Eating Disorder Therapy

Orthorexia Nervosa Vs. Anorexia Nervosa

Two restrictive types of eating disorders with key differences.

Health Butterfly made out of fruits and orthorexia food that could also look like anorexia.

Many people are familiar with anorexia nervosa (anorexia) and have a general idea of its diagnostic criteria, which entails an intense fear of gaining weight and a distorted body image. These deep-seated fears lead to self-imposed starvation or extreme restriction when it comes to food intake, making anorexia not only a very serious eating disorder but also the most deadly.

Orthorexia is a lesser-known restrictive type of disordered eating and only emerged as a diagnosable illness in the late 90s. You can think of it as anorexia’s long-lost cousin, given that it’s spent most of its existence buried in the shadows yet shares many characteristics with anorexia while also possessing its own unique qualities.  

Here, we’ll go over the similarities and differences between anorexia and orthorexia, including what makes both harmful from a physical, psychological, and social standpoint.

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Etymology Breakdown

First, it can be helpful to understand the literary and medical origins of the terms “anorexia” and orthorexia.”

Anorexia Nervosa

The term “anorexia” comes from the Greek words “an” (meaning “without”) and “orexis” (meaning “appetite”), directly translating to “lack of appetite.” The term was initially used to describe a side effect or condition caused by various medical conditions or diseases.

The usage of “anorexia” in the context of the eating disorder we now refer to as “anorexia nervosa” began in the late 19th century to describe a specific disorder characterized by self-imposed starvation and a fear of gaining weight. “Nervosa” emphasizes the loss of appetite not due to a lack of hunger but, rather, driven by psychological factors such as body image issues, intense fear of weight gain, and a desire for extreme thinness.

Orthorexia Nervosa

The word “orthorexia” is derived from the Greek words “orthos,” meaning “right” or “correct,” and “orexis,” meaning “appetite.” Therefore, “orthorexia” can be translated to mean “right appetite” or “correct eating.”

Dr. Steven Bratman introduced “orthorexia nervosa” in an article he wrote for Yoga Journal in 1997. He used the term to describe individuals who displayed an unhealthy fixation on the quality and purity of their food, often to the detriment of their physical and mental health.

Since its introduction, the term “orthorexia” has been used to describe a specific type of disordered eating behavior, characterized by an unhealthy obsession with perceived healthy eating or “clean eating” that can lead to social isolation, malnutrition, and an impaired overall quality of life. 

Similarities and Differences Between Anorexia and Orthorexia

Of all the known eating disorder types, there are various reasons why orthorexia and anorexia often coalesce into a similar bucket. However, the differences arguably outnumber the similarities.

Similarities
  • Restrictive Eating Habits: Individuals struggling with orthorexia or anorexia have a personalized and extensive list of banned or off-limits foods, resulting in an unnatural and unhealthy relationship with food. 
  • Reduced Quality of Life: Both orthorexia and anorexia can lead to social isolation and strained relationships as individuals avoid events or interactions where they cannot control food choices.
  • Negative Impact on Mental Health: The obsession with restrictive eating common in both conditions can contribute to anxiety, depression, and other mood disorders.
  • Negative Impact on Physical Health: Malnourishment, nutritional deficiencies, loss of bone density, electrolyte Imbalances, gastrointestinal Issues, a compromised Immune System, physical weakness, fatigue, poor muscle function, and other health problems may result from the extreme dietary restrictions in both cases.
  • Personality Traits: Perfectionism, anxiety or anxiety disorders, obsessive-compulsive disorder or tendencies, neuroticism, low self-esteem, rigidity, and a need for control are traits commonly seen in people who suffer from both orthorexia and anorexia.

Food Quality vs Food Quantity:
Overhead,Shot,Of,Colorful,Rainbow,Made,Of,Bell,Peppers,And, healthy, eating, vs., junk food
  • Orthorexia: Those suffering from orthorexia have an obsessive preoccupation with eating only what they deem “quality food,” “healthy food” or “pure food” and getting what they consider the “proper nutrition.” They may follow strict dietary rules and feel anxious or guilty when they deviate from them. The specific foods individuals with orthorexia avoid can vary from person to person but may include:
  • Processed foods (due to having additives, preservatives, and artificial ingredients)
  • Foods with artificial sweeteners
  • Sugary foods
  • Salty foods
  • Fried foods
  • High-fat foods (especially those with saturated or trans fats)
  • Carbohydrate-rich foods (especially refined carbohydrates like white bread, cake, donuts, cookies and sugary cereals)
  • Dairy products.
  • Gluten-containing foods
  • Food with genetically modified organisms (GMOs)
  • Non-organic foods
  • Anorexia: Because the primary concern for individuals suffering from anorexia is often an extreme fear of weight gain coupled with a deep desire for weight loss, they typically care more about controlling the amount of calories they consume rather than how nutrient-dense the food is. For example, they may eat a rice cake (a processed food) but refuse to spread it with any nut butter (a food someone with orthorexia may eat regularly).

Healthy Body vs Thinner Body:
  • Orthorexia: While individuals with orthorexia may become underweight or malnourished due to their strict dietary restrictions, their primary focus is typically on the healthfulness of the foods they eat rather than on losing weight or achieving a desired body weight or physical appearance.
  • Anorexia: Individuals with anorexia intentionally limit their food intake with the goal of losing weight and becoming thinner. They often have a distorted perception of their own body size, seeing themselves as overweight even if they are underweight or severely malnourished.

