and the wording repays attention.
The first criterion is an obsessive focus on healthy eating as defined by a dietary theory whose specific details may vary, with exaggerated distress about food choices perceived as unhealthy. Violating a self-imposed dietary rule produces one of three things, with anxiety and shame attached:
- exaggerated fear of disease
- a sense of personal impurity
- negative physical sensations Restrictions escalate over time, eliminating entire food groups and introducing progressively more frequent or severe cleanses understood as purifying.
The phrase that does the most work is periodic shifts in dietary beliefs while other processes persist unchanged. The theory can be replaced entirely, from one dietary doctrine to a contradictory one, and the restricting, the escalation and the moral judgement continue undisturbed. The content is interchangeable and the structure is the condition.
The second criterion requires clinical impairment: malnutrition or medical complications, distress or impaired social, academic or occupational functioning, or a positive body image and sense of self-worth that depends excessively on compliance with the person's own rules.
Why it is still not a diagnosis
Orthorexia is not recognised in DSM-IV or DSM-5, nor in ICD-10 or ICD-11. Proposals to consider it a novel mental illness exist and no consensus has formed, and the argument against is specific rather than dismissive: the overlap with other conditions is strong enough that people presenting with it may be better diagnosed with an existing restrictive eating disorder.
Strong correlations with obsessive-compulsive disorder have been found, which supports that reading. The psychological factors named are the familiar ones, lower self-esteem arising from social comparison, perfectionism, a need for control, and coping with difficult emotions or past trauma, with some association reported to substance misuse.
The biological components have not been identified for orthorexia specifically. What is available is imported from the anorexia, bulimia and binge eating literatures: hormone levels, neurotransmitters and genetic contributions.
Why it is hard to see
A person eating only food they consider pure is doing something the surrounding culture rewards. The Tripartite Influence Model names parents, peers and media as the key influences on body image and disordered eating, and all three currently supply the material orthorexia is built from. That is the practical reason the condition is difficult to notice from outside: every individual decision looks like a good one.
Told apart
Often confused with Orthorexia
- Fear of FoodBoth narrow what may be eaten and the reasoning differs entirely. A food fear treats food as a route to illness; orthorexia treats it as a route to purity, and the restrictions are additive rather than protective.
- Fear of ImperfectionOrthorexia correlates significantly with perfectionism and with narcissism, and not with self-esteem, which places it closer to the perfectionism literature than to the eating disorder literature it is usually filed beside.
- Holy AnorexiaAnorexia mirabilis organised food restriction around religious purity centuries before orthorexia organised it around dietary purity, and the vocabulary of cleansing and impurity is shared almost word for word.
Common questions
Questions about Orthorexia Nervosa
- Who coined the word and when?
- Steven Bratman, an American physician, introduced orthorexia nervosa in 1997. He built it by analogy with anorexia, which names the absence of appetite: orthos and orexis give correct appetite. His observation was that restriction adopted to promote health could produce isolation, anxiety, loss of intuitive eating and, in rare cases, severe malnutrition or death.
- How is it different from anorexia?
- Quality against quantity. Ursula Philpot, chair of the British Dietetic Association, describes people with orthorexia as concerned solely with the quality of what they eat, refining and restricting according to their own understanding of which foods are pure. Anorexia and bulimia concern how much is eaten. Where body image distortion appears in orthorexia it is organised around impurity rather than weight.
- Does it affect women more than men?
- No, and this is one of the clearest markers separating it from other eating disorders. Studies have found orthorexia equally in men and women with no significant difference at all.
- What does it correlate with?
- Significantly with narcissism and with perfectionism, and not significantly with self-esteem. Strong correlations with obsessive-compulsive disorder have also been found. A pattern of dietary restriction that does not track self-esteem is not behaving the way an eating disorder is expected to.
- Can the diet itself change?
- Completely, and the criteria account for it. Dunn and Bratman's wording allows for periodic shifts in dietary belief while other processes persist unchanged, so a person can abandon one dietary doctrine for a contradictory one while the restricting, the escalation and the moral judgement of others continue untouched. The content is interchangeable; the structure is the condition.
- Why is it not in the DSM?
- No consensus has formed, and the argument against is that the overlap with existing restrictive eating disorders is strong enough that people presenting with orthorexia may be better diagnosed under one of those. It is absent from DSM-IV, DSM-5, ICD-10 and ICD-11 alike.
Added 2026-08-23 · Revised 2026-08-26
Nearby in the catalogue
Related entries
- Fear of FoodAnorexia is a fear of gaining weight, not of food. The two produce identical plates and identical weight loss, and the treatments point in opposite directions.
- Fear of ImperfectionMaladaptive perfectionism has a name most people have not met, and a dated trend: rising among young people in higher education since the late 1980s.
- Holy AnorexiaBrumberg argues it vanished because the coding changed, not the motives. A woman fasting to commune with Christ today would be recorded as anorexia nervosa.
- Extreme Picky EatingBody image disturbance is not a root cause of it. The three routes in are sensory difficulty, fear of what eating causes, and simply no interest in food.
- Fear of Gaining WeightThe penalty this fear anticipates has been measured: worse marriage, education, career and income outcomes. What makes it a disorder is what people do about it.
- Fear of AlcoholThe reference books give potophobia three words. The laboratory work on alcohol and fear runs the other way, and found it damps anxiety but not fear.