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Orthorexia Nervosa: Significant facts about eating disorders

Orthorexia (Orthorexia Nervosa) is the term used when people obsessively try to eat a healthy diet.  Read here which signs are typical for orthorexia, which negative health consequences threaten and how the eating disorder can cure.

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Orthorexia – What is it?

It describes an eating behavior in which healthy eating is more than just a desirable goal. “Orthorexia is a fixation on the consumption of exclusively healthy foods,” explains Friederike Barthels of the Institute for Experimental Psychology at the University of Düsseldorf.

The term orthorexia (Greek orthos = correct, orexis = desire, appetite) was first used in 1997 by US alternative physician Steven Bratman. Bratman himself followed a very extreme diet and at times only fed on vegetables that were organically grown and harvested no more than 15 minutes before preparation.

Orthorexia Rarely Treated as an Independent Disease

In contrast to eating disorders, orthorexia is not an accepted disease in orthodox medicine. In ICD-10, the World Health Organization’s (WHO) diagnostic classification system, the term searched for in vain. According to experts, the eating disorder closely relates to anorexia. “In both cases, sufferers select their food very precisely and delete many foods from their diet,” says Barthels. Orthorectics, however, pay less attention to the quantity than to the quality of what they eat.

Info: How many people think compulsively of healthy food has not been statistically investigated. According to initial estimates from a study by the University of Düsseldorf, about one to two percent of people in Germany are almost obsessed with the desire to eat healthily. Women are more often affected than men.

Typical Symptoms of Orthorexia Nervosa

The boundary between healthy and compulsively healthy food is often fluid. “One always speaks of a mental disorder when it dominates the everyday life of those affected,” says Cora Weber, a specialist in psychosomatic medicine at the Charité in Berlin, Germany. So it becomes critical when the enjoyment and joy of eating recede into the background and food becomes a substitute religion around which all thoughts revolve.

Orthorexia is noticeable in that those affected avoid all supposedly unhealthy foods – especially those that contain a lot of sugar and fat. The criteria for “healthy” and “unhealthy” are chosen subjectively and based only to a limited extent on general nutritional recommendations. For example, gluten often avoided, even if there is no gluten intolerance. Many people avoid products from conventional cultivation due to possibly harmful substances; others avoid foods that consider carcinogenic. In extreme cases, orthorecticians only feed on vegetables and fruit. Therefore vegetarians or Veganer are often Orthorektiker.

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It is also typical for orthorexia that those affected submit to certain types of preparation or schedules. Thus food may be eaten, for example only in certain combinations or at certain times. The purchase, organization, and development of meals play an essential role.

Deviations from the self-imposed diet usually cause resentment and anxiety in those affected. The consumption of unhealthy food leads to feelings of guilt and is tried by even more extreme self-mortification to compensate again. In contrast, keeping to the diet gives them a sense of control and security.

Typical symptoms of Orthorexia Nervosa are

  • a very unbalanced diet
  • specific rules and rituals relating to the preparation and consumption of foodstuffs
  • healthy debate on the topic of nutrition and the ingredients of foods
  • early planning of meals (often several days in advance)
  • bad temper after eating unhealthy foods
  • compulsive control and documentation of diet

Possible consequences of orthorexia

People who suffer from Orthorexia Nervosa lose a lot of weight.

In some cases, eating habits are so one-sided and limited that deficiency symptoms and physical impairments occur. Tiredness, listlessness, sleep and concentration disorders and, in severe cases, even low blood pressure and a slower pulse are frequent consequences of orthorexia. The risk that eating disorder becomes life-threatening anorexia (loss of appetite) also increases.

Social contacts often suffer from the disease: For those affected, healthy eating is usually the only focus of life, hobbies, or interests often fall by the wayside. Orthorecticians hardly accept invitations or appointments to eat anymore – for fear of not having any control over the ingredients and not knowing precisely what is in the respective food.

The AOK draws attention to the fact that family and friends also often withdraw because sick people usually try to convince their environment of their idea of a healthy diet. The result is social isolation, which in turn can make people more susceptible to other mental illnesses, such as depression.

Possible causes of eating disorders

The reason for orthorexia is usually the fear that a supposedly unhealthy diet will damage your body. Not to lose weight, they have removed schnitzel and fries from their diet, but to prevent a heart attack. Some people do not eat certain foods to alleviate chronic ailments.

These worries often combined with the desire to be slim. In many cases, the disease develops as a result of a diet. The risk of orthorexia is, therefore, particularly high in women.


According to Weber, the whole thing is a phenomenon of our time. He alludes to the back-to-the-nature trend as well as the various food scandals of recent times. “It is the desire for control and health. The recently published value index by trend researcher Peter Wippermann also shows that health is of the utmost importance for Americans – even more than freedom and success.


How to cure orthorexia?

Orthorexia rarely considers disease in its own right. Orthorexia and anorexia usually have a very similar clinical picture. Therefore, the two groups often combined for group therapies. Further treatment takes place as behavioral therapy together with a psychotherapist. In severe cases, in-patient therapy lasting several weeks can also make in a clinic for eating disorders.

Test: Is Your Diet Healthy or Pathological?

Steven Bratman developed a self-test with which you can assess whether your eating habits disturb.

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If you answer four or more questions with YES, you may suffer from orthorexia and should consult a doctor.

  1. Do you think about your diet for more than three hours a day?
  2. Do you plan your meals for several days in advance?
  3. Is the nutritional value of your meal more relevant to you than the pleasure of eating it?
  4. Has the increase in the assumed food quality led to a reduction in your quality of life?
  5. Do you look down on others who don’t?
  6. Have you become stricter with yourself lately?
  7. You avoid your favorite food to “eat right”?
  8. Does a healthy diet increase your self-esteem?
  9. Do you feel guilty if you deviate from your diet?
  10. If you eat a healthy diet, do you feel happy that you have everything under control?
  11. Do your eating habits socially isolate you?

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