Orthorexia: a neurogenic eating disorder

An eating disorder of neurogenic etiology, which manifests itself in a compulsive desire to eat only healthy foods, is called orthorexia. The essence of the disorder is a limited assortment of foods, as they are guided only by their usefulness, rather than their taste. Patients are strictly bound by diets, food systems, have a constant fear of the risk of accidentally breaking the rules, feel a strong sense of guilt and self-loathing, and carefully plan the daily menu.

Interestingly, any eating disorder pathology is naturally affiliated with leptin, the adipose tissue hormone, so this attitude toward food automatically disrupts its synthesis and ability to adequately influence normal feelings of satiety. This threatens the development of leptin resistance and, indirectly, insulin resistance with the formation of endocrine disorders. You will learn how to diagnose and correct the pathology in this article.


  1. General information.
  2. Etiopathogenesis.
  3. Symptomatology.
  4. Complications.
  5. Diagnosis.
  6. Treatment.
  7. Prognosis.

General information

Orthorexia means “proper appetite” in Greek, although this is a controversial definition from a modern point of view. The term itself was introduced into medical practice at the end of the last millennium by the American physician S. Braman. He himself for quite a long time was eating exclusively organic fresh fruits and vegetables, but then he discovered that the right, inherently, diet became a trigger for nervous tension, which drastically narrowed his circle of communication.

To this day, there is heated debate about how to diagnose orthorexia, and there are no clear criteria. Obviously, it is an eating disorder, but you will not find it in any official classification. This complicates correction, excludes statistics and epidemiology of the pathology.


The obsession with good nutrition is not new. It seems to have existed at all times, only interpreted in its own way. The problem is correlated with education, self-esteem, self-confidence. Basically, it is part of a huge concept of healthy lifestyle, which involves dosed and regular physical activity, improving immunity, the right daily regimen, mental techniques. Every NEXT generation chooses a healthy lifestyle and active longevity, paying tribute to the new times. Why, then, is otorrhexia referred to as a pathological process?

Take a closer look at the triggers that cause it:

  1. High self-importance, sense of superiority, desire to dominate. An adherent of healthy eating is ready to refuse favorite dishes, showing willpower, spends a lot of time searching for products, preparing meals, composing menus, reading health literature in order to show everyone their “self”. Such people are proud of themselves, feel their exclusivity, are indulgent to others, do not allow even the thought of self-restraint and discipline. Is this the norm? Hardly.
  2. There is another essence of the problem: perfectionism. The risk of forming orthorexia is associated with high levels of anxiety, a constant need to control one’s life. An obsession with healthy eating is nothing less than a condition for staying healthy, young, clean of mind and body.
  3. Extra pounds. The obsession with achieving the canon of modern beauty is slimness. Unlike anorexia, the focus here is not on the caloric content of food and the volume of its consumption, but on the usefulness of food, its ability to be absorbed. Affiliation with leptin is obvious; no one has ever cancelled the feeling of satiety. Fluctuations in the level of the hormone in the blood can deliver a lot of experience to patients with orthorexia, increase nervous tension, lead to a breakdown.
  4. Social attitudes toward ecological nutrition also play an important role. Promoting a healthy lifestyle is economically beneficial. Products marked “eco” motivate customers, as they are identified with a guarantee of health, slimness, attractiveness, and, therefore, success.

If we talk about how the pathological process develops, it is worth drawing an analogy with neuroses, hypochondria, and psychogenic anorexia. The basis of the disorder is emotional personality traits. That’s why some people develop this disorder and others don’t. High anxiety, emotional lability, a need for approval and even admiration of others, high self-control – these are the building blocks of orthorexia.

Eating becomes a ritual that avoids the need to make choices. This minimizes emotional stress, giving a sense of predictability. On the other hand, observing the principles of healthy eating is a way of exercising willpower, discipline, determination. The patient demonstrates to himself and others his strong qualities of personality, thus increasing his self-esteem.


The main symptom of orthorexia can be called different phobias. Since patients are strictly focused on a certain type of food, which preserves physical health, any violation of it is associated with the fear of losing the set goal – healthy longevity. Patients study the composition of foods, the rules of mutual compatibility, preparation. The only criterion is usefulness. The desires of taste are ignored. White death” and “sweet death” (salt and sugar), fat, starch, gluten, alcohol, yeast, meat, milk, all artificial taste enhancers, preservatives, genetically modified vegetables, cereals are excluded.

For orthorexic patients, there is a rigid division of foods into healthy and forbidden; this inevitably leads to nervous tension. There is a conflict between the natural desire for delicious food and the rules of a healthy diet. Dangerous food becomes a trigger for phobias. Patients are compelled to limit themselves in food, change behavior, stop visiting guests, restaurants, and stores. If there is a breakdown, and the person breaks the diet, subsequently there is a feeling of guilt with self-deprecation and toughening of fasting, physical activity. Often even the way food is prepared and consumed becomes a source of obsessive fears.

Tableware is another trigger of phobias: only wood, ceramics, glass. Cooking times are strictly observed, and any heat treatment, including freezing, is ruled out. The ritual of cooking and eating reassures patients, but there is condemnation or disdain for anyone who does not adhere to their rules. Orthorexians consider themselves experts on nutrition and give advice.


Food restrictions lead to a decrease in social activity. Questions of good nutrition prevail over any other interests. They become uninterested in communication with relatives and friends, they avoid friendly gatherings, holidays, corporate parties. All the time is occupied by the search for information about the usefulness or danger of products, which is not always reliable. As a result, exhaustion, intoxication, avitaminosis, anemia, tooth decay, amenorrhea, alopecia – you name it.


The difficulty in diagnosis is due to the lack of diagnostic criteria. There is little evidence to support the danger of orthorexia to the individual. But there is no escape from the problem of emotional and behavioral disorders, social disorientation, and somatic pathologies associated with a strict diet.

That’s why specialists make diagnoses, focusing on the following techniques:

  1. Conversation of the doctor with the patient with collection of anamnesis and identification of symptoms of eating disorders.
  2. Psychodiagnosis of the personality with analysis of the patient’s character qualities, peculiarities of affective behavior, level of neuroticism, depression, anxiety (special questionnaires are used).
  3. Special tests, the results of which indicate the presence of an eating disorder.


The key to recovery is the patient’s own recognition that their desire for healthy eating is becoming an obsession that diminishes their quality of life. If this awareness comes at the beginning of the disease, it can be managed on its own by switching from thoughts about healthy food to social communication, restoring lost friendships, and listening to the body’s desires. Psychotherapists, psychiatrists and nutritionists can provide professional help.

The complex of measures consists of:

  1. Psychotherapeutic sessions (individual and group) aimed at correcting erroneous ideas about oneself and developing new habits, self-control and communication skills.
  2. Slowly changing the diet with a gradual introduction of previously “forbidden” products against the background of vitamin and mineral complexes.
  3. The use of drugs for severe tension, emotions, anxiety, depression. All medications are selected individually.


With timely medical care, orthorexia is perfectly corrected, that is, the prognosis is favorable. Prevention involves avoiding strict diets, choosing wholesome foods with regard to their taste and pleasure. In addition to a healthy diet, longevity can be ensured by the absence of stress, walks in the fresh air, fascinating hobbies.


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