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Anorexia a Bad Comparison?

Guest Angela

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I see the site has a section outlining how CR is different than anorexia.  I would think it would be equally/more helpful to explain how it is not like orthexia.  When I describe what I do with CR--low calories, high quality food, tracking micro-nutrients, etc--people who know EDs immediately cry "Orthexia!"  Then it takes a lot of explaining to clear that up and sometimes we just agree to disagree because it is inconceivable to some people how I could track my nutrient levels every day and not have a "disorder."


Wondering if anyone else has gotten asked about this?


I know a number of people who suffer from anorexia and they would never be mistaken for CR people.  They smoke, take laxatives and do peanut-butter "mono-diets"...

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  • 3 years later...

I think that CR shares a lot with orthorexia, the difference between "being obsessed with being healthy" and "having a disorder consisting in being obsessed with being healthy" is, in my opinion, in the results: is the social life of this person damaged by his/her diet? Does he/she avoid friends to avoid eating with them? Is he/she going trhough a divorce caused by his/her low libido? Is the physical health of this person damaged by this strict diet? Is the mood of this person too low or irrationally high? Does he/she have other interests than CR? Can he/she take pleasure in other activities?

I also think we should ask ourselves "Why am I doing this?", "Am I using my diet as a substitute for something?", "What does it gives me that I feel lacking in my life?" 

Almost everything can be done in a healthy way and for healthy reasons or in an unhealthy way and for unhealthy reasons.

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Maria Grazia,

good concise analysis on the issue. I see that you are putting in practice your studies of psychology!

I often describe myself as exhibiting an orthorexic behaviour. But, as you rightly point out, a psychological disorder is different from a mere mental fixation or slight obsession or better, a perfectionistic behaviour or even a hobby. In my case, I have fun using cronometer and pursuing health and longevity is not a goal by itself, rather a means to pursue other activities better. I might add, it's also a means to help and serve better our family and society and maybe to pursue higher spiritual goals. Our body and brains are just tools, and the optimization of a working utensil, if not morbidly executed for its own sake, cannot be considered a proper disorder.

I believe it's the same in most members of this forum.

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On 10/21/2014 at 2:55 AM, Guest Angela said:

....Wondering if anyone else has gotten asked about this?

Yes, my wife insists I have some kind of disorder, LOL!

I would answer like I wrote above, optimization of an utensil if not carried out morbidly and for its own sake by definition does not constitute a mental disorder. 

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Maria,  excellent analysis--and excellent English!

Mccoy,  Your argument is unassailable.   But an argument is not a STUDY!

Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy.

Dell'Osso L1, Carpita B2, Muti D1, Cremone IM1, Massimetti G1, Diadema E1, Gesi C1, Carmassi C1.

Eat Weight Disord. 2018 Feb;23


Full text: http://www.rivistadipsichiatria.it/r.php?v=2476&a=25888&l=328534&f=allegati/02476_2016_05/fulltext/04.DellOsso (190-196).pdf




Orthorexia nervosa (ON) has been recently defined as a pathological approach to feeding related to healthiness concerns and purity of food and/or feeding habits. This condition recently showed an increasing prevalence particularly among young adults. In order to investigate the prevalence of ON and its relationship with gender and nutritional style among young adults, we explored a sample of students from the University of Pisa, Italy.


Assessments included the ORTO-15 questionnaire and a socio-demographic and eating habits form. Subjects were dichotomized for eating habits (i.e. standard vs vegetarian/vegan diet), gender, parents' educational level, type of high school attended, BMI (low vs high vs normal BMI). Chi square tests were performed to compare rates of subjects with overthreshold ORTO-15 scores, and Student's unpaired t test to compare mean scores between groups. Two Classification tree analyses with CHAID growing method were employed to identify the variables best predicting ON and ORTO-15 total score.


more than one-third of the sample showed ON symptoms (ORTO-15 ≥ 35), with higher rates among females. Tree analyses showed diet type to predict ON and ORTO-15 total score more than gender.


Our results seem to corroborate recent data highlighting similarities between ON and anorexia nervosa (AN). We propose an interpretation of ON as a phenotype of AN in the broader context of Feeding and eating disorders (FEDs) spectrum.



As far as the diagnostic boundaries of ON are concerned, is of note that this condition shows similarities and differences with anorexia nervosa (AN) and obsessive-compulsive disorder (OCD), which are themselves often comorbid. 

Even if ON and AN share abnormal eating attitudes and behaviours, and ON and AN patients both have a poor insight about the consequences of their disorders , the core beliefs of the two syndromes are different in nature . As a matter of fact, AN patients are mainly worried about body image, the quantity of food and gaining weight. Their eating pattern is the consequence of the need of losing weight and the self-esteem depends on the weight lost. However, it is of note that severe orthorexic attitude towards food can risk to evolve in AN . On the other hand, considering OCD, both syndromes share high anxiety traits, need to exert control, perfectionism and concerns about contamination, whereas the most significant difference is the ego-syntonic content of obsessions characterizing individuals with higher tendency to orthorexic symptoms , with a limited insight.



In conclusion, most striking results of our study are provided by logistic regression analysis showing that female gender, younger age range, being student, being vegetarian/vegan and underweight, were the factors significantly predictive of ON.


For a description of the Orto-15 questionnaire (which has been used in the vast majority of studies, and which has been greatly criticized) see:    https://orthorexia.com/wp-content/uploads/2010/06/Donini-Orthorexia-Questionaire.pdf

Prevalence of orthorexia nervosa is less than 1 %: data from a US sample.

