The clinical basis of orthorexia nervosa: emerging perspectives

Abstract

Orthorexia nervosa describes a pathological obsession with proper nutrition that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy or impure. Although prompted by a desire to achieve optimum health, orthorexia may lead to nutritional deficiencies, medical complications, and poor quality of life. Despite its being a distinct behavioral pattern that is frequently observed by clinicians, orthorexia has received very little empirical attention and is not yet formally recognized as a psychiatric disorder. In this review, we synthesize existing research to identify what is known about the symptoms, prevalence, neuropsychological profile, and treatment of orthorexia. An examination of diagnostic boundaries reveals important points of symptom overlap between orthorexia and anorexia nervosa, obsessive–compulsive disorder (OCD), obsessive–compulsive personality disorder (OCPD), somatic symptom disorder, illness anxiety disorder, and psychotic spectrum disorders. Neuropsychological data suggest that orthorexic symptoms are independently associated with key facets of executive dysfunction for which some of these conditions already overlap. Discussion of cognitive weaknesses in set-shifting, external attention, and working memory highlights the value of continued research to identify intermediate, transdiagnostic endophenotypes for insight into the neuropathogenesis of orthorexia. An evaluation of current orthorexia measures indicates a need for further psychometric development to ensure that subsequent research has access to reliable and valid assessment tools. Optimized assessment will not only permit a clearer understanding of prevalence rates, psychosocial risk factors, and comorbid psychopathology but will also be needed to index intervention effectiveness. Though the field lacks data on therapeutic outcomes, current best practices suggest that orthorexia can successfully be treated with a combination of cognitive-behavioral therapy, psychoeducation, and medication.

On a correct diet: exploration of the orthorexia construct from the essential nuclei of experimental discourse

“…The results represented in the present study with respect to the correct appetite are in tune with some studies in which the characteristics of people with orthorexia or with a pathological inclination are indicated for the food considered healthy; 23,27 that is, their ideology (what and how they think) is in line with the themes expressed in this paper "The World of Healthy Eating", "Why I Choose to Eat It" and "Absence of Infirmity as an Object of Ideal Consciousness". The set of strategies and constitutive mechanisms of experience (what do they do), are related with the theme "A recreated optimism", as an exercise of feedback of the condition between knowledge, manipulation and consumption of natural and organic food.…”

“…First developed by Bratman, the study has experienced modifications in its various validation attempts in other languages, as well as in its psychometric development to know psychosocial factors and comorbid psychopathology. 27 Consequently, due to insufficient research (ambiguity and variability in results) and because it is a multifaceted reality, a qualitative study approach is necessary in orthorexia; in fact, there are studies that rely on the requirement of an empirical-holistic approach and an interpretative analysis. 23 The increase in literature and other documents, relevant clinical experience and research studies in recent years circumscribe the relevance of the topic:…”

“If it’s not Iron it’s Iron f*cking biggest Ironman”: personal trainers’ views on health norms, orthorexia and deviant behaviours

“…Today, ON is not an accepted diagnostic category, that is, it is not included in the diagnostic manuals DSM-5 or ICD-10 (Varga, Dukay-Szabó, Túry, & Van Furth, 2013). Research has shown that ON shares many characteristics with diagnosed eating disorders (ED) and Obsessive Compulsive Disorder (Koven & Abry, 2015), and ED professionals suggest that ON deserves more attention in research and clinical practice (Vanderycken, 2011). In a Swedish context, ON is understood in terms of unhealthy exercise, and it has been linked to fitness gyms and emerging aggressive health and exercise trends (Håman, Barker-Ruchti, Patriksson, & Lindgren, 2016).…”

Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction?

“…Second, the psychosocial risks of imposing dietary change cannot be underplayed. These range from difficulties in socialisation and eating away from home through to the precipitation of eating disorders such as orthorexia nervosa 80. Third, the physiological effects of reducing FODMAP intake beyond those targeted to improve symptoms may have other implications.…”