Orthorexia Nervosa – Causes, Symptoms & Treatment

Orthorexia nervosa

Not every preoccupation with healthy eating is immediately to be assessed as an eating disorder. In the case of the disease known as orthorexia nervosa , those affected suffer from an exaggerated obsession with healthy eating and also proselytize their environment. If you are obviously underweight, family members should think about this disease and encourage the person concerned to take countermeasures.

What is orthorexia nervosa?

Orthorexia nervosa is an eating disorder discovered in 1997 by Dr. Steve Bratman was first described. Those affected strive to eat as healthy food as possible and, as the disease progresses, they ban more and more foods that they classify as unhealthy.

The amount of food is less important than its composition. However, patients with orthorexia nervosa can still suffer from deficiencies because they are giving up more and more food, which can lead to life-threatening weight loss, similar to anorexia . Patients feel superior to anyone with normal eating habits and spend more and more time choosing, preparing, and eating their meals.

Sometimes they spend several hours a day on the topic of food, so that they also neglect their social environment. When it comes to the composition of their meals, they set themselves increasingly narrow limits.


People with orthorexia nervosa are obsessed with the thought of food and categorizing it as healthy or unhealthy. The disorder often begins insidiously as a process to cure another illness or to improve general well-being.Reports from the media about factory farming, various food scandals and the discussed use of genetic engineering for the production of food can trigger this disease.

With orthorexia nervosa, however, health awareness goes far beyond the normal level of avoiding certain foods for a while.

Typical Symptoms & Signs

Diagnosis & History

The diagnosis of orthorexia nervosa is made by a doctor or a psychologist after a detailed discussion with the patient. Deficiency symptoms may already be noticeable. However, since those affected consider themselves to be particularly healthy, there is usually no insight that they are ill.

It can lead to concentration disorders , listlessness and underweight. It is also noticeable that those affected try to proselytize their social environment and encourage healthier eating habits. People with orthorexia nervosa often bring their own food to celebrations under certain pretexts because they are no longer able to share a meal.


Orthorexia nervosa can favor an unbalanced diet. Possible physical complications that can arise from this are underweight and deficiency symptoms such as iron or vitamin B-12 deficiency. Although orthorexia nervosa is not a definable and diagnosable eating disorder, it can be associated with other eating disorders.

For example, it’s possible for an anorexic person to not only restrict the amount of calories they eat, but also eliminate all unhealthy foods from their diet. Orthoretics often do not consider their condition as an illness, but as a free choice. In this respect they are like many anorexics.

As with anorexics, the treatment of orthoretics is often very difficult at the beginning if there is a lack of awareness of the disease. Various mental illnesses and syndromes can arise as a complication of or accompany orthorexia nervosa. The most common are depressive disorders.

However, orthorexia nervosa can also progress without physical and psychological complications. The differences between individuals affected and their eating habits are too great to make a general statement. The most common complication is social isolation, which can develop intentionally or unintentionally. Orthoretics often withdraw from other people because they feel misunderstood or are ridiculed for their eating habits.

When should you go to the doctor?

As with any other eating disorder, the time to see a doctor is when the eating behavior begins to harm the body. With orthorexia nervosa, this can happen just as quickly as with any other eating disorder, even if, paradoxically, sufferers try to prevent it. Most people affected by orthorexia nervosa will not see a doctor at the beginning, because they do not yet realize that their eating habits are anything but healthy. Deficiency symptoms and physical symptoms often first appear as a result of the diet, but psychological effects are also conceivable.

If those affected are still minors, the legal guardians must consult the doctor as soon as they get the feeling that the striving for (supposedly) healthy eating is becoming obsessive and harmful to the person concerned. In the case of orthorexia nervosa, it is sufficient to contact your family doctor , who will refer you to a specialist. Ultimately, only a psychologist can treat orthorexia nervosa in the long term.

If an affected person places themselves in an acutely dangerous situation, such as refusing food intake completely or to such an extent that their health is seriously threatened, there is also the possibility of forced admission. As a result, the person affected would get help quickly, but such extreme conditions rarely occur with orthorexia nervosa. Rather, at some point the sufferer will realize for himself that his diet is not conducive to health and consult the doctor first to find out why his expectations do not match his health condition.