Eat Weight Disord. 2017 Mar;22(1):185-192. doi: 10.1007/s40519-016-0258-8. Epub 2016 Feb 22.




Orthorexia nervosa, or pathological dieting based on being "healthy," has been of growing interest. Clinical data are limited to less than a half-dozen case studies reporting instances of medical problems due to healthful eating. However, more than a dozen studies using a measure to identify orthorexia, the ORTO-15, report very high prevalence rates in non-clinical samples. Point prevalence rates are reported from 6 % to nearly 90 %. Such variability could be due to cultural issues or psychometric problems with the instrument. This study examines prevalence rate of orthorexia in a US sample.


The ORTO-15 was administered to 275 US college students along with other questions regarding diet, exercise, and health.


While the ORTO-15 indicated a prevalence rate of 71 %, only 20 % of the sample endorsed a dietary practice of removing a particular food type (e.g. meat) from their diet. Those who endorsed following a vegan diet had the highest (less pathological) mean ORTO-15 score. Further, when classifying participants based on their seriousness about healthy eating and whether their diet had led to impairment in everyday activities and medical problems, less than 1 % of the sample fell into such a category.


As in other countries, a large proportion of a non-clinical US sample scored in the orthorexia range on the ORTO-15. However, this instrument is likely unable to distinguish between healthy eating and pathologically healthful eating. Our estimate is that orthorexia nervosa like anorexia nervosa and bulimia nervosa, is not a common condition.


Bidimensional Structure of the Orthorexia: Development and Initial Validation of a New Instrument  [2018]

Juan Ramón Barrada, María Roncero


Full Text:  http://revistas.um.es/analesps/article/view/analesps.34.2.299671/227431




Orthorexia nervosa could be conceptualized as extreme or excessive preoccupation with eating food believed to be healthy. Up to now, there is no available instrument evaluating every aspect of orthorexia with sufficient psychometric guarantees. The objective of the present study was two-fold. First, to develop and validate a new questionnaire of orthorexia –the Teruel Orthorexia Scale– and, second, to analyze the association with other psychological constructs and disorders theoretically related to orthorexia nervosa: eating disorder symptoms, obsessive-compulsive disorder symptoms, negative affect, and perfectionism. Participants were 942 mainly university students who completed a battery of online questionnaires. Starting with an initial item bank of 31 items, we proposed a bidimensional test of orthorexia. This final version, with 17 items, encompassed two related, although differentiable (r = .43), aspects of orthorexia. First, Orthorectic Efforts, which evaluates the “healthy” preoccupation with diet, which is independent of psychopathology, and even inversely associated with it. Second, Orthorectic Concerns, which assesses the negative social and emotional impact of trying to achieve a rigid way of eating. This dimension represents a pathological preoccupation with a healthy diet. This study presents a new instrument that offers promising possibilities in the study of orthorexia.

Edited by Sibiriak
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Sibiriak, those are interesting studies of course since the members of this forum are all more of less afflicted by such 'disorder'.

I cannot but criticize the Italian study. They call OR a syndrome, which is a synonimous of mental disorder, with a negative connotation. My objections are: 

  1. Which is the control? The junk food lovers and couch potaotes? The moderately attentive ones? In which area? Italy? Europe? Western society?
  2. The study apparently does not consider the achievements. If the orthorectic behaviour is followed by an improvement of health and longevity, that can be regarded as an investment, not a mental disorder.
  3. According to the conceptual framework behind the definition of orthorexia, the very meticolous worker, the very diligent manager who works long hours, the investor who wants to make a lot of money, the artists obsessed with achieving perfection in their fields, the athletes who compete for an olympic medal, all would also suffer a mental disorder
  4. If the issue is detachment from social average behaviour or unsocial behaviour, then it's an issue of social and behavioural sciences, not of psychiatric  and medical sciences. 

My bottom line, in that study everything seems to be conceptually wrong, the issue is ill posed. I couldn't see the ortho-15 questionnaire though.

The premises of the Barrada & roncero study seem to be more rigorous. Here they separate the aspects of Orthorectic Efforts, (which evaluates the “healthy” preoccupation with diet, which is independent of psychopathology, and even inversely associated with it) and Orthorectic Concerns, (which assesses the negative social and emotional impact of trying to achieve a rigid way of eating).

So, the  possible negative impact is declaredly more social and emotional . The emotional issue is a factor in adovocates of a specific regime (vegans, paleo, Low-carb) which prevents an objective analysis of nutrition. That is not part of the members of this forum, not to a significant level.

Social impact: that's a personal choice, some people are even adverse to socialization which implies going out and eat , paying far more for foods which are of lower quality and choice of those which we can prepare at home.


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I couldn't see the ortho-15 questionnaire though.

The questionnaire is described here:    https://orthorexia.com/wp-content/uploads/2010/06/Donini-Orthorexia-Questionaire.pdf

Apparently,  the Orto-15  has been used in the vast majority of studies, and has been greatly criticized.     Your four points are  compelling  and very well stated.   


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I believe this thing is about expectations. I live in the US. People here expect to get sick in their 70s or 80s, expect to get diabetes, expect to gain weight as they age, expect to die from heart disease or cancer. I just don't expect those things, don't want them. Although I realize they may happen to me, I don't accept that they are inevitable. 

I don't think it's those of us who think carefully about what we eat who have disordered thinking. It is the other people who are operating on misinformation and incorrect assumptions.

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