Therefore, we suggest that ON be treated as a distinct disorder within the "Eating Disorders" category in classifications such as the DSM or ICD. Conversely, under-scoring and overlooking cases of ON may involve overlooking a health problem, which can also have serious consequences. For example, an overestimation of the scores obtained may result in the unnecessary implementation of dietary or psychological interventions for patients. In the absence of standardization, a diagnostic tool such as ORTO-15 can lead to an incorrect diagnosis. The reason for this is the varying number of cut-off points used by researchers—some studies use a threshold of 35 points, others 40 or 45 .
However, in these studies, these factors did not collectively explain a large proportion of the variance observed across the ORTO-15 items. With the latter, individuals experience heightened bodily sensations and are intensely anxious about the possibility of an undiagnosed illness, often devoting excessive time and energy to these health concerns. Although the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)23 introduced significant changes to the nomenclature and scope of the somatoform conditions relative to the DSM-IV-TR edition, the potential relevance of orthorexia to these conditions, namely somatic symptom disorder and illness anxiety disorder, is noteworthy. 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. In this review, we synthesize existing research to identify what is known about the symptoms, prevalence, neuropsychological profile, and treatment of orthorexia. 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.
Thus, even though the distinction between orthorexia and orthorexia nervosa is addressed at different parts of the review article, this article focuses on orthorexia nervosa. Individuals with orthorexia exhibit rigid dietary rules, often avoiding entire food groups and becoming increasingly preoccupied with their meals’ sourcing, preparation, and nutritional content . Orthorexia can be defined as an obsessive and extreme fixation on consuming only "pure" and "healthy" foods, primarily focusing on the quality and cleanliness of the diet . The paper offers an overview of orthorexia and its historical context and explores the challenges and considerations in diagnosing orthorexia and orthorexia nervosa. Furthermore, DOS scores significantly decreased from admission to discharge, although orthorexic eating was not targeted in the eating disorder-specific treatment.
Orthorexia nervosa (ON), characterized by a pathological preoccupation with "extreme dietary purity," is increasingly observed as a mental health condition among young adults and the general population. Unchecked by any scientific regulatory process, the sharp rise in healthy lifestyle-related propaganda through book, magazine, and electronic formats, further bolstered by a rapid exchange of ideas through social media, means that the average individual is regularly bombarded by advice and admonitions about diet and health. Various forms of relaxation training may assist with pre- and postprandial anxiety67 and other manifestations of health anxiety.68,69 Moreover, behavior modification strategies may be useful to expand one’s food repertoire, increase socialization during meals, and diversify leisure activities to include nonfood themes.
Subsequently, the term "orthorexia nervosa" emerged to describe a more severe variant characterized by intense anxiety, distress, and functional impairments related to the rigid pursuit of an idealized and "pure" diet . However, discussions around clean eating also come with debates about the potential for creating rigid eating patterns, promoting unrealistic body standards, and contributing to the stigmatization of certain foods . Disordered eating behaviors have emerged as a critical public health concern, drawing increasing attention from researchers, healthcare professionals, and policymakers.