Treatment & Therapy

The treatment of orthorexia nervosa is that of an eating disorder and is carried out on an outpatient basis or, in severe cases, as an inpatient. If the underweight is life-threatening, a stomach tube may have to be inserted to ensure nutrition.

As soon as the person concerned has stabilized, psychological support should follow. The patient is encouraged to first gain insight into the illness and then to learn normal eating habits. The main thing is that those affected can experience the meals in a relaxed manner again and can also enjoy them at the same time. The patient’s thinking about nutritional value tables and the health aspects of the individual foods must also change in such a way that he also allows himself formerly forbidden foods because he likes them.

Inpatient therapy is possible here. However, there are also outpatient options. Psychological care or psychotherapy can strengthen the success of the treatment and effectively change old thought patterns. In principle, the patient with orthorexia nervosa must participate in his recovery, otherwise all measures to gain weight will fizzle out and he will return to the usual thought patterns immediately after being released from therapy.

Outlook & Forecast

A prognosis for the disease called orthorexia nervosa is not easy to make. Those affected eat a very healthy diet. However, the health value of the food eaten is evidenced by a fanatical attitude and unhealthy behavior towards food. Anything that is not considered healthy based on the ingredients or other criteria is not consumed as a food.

The narrow selection of foods considered healthy can lead to psychological strain. It can affect those affected mentally. Orthorexia nervosa often leads to hours of preoccupation with healthy food. In this respect, doctors do not agree whether orthorexia nervosa can be put on the same level as eating disorders such as anorexia and bulimia . The fact is that orthorexia nervosa often does not cause any damage to health on a physical level. However, self-imposed food taboos and rules can severely limit food choices.

If orthorexia nervosa leads to pathologization of food selection, at least a mental disorder is present. It is difficult to convey to those affected the illness value of their behavior. The prognosis is positive if psychotherapy can uncover and eliminate the causes of the eating disorder. However, the fixation on healthy foods is a subject of controversy among experts. The decisive factor for orthorexia to be recognized as a disease is the level of suffering.


There are only limited measures to prevent orthorexia nervosa . As soon as preoccupation with nutrition exceeds a normal level and, for example, affects the performance of daily duties or leads to permanent neglect of social contacts, personal eating behavior should be assessed self-critically. The earlier orthorexia nervosa is counteracted, the easier it is to treat in the long term.


In the case of orthorexia nervosa, the measures and the options for aftercare prove to be relatively difficult in most cases or are not even available to the patient. In the first place, the person affected should see a doctor very early on in order to avoid other complications or symptoms that could have a negative impact on the quality of life and everyday life of the person affected.

As a rule, self-healing cannot occur, so that a doctor should be consulted at the first sign. Relatives or friends often have to point out the symptoms of orthorexia nervosa to those affected, although in some cases treatment in a closed clinic may be necessary.

Most of those affected are dependent on the help and support of their own families during treatment. Psychological support is also very important, which can prevent depression and other mental disorders.

Strict control of the diet is very important to prevent a possible relapse. The further course of orthorexia nervosa depends very much on the severity of the disease, so that a general prediction cannot be made.

You can do that yourself

After the actual treatment of orthorexia nervosa, follow-up care is very important so that secondary diseases can be avoided and to prevent relapses. If medical underweight is still present after the acute treatment, this should definitely be treated during follow-up care. A healthy body weight is important so that many bodily functions, such as body temperature and the immune system, function properly again.

Psychotherapeutic therapy is very helpful in most cases during the follow-up care of orthorexia. Good contact with the therapist can prevent a relapse into orthorexia. In any case, an important point for follow-up care is to treat the underlying cause beforehand. If the cause is not treated beforehand, successful follow-up care is not possible. Orthorexia nervosa can lead to long-term deficiency symptoms. During aftercare, it is important to compensate for these deficiency symptoms after the treatment. If this does not happen, the consequences of deficiency symptoms such as osteoporosis, hair loss, etc. can occur.

Even after the treatment, some of those affected find it difficult to deal with foods that they avoided during the illness. Here, an exchange with former victims can be useful for aftercare. Depending on the everyday situation of the person concerned, a low-stress lifestyle is recommended so that there is enough time for self-care. This is very important, especially at first. It can be helpful to reduce the workload, avoid stressful contacts or make arrangements for any absences due to therapy.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.