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Orthorexia, causes, symptoms and treatments



Miracle diets diets that promise to lose weight quickly detox, single-food diets, particular eating styles carried out in an attempt to prevent diseases and live longer: these are the messages we are continually subjected to. The media emphasize the therapeutic effects of organic, zero fat, gluten free foods, thus giving foods a medicalizing power.

This bombardment of information which should focus on the value of healthy food as a means to nourish oneself better and take care of oneself, together with a reality like the current one, in which the Diet Industry has solutions for any problem, unfortunately opens up a completely unexpected scenario . Excessive attention to what you eat and adherence to alternative diets become the central core of an excessive health quest, a hypersalutism, a lifestyle that is only apparently healthy. However, a new picture is emerging, in reality, already reported by the doctor Steven Bratman in 1997, who defined it “orthorexia”, [dal greco, orthos- (corretto) -órexis (appetito)].

L'Ortoressia Nervosa (ON) is mentioned among «Nutrition and Eating Disorders» of the DSM-5® (American Psychiatric Association, 2013). Orthorexia nervosa has elements in common with anorexia nervosa and bulimia nervosa and shares similarities with avoidant/restrictive food intake disorder or body dysmorphic disorder. At the moment ON is not yet associated with a specific diagnostic category. The literature on the subject is still conflicting, there are few studies in which specific diagnostic criteria appear.

Orthorexia. What is it?

Orthorexia is unhealthy attention, one pathological concern towards pure and healthy food thinking that this is the way to achieve lasting well-being. The concept of health is taken to the extreme. A sort of dietary fundamentalism is established to achieve a perfect state of health. We are more concerned with the quality and nutritional properties of foods and less with the quantity, as is the case for anorexia and bulimia. Some similar traits of orthorexia with anorexia and bulimia are: perfectionism, attitudes towards body image and the need to maintain control.

What it looks like. Characteristics of this disorder

L'ortoressia nervosa is characterized by a series of concerns and beliefs associated with food.

People with orthorexic symptoms have an unusual interest in their health.

In orthorexia, the principles of a rich, complete and healthy diet such as the Mediterranean diet are lost. They give way to very rigid, self-imposed rules that lead to reducing the variety of foods to a minimum, to the obsessive avoidance of those uncontrolled foods (such as those rich in preservatives or artificial food additives) that can damage health and, therefore, to their exclusion even in the absence of allergy or intolerance.

The orthorexic subject carefully plans meals even several days in advance, dedicates more than 3-4 hours a day to choosing the foods to buy, worries about the purity of the food, focuses strongly on the preparation and cooking methods, even to the detriment of taste and pleasure.

Always in the interest of purity and health, those suffering from orthorexia he also usually spends large sums of money to buy “quality” food.

People with orthorexia nervosa are also distinguished by their sense of superiority and their position of intolerance towards those who do not have the same eating habits.

Consequences of orthorexia

And this is how the selection of “good food” based on quality becomes a set of repetitive and constant thoughts, a obsessive attitude, sometimes manic, which limits the social sphere, as it exposes one to a lack of control of the food itself and its effect on health.

The sense of conviviality is lost, the work environment can be compromised, everything becomes a… uneasewhich leads to personal isolation, in the most total conviction of one's choices.

When the person suffering from orthorexia is unable to follow the rules he imposes on himself, negative emotions such as guilt and anger arise in him. He feels depressed and this leads him to impose new and more rigid rules of behavior to follow. He can easily understand how this can increase anguish, shame and anxiety. On the contrary, where he respects the rules, and therefore has control over healthy eating habits, personal satisfaction appears, self-esteem grows and he has a positive perception of his own body image.

Those who suffer from orthorexia, with the choices made aimed at promoting health, actually undermine not only their emotional and social well-being, but also their physical well-being. There food restriction to which one is subjected can cause malnutrition, nutritional imbalances and weight loss, resulting in impaired physical health.

Those who suffer from Orthorexia

It is not possible to generalize the epidemiological data because the studies in the literature present differences in methodological choices. The results of studies conducted on the general Italian population have highlighted that the prevalence of ON in Italy is between 6.9% (Donini et al., 2004) and 57.6% (Ramacciotti et al., 2011) . The wide variability of these data can be traced back to the fact that the studies conducted present differences in methodological choices.
Discordant data also concern gender: according to some studies (Donini et al., 2004; Fidan et al., 2010; Donini et al., 2005) men are more affected than women. While other studies (Arusoğlu et al., 2008) highlight a prevalence of ON in women or no difference (Bağci Bosi, Camur, & Guler, 2007).

How is it treated?

The orthorexic subject is unable to become aware of his problem there is no perception of his disorder.

Usually, however, awareness is the first step towards actively engaging in treatment. Treating orthorexia is not easy because of the sense of superiority that distinguishes people who suffer from it: they, in fact, turn their beliefs into ideals of inner purity so they do not recognize their behavior as a problem. Early diagnosis is necessary for treatment. The family, school environment or friends could be the first to intervene early, if they can recognize some warning signs such as weight loss, the absence of social relationships, food worries.

To cure orthorexia, a multidisciplinary approach: doctor, psychologist, nutritionist. This allows you to keep the clinical picture under control, work on emotions and reintroduce eliminated foods, highlighting the real benefits of food on health.


Currently have one healthy lifestyle that allows us to reach an optimal state of health is rather difficult. Today the scenarios that society shows us are opposite and extreme situations: on the one hand, the spread of obesity and the diseases connected to it, on the other the orthorexic attitude linked to the need to acquire exclusively health. It is clear that in neither of the two attitudes there is balance: in both cases food is a problem and loses its value as a beneficial tool.

We need to give food back a positive value, that of emotions, memories, sharing. It is also important to recover that balance that no longer exists. Food cannot and must not be a limit for anyone, it must excite again.

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