Fear of Health Ramifications vs Fear of Weight Gain
  • Orthorexia: The motivation behind orthorexia is a desire to lead a healthy lifestyle through seeking purity in food choices. People with orthorexia may believe that strict dietary habits will improve their physical and mental well-being.
  • Anorexia: Those with anorexia have such a deep-seated fear of existing in a larger body that they often ignore the short- and long-term health conditions (some of which can be fatal) they may potentially suffer in their quest to attain a thin or emaciated appearance. 

Lack of Variety vs Lack of Sustenance:
  • Orthorexia: Between the excessive focus on food rules (e.g. eating a very specific amount of “pure” or “clean” foods each day), dietary regimens (e.g. veganism, raw foods diet, paleo diet), and the extensive list of off-limits foods, people with orthorexia are often left with a narrow window of foods they permit themselves to eat—in some cases eliminating entire food groups. However, because being healthy is of utmost concern, they typically (though not always) eat enough food to prevent their bodies from reaching a starved or emaciated state. 
  • Anorexia: Some individuals with anorexia lack variety in their diet due to a dependency on safe foods, rigidity, and routine. However, the overarching concern is that they consume less food than their body needs to feel adequately satiated and function properly. While people with anorexia come in all shapes and sizes, this lack of sustenance can leave some severely underweight. Additional physical symptoms from a lack of sustenance may include:
    • Menstrual irregularities
    • Difficulties concentrating 
    • Dizziness, especially upon standing 
    • Fainting/syncope 
    • Feeling cold all the time 
    • Sleep concerns
    • Dry skin and hair and brittle nails
Disordered Eating vs Eating Disorder:
  • Orthorexia: Orthorexia is not officially recognized as a distinct mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), However, in recent years, it has gained attention and is the subject of ongoing discussion and research within the fields of nutrition, psychology, and eating disorders.
  • Anorexia: Anorexia nervosa is a well-established eating disorder with specific diagnostic criteria outlined in the DSM-5.

A Day in the Life

Now that you have a general understanding of the similarities and differences between someone with orthorexia compared to someone with anorexia, let’s consider some hypothetical examples of what a day in the life of someone living with each condition is like. After reading through each portrayal, take a mental note of which persona you believe has anorexia and which has orthorexia. 

Healthy,Man,And,A,Woman,Separately,obsessive, food, macrobiotic

Robbie, age 23 

Each morning when Robbie wakes up at precisely 6:26 a.m. he walks to the mirror and assesses his body, seeking to find (though always hopeful not to) places where he has excess fat to lose. Next, he goes to the bathroom to clear out all fluids and gets a dopamine rush from the anticipation of weighing himself just seconds later. Even if lower than in recent days, Robbie is almost never satisfied with the number on the scale.

He’s very meticulously planned out his food for the day, which includes things like black coffee with artificial sweetener, diet soda, puffed rice cereal, chewing gum, fat-free salad dressing and lettuce, a single-serve bag of fat-free popcorn, celery and carrot sticks, a chicken breast with a small serving of rice and more fat-free salad dressing, and two popsicles. 

In total, his caloric intake for the day is about one-sixth of what it should be for someone his age, height, and level of physical activity (he is very adamant about walking a minimum number of steps each day).

He is almost always cold and wears baggy clothes and layers to keep himself warm and conceal his body. He often lacks energy and mental focus and rarely engages in social activities out of fear that food will somehow be involved.   

Erin, age 44 

Erin begins her day at a spin class just as she has every Tuesday for the last three years. Following class, a group always goes to the cafe next door for breakfast, but not Erin. In addition to there not being anything on the menu that fits within her dietary constraints, she needs to get home to make her post-workout breakfast, which consists of four farm fresh eggs (sans the yolks), an organic grapefruit, a slice of sprouted grain bread on which she mashes an organic avocado and tops with some organic cherry tomatoes and sesame seeds. For a beverage, she sips on a juice blend she’s concocted out of carrots. Oranges, pineapples, ginger, turmeric, and lemons—yes, all organic.

Her coworker offers her a homemade brownie, but she vehemently refuses when her coworker acknowledges he used vegetable oil and granulated sugar in the recipe. Her treat for the day, instead, is some Greek yogurt sprinkled with pumpkin seeds and drizzled with a small bit of honey. 

Her friends invite her to happy hour, but she declines, saying there is absolutely nothing for her to eat at the restaurant. She also doesn’t drink alcohol or unfiltered water, so “what’s the point of even going,” she surmises. 

She spends her evening making dinner and prepping her food for the next day, which is quite laborious given the fact she refuses to eat almost anything that’s been packaged or frozen. She precisely measures each ingredient and weighs her food to ensure she doesn’t exceed or fall short of her daily allotment of carbs, fats, or proteins. 

. . . . .

Which persona suffers from anorexia, and which suffers from orthorexia?

More importantly, the intricacies of the experience help you gain perspective on how debilitating and disordered both of these mental health conditions are. 

If you eat and behave in a way similar to either Robbie or Erin, you may meet the criteria for—or be on the brink of developing—anorexia or orthorexia. The good news is there are treatment options available for both conditions. 

As a first step, meet with a licensed mental health provider who specializes in treating eating disorders. They can help you determine what level of care you need and the treatment modalities that may be most effective for your diagnosis.

Build up the strength to make the phone call or send the email. Doing so may not only lead to a healthier relationship with food but also a more joyful and gratifying